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Severe hypoglycemia and long-term spatial memory in children with type 1 diabetes mellitus: a retrospective study
Tamara Hershey1, Rema Lillie, Michelle Sadler
1Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110, USA. tammy@npg.wustl.edu
Insights
Severe hypoglycemia in children with type 1 diabetes mellitus (T1DM) negatively impacts spatial memory performance on tasks with long delays. This suggests specific cognitive deficits related to the frequency of severe hypoglycemic events.
Area of Science:
- Neuroscience
- Endocrinology
- Pediatrics
Background:
- Medial temporal lobe function is crucial for delayed response tasks.
- Severe hypoglycemia can affect medial temporal lobe function.
- Previous studies indicated potential cognitive impacts of hypoglycemia in type 1 diabetes mellitus (T1DM).
Purpose of the Study:
- To investigate the specific relationship between the frequency of severe hypoglycemia and performance on spatial delayed response (SDR) tasks in children with T1DM.
- To determine if severe hypoglycemia has a specific impact on memory skills requiring longer delays.
Main Methods:
- Children with T1DM (n=51) and controls (n=32) completed SDR tasks with short and long delays.
- Data on the frequency of past severe hypoglycemic episodes were collected for T1DM participants.
- Statistical analyses controlled for age and age of onset.
Main Results:
- In children with T1DM, the number of past severe hypoglycemic episodes significantly predicted performance on the long-delay SDR task, even after controlling for covariates.
- This association was not observed for the short-delay SDR task or other cognitive tasks (verbal memory, object memory, attention, motor speed).
Conclusions:
- Severe hypoglycemia has specific, detrimental effects on memory skills in children with T1DM, particularly those involving longer delays.
- The frequency of severe hypoglycemia may impact daily functioning in children with T1DM, warranting consideration in treatment strategies.
Abstract:
Performance on long delays of delayed response tasks is associated with medial temporal function, a region of the brain affected by severe hypoglycemia. A previous study showed that children with type 1 diabetes mellitus (T1DM) with higher risk for severe hypoglycemia performed worse than controls on long delays of a spatial delayed response (SDR) task. We tested the more specific hypothesis that frequency of severe hypoglycemia would relate to long delay SDR performance. Children with T1DM (n = 51) and controls (n = 32) performed the SDR task with short and long delays. Information was collected on children's past severe hypoglycemia. In children with T1DM, number of past severe hypoglycemic episodes accounted for a significant portion of the variance in long delay SDR after controlling for age and age of onset. This relationship was not seen with short delay SDR or with other tasks (verbal or object memory, attention, motor speed). These results support the hypothesis that severe hypoglycemia has specific, negative effects on memory skills in children. If this relationship is extrapolated to children with higher frequency of severe hypoglycemia, due to longer duration of disease or poorer glucose control, it may affect daily functioning and thus need to be considered in treatment decisions.