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Intellectual characteristics of diabetic children at diagnosis and one year later
J F Rovet1, R M Ehrlich, D Czuchta
1Psychology Department, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Pediatric patients with insulin-dependent diabetes mellitus (DM) showed no cognitive decline after one year. Early-onset DM (under 5) impacted spatial and verbal abilities, while severe hypoglycemia had no adverse effects.
Area of Science:
- Neuroscience
- Pediatrics
- Endocrinology
Background:
- Insulin-dependent diabetes mellitus (DM) is a chronic condition affecting children.
- Neurocognitive function in pediatric DM requires further investigation.
Purpose of the Study:
- To examine neurocognitive functions in newly diagnosed pediatric patients with DM.
- To assess the impact of disease onset and control on cognitive abilities over one year.
Main Methods:
- Neurocognitive tests (verbal, visuospatial) administered to 63 pediatric DM patients at diagnosis (T0) and 1 year (T1).
- Sibling controls assessed at T0.
- Diabetic control, glycemic events, ketonuria, and hospitalizations monitored.
Main Results:
- No significant cognitive differences between DM patients and controls at T0.
- No acquired cognitive impairment observed in DM patients after 1 year.
- Early-onset DM (<5 years) associated with lower spatial and verbal abilities.
- Ketonuria, hospitalizations, and diabetic ketoacidosis linked to lower performance IQs.
Conclusions:
- Diabetes onset itself does not appear to cause immediate neurocognitive deficits in children.
- Disease duration and specific metabolic factors (ketonuria, DKA) may influence cognitive outcomes.
- Further research is needed to understand long-term effects and critical developmental periods.
Abstract:
Examined neurocognitive functions in 63 newly diagnosed pediatric patients with insulin-dependent diabetes mellitus (DM) at onset of illness (T0) and 1 year postdiagnosis (T1). Siblings (S) serving as controls were assessed at T0 only. Subjects were given age-appropriate tests of verbal and visuospatial abilities. In addition, DM were interviewed regularly during diabetes clinic to determine current diabetic control and different intervening glycemic-related events. Results revealed no differences between DM and S at T0, nor any specific impairment in DM predating illness. Also, DM did not demonstrate any acquired impairment after 1 year of illness. Children with early onset DM (less than 5 years) scored lower in spatial ability at T0 and T1 than children with later onset DM, who scored lower in verbal ability. Episodes of asymptomatic and mild chronic hypoglycemia correlated positively, not negatively, with improved outcome over time. There were no adverse effects of severe hypoglycemia. Ketonuria and hospitalizations were associated with lower performance IQs 1 year after onset, as was diabetic ketoacidosis at onset. Results are discussed in terms of critical periods of sensitivity of different brain regions to the effects of diabetes and the need for longer follow-up of these children.