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Cognitive function and mood after profound nocturnal hypoglycaemia in prepubertal children with conventional insulin
K A Matyka1, L Wigg, S Pramming
1Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
Insights
Children with insulin-dependent diabetes mellitus (IDDM) frequently experience asymptomatic nocturnal hypoglycemia. While cognitive function remained unaffected, mood changes were observed following these hypoglycemic events.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Management
Background:
- Nocturnal hypoglycemia is a significant concern in children with insulin-dependent diabetes mellitus (IDDM).
- Understanding the impact of these events on cognitive function and mood is crucial for comprehensive diabetes care.
Purpose of the Study:
- To determine the incidence of nocturnal hypoglycemia in children with IDDM.
- To evaluate the subsequent effects on cognitive performance and mood.
Main Methods:
- Overnight continuous glucose monitoring was performed in 29 prepubertal children with IDDM and 15 healthy controls.
- Cognitive function and mood assessments were conducted the following day.
Main Results:
- Asymptomatic hypoglycemia (glucose < 3.5 mmol/l) occurred in over half of the IDDM patients across two nights.
- The median duration of hypoglycemia was 270 minutes; it was linked to insulin dose but not HbA1c.
- No significant changes in cognitive performance were noted, but a decline in mood was observed.
Conclusions:
- Young children with IDDM on conventional insulin regimens are at high risk for severe, asymptomatic nocturnal hypoglycemia.
- Predicting these events is challenging, and while short-term cognitive effects are absent, mood alterations are evident.
Objectives:
To examine the frequency of nocturnal hypoglycaemia, and the effects on cognitive function and mood, in children with insulin dependent diabetes mellitus (IDDM).
Design:
Two overnight glucose profiles, in the home environment, and assessments of cognitive function and mood the following day. Twenty nine prepubertal patients with IDDM (median age, 9.4 years; range, 5.3-12.9) and 15 healthy controls (single overnight profile), median age 9.5 (range, 5.6-12.1) years were studied.
Results:
Asymptomatic hypoglycaemia (glucose < 3.5 mmol/l) was observed in 13 of 29 patients studied on night 1: four of these and seven others were hypoglycaemic on night 2. The median glucose nadir was 1.9 (range, 1.1-3.3) mmol/l and the median duration of hypoglycaemia was 270 (range, 30-630) minutes. Hypoglycaemia was related to insulin dose, but not glycosylated haemoglobin (HbA1c) values, and was partially predicted by a midnight glucose of < 7.2 mmol/l. Cognitive performance was not altered after hypoglycaemia but a lowering of mood was observed.
Conclusions:
Young children on conventional insulin regimens are at high risk for profound, asymptomatic nocturnal hypoglycaemia, which is difficult to predict. There was no short term effect on cognitive function but mood change was detected.