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Impact of Early Diabetic Ketoacidosis on the Developing Brain

Tandy Aye1, Paul K Mazaika2, Nelly Mauras3

  • 1Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA taye@stanford.edu.

Diabetes Care
|December 22, 2018
PubMed

Insights

A history of moderate to severe diabetic ketoacidosis (DKA) in young children with type 1 diabetes is linked to lower cognitive scores and altered brain growth. Early diagnosis and DKA prevention may protect developing brains.

Area of Science:

  • Pediatric Endocrinology
  • Neuroscience
  • Developmental Psychology

Background:

  • Type 1 diabetes (T1D) management in children requires careful monitoring to prevent complications.
  • Diabetic ketoacidosis (DKA) is a serious complication of T1D, particularly in young children.
  • The long-term effects of DKA on cognitive and brain development in early childhood are not fully understood.

Purpose of the Study:

  • To investigate the association between a history of diabetic ketoacidosis (DKA) severity and longitudinal changes in cognitive and brain development in young children with type 1 diabetes.
  • To determine if DKA impacts cognitive function and brain growth trajectories in children aged 4 to <10 years with T1D.

Main Methods:

  • Analysis of cognitive and brain imaging data from 144 children with T1D (ages 4 to <10 years) from the DirecNet observational study.
  • Participants were categorized by DKA severity (none/mild vs. moderate/severe).
  • Unsedated MRI scans and cognitive testing were conducted at baseline and 18-month follow-up.

Main Results:

  • Children with a history of moderate/severe DKA showed greater white and gray matter volume gains over 18 months compared to those with none/mild DKA.
  • When matched for age and HbA1c, the moderate/severe DKA group exhibited significantly lower Full Scale Intelligence Quotient scores.
  • Cognitive deficits were observed in specific areas, including attention (Conners' CPT II) and memory (Children's Memory Scale), in the moderate/severe DKA group.

Conclusions:

  • A single episode of moderate/severe DKA at diagnosis in young children is associated with reduced cognitive performance and altered brain growth.
  • These findings suggest a potential neurodevelopmental impact of DKA in early childhood T1D.
  • Further research is warranted to explore the benefits of early T1D diagnosis and DKA prevention on long-term brain development.
Abstract

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