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Cognitive Function in Early Onset Type 1 Diabetes in Children
K Swaminathan1, Pamali Mahasweta Nanda1, Jaivinder Yadav2
1Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Insights
Children with early-onset type 1 diabetes (T1D) exhibit lower cognitive function and IQ. Poor glycemic control and severe hypoglycemia are linked to these deficits, highlighting the need for better management in young T1D patients.
Area of Science:
- Pediatric Endocrinology
- Neuroscience
- Developmental Psychology
Background:
- Type 1 Diabetes (T1D) is a chronic autoimmune condition requiring lifelong management.
- Early-onset T1D, diagnosed before age 6, presents unique challenges in growth and development.
- Cognitive function in children with T1D is an area of growing concern, particularly in diverse populations.
Purpose of the Study:
- To evaluate cognitive function in Indian children diagnosed with early-onset T1D.
- To identify factors influencing cognitive performance in this vulnerable group.
- To compare cognitive outcomes between children with early-onset T1D and healthy controls.
Main Methods:
- A cross-sectional study involving 60 children with early-onset T1D (onset < 6 years, disease duration ≥ 2 years) and 60 age/sex-matched controls.
- Cognitive assessment utilized Malin's Intelligence Scale for Indian Children (MISIC).
- Exclusion criteria included birth asphyxia, intellectual disability, syndromic conditions, and pre-existing psychiatric illness.
Main Results:
- Children with early-onset T1D demonstrated significantly lower scores across most MISIC subtests, including verbal, performance, and overall Intelligence Quotient (IQ).
- Poor glycemic control (HbA1c > 9%), history of severe hypoglycemia, and shorter duration since the last diabetic ketoacidosis (DKA) episode were associated with reduced neurocognitive scores.
- Average IQ in the T1D group was 100.62 ± 3.26 compared to 103.23 ± 1.22 in the control group.
Conclusions:
- Early-onset T1D is associated with significant deficits in cognitive domains and overall IQ.
- Suboptimal glycemic control, heightened glycemic variability, and severe hypoglycemia are identified as critical risk factors impacting cognitive development in these children.
- Longitudinal research is recommended to further elucidate the complex interplay of factors affecting cognitive outcomes in T1D children within developing countries.
Objectives:
To assess cognitive function and factors affecting it in Indian children with early-onset type 1 diabetes (T1D) (less than 6 y).
Methods:
This cross-sectional, single-centre study recruited children diagnosed with T1D before 6 y of age and having a disease duration of at least 2 y, as cases. Controls were age- and sex-matched apparently healthy children or siblings. Children with birth asphyxia, intellectual disability, syndromic children, or pre-existing psychiatric illness were excluded. Enrolled children underwent cognitive assessment using Malin's Intelligence Scale for Indian Children (MISIC), and scores in various subtests were compared between cases and controls.
Results:
A total of 60 children were enrolled in each group. When compared to controls, cases had significantly lower scores on most subtests, verbal, performance and overall Intelligence Quotient (IQ- 100.62 ± 3.26 vs. 103.23 ± 1.22). HbA1c >9%, severe hypoglycemia and lesser duration since the last diabetic ketoacidosis (DKA) episode significantly correlated with lower neurocognitive scores.
Conclusions:
Children with early onset T1D showed significant deficits in various cognitive domains and IQ. Poor glycemic control, higher glycemic variability and exposure to severe hypoglycemia are risk factors for poor cognitive outcomes in these children. Further longitudinal studies could potentially aid in a finer understanding of factors affecting cognitive functioning in T1D children in developing countries.
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