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Cognitive function is disrupted by both hypo- and hyperglycemia in school-aged children with type 1 diabetes: a field

Linda A Gonder-Frederick1, John F Zrebiec, Andrea U Bauchowitz

  • 1Behavioral Medicine Center, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health Sciences Center, Charlottesville, Virgina, USA. Linda Gonder-Frederick, lag3g@virginia.edu

Diabetes Care
|March 28, 2009
PubMed

Insights

Cognitive function in children with type 1 diabetes declines during both hypoglycemia and hyperglycemia. This study used personal digital assistant (PDA) technology to detect these changes in mental efficiency during glucose fluctuations.

Area of Science:

  • Pediatric Endocrinology
  • Neuroscience
  • Diabetes Management

Background:

  • Type 1 diabetes (T1D) management requires careful blood glucose control.
  • Hypoglycemia and hyperglycemia can impact cognitive function, but real-world data in children is limited.
  • Previous studies often relied on laboratory settings, not reflecting daily fluctuations.

Purpose of the Study:

  • To develop and validate a field procedure using personal digital assistant (PDA) technology to assess cognitive function in children with T1D.
  • To test the hypothesis that naturally occurring hypo- and hyperglycemic episodes are associated with cognitive deterioration.
  • To quantify the impact of glucose extremes on specific cognitive tasks.

Main Methods:

  • A cohort of 61 children (aged 6-11 years) with T1D used PDAs for 4-6 weeks.
  • PDAs administered brief cognitive tests (mental math, choice reaction time) before home glucose monitoring.
  • Performance metrics (completion time, accuracy) and glucose levels were recorded; individual impairment scores (IISs) were calculated.

Main Results:

  • Cognitive performance, specifically task completion time, significantly worsened during both hypoglycemia and hyperglycemia.
  • Mental math performance decline was equivalent at glucose levels below 3.0 mmol/l and above 22.2 mmol/l.
  • No significant differences were observed in task accuracy, indicating slowed processing rather than errors.

Conclusions:

  • Naturally occurring blood glucose fluctuations in children with T1D are associated with measurable declines in mental efficiency.
  • PDA technology provides a feasible method for detecting cognitive effects of glucose variability in a real-world setting.
  • Hyperglycemia above 22.2 mmol/l can impair cognitive function as much as significant hypoglycemia in this population.
Abstract

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