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Conventional versus intensive diabetes therapy in children with type 1 diabetes: effects on memory and motor speed
T Hershey1, N Bhargava, M Sadler
1Department of Psychiatry, Washington University School of Medicine, Washington University, St. Louis, Missouri, USA. tammy@npg.wustl.edu
Insights
Intensive therapy in type 1 diabetes increases severe hypoglycemia, leading to memory deficits in children. This suggests caution is needed with strict glucose control to protect cognitive function.
Area of Science:
- Pediatric Endocrinology
- Neuropsychology
- Diabetology
Background:
- Severe hypoglycemia can negatively impact cognitive functions, particularly memory.
- Medial temporal lobe structures are crucial for explicit memory recall.
- Children with type 1 diabetes, especially those on intensive therapy, face an elevated risk of severe hypoglycemia.
Purpose of the Study:
- To investigate the presence of delayed declarative memory deficits in diabetic children at high risk for severe hypoglycemia.
- To compare cognitive performance between children with type 1 diabetes on intensive therapy, conventional therapy, and healthy controls.
Main Methods:
- A prospective study involving children with type 1 diabetes (intensive therapy [IT] and conventional therapy [CT]) and nondiabetic controls.
- Ascertainment of all severe hypoglycemia episodes.
- Assessment of memory tasks linked to medial temporal functioning and reaction time measures.
Main Results:
- The IT group experienced a threefold higher rate of severe hypoglycemia compared to the CT group and controls.
- Children in the IT group showed impaired performance on a spatial declarative memory task.
- Both diabetic groups exhibited deficits in motor speed compared to controls.
Conclusions:
- Intensive therapy in type 1 diabetes is associated with selective memory impairments, potentially due to severe hypoglycemia and medial temporal dysfunction.
- Findings suggest a need for caution regarding overly strict glucose control in young type 1 diabetic patients to mitigate hypoglycemia risks and preserve cognitive function.
Objective:
Severe hypoglycemia may impair medial temporal-mediated cognitive skills, such as the ability to recall past events explicitly (delayed declarative memory). The objective of this study was to determine whether delayed declarative memory deficits are present in a group of diabetic children with an increased risk of severe hypoglycemia.
Research Design And Methods:
Nondiabetic children (n = 16) and children with type 1 diabetes who had been randomly assigned to either intensive (IT) (n = 13) or conventional (CT) (n = 12) diabetes therapy at the time of diagnosis participated in the study. All episodes of severe hypoglycemia were prospectively ascertained. All children were tested on memory tasks that have been closely linked to medial temporal functioning and on reaction time measures.
Results:
Our results demonstrated that the IT group had a threefold higher rate of severe hypoglycemia, performed less accurately on a spatial declarative memory task, and performed more slowly, but not less accurately, on a pattern recognition task than did the CT group or control subjects. In addition, both groups of type 1 diabetic children were significantly impaired on a motor speed task compared with their nondiabetic peers.
Conclusions:
These results indicate a selective relative memory impairment associated with IT that is consistent with the effects of severe hypoglycemia and medial temporal damage or dysfunction. If larger prospective studies determine that severe hypoglycemia is the mediating factor for this memory impairment, extreme caution in imposing overly strict standards for glucose control in young patients with type 1 diabetes would be indicated because of the increased risk of hypoglycemia associated with IT regimens.