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Multimodal MRI neurodevelopmental profiling in type 1 diabetes: long-term effects of MDI vs CSII treatments
Pasquale Anthony Della Rosa1,2, Nicolò Pecco1, Sonia Francesca Calloni1
1Department of Neuroradiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan 20132, Italy.
The Journal of Clinical Endocrinology and Metabolism
|March 7, 2026
Summary
Children with type 1 diabetes (T1D) show brain differences, with Continuous Subcutaneous Insulin Infusion (CSII) potentially offering neuroprotection over Multiple Daily Injections (MDI). Right inferior frontal gyrus volume links metabolic control to cognitive function.
Area of Science:
- Neuroscience
- Pediatric Endocrinology
- Medical Imaging
Background:
- The developing brain is highly susceptible to blood sugar fluctuations in early-onset type 1 diabetes (T1D).
- Long-term neurodevelopmental effects of different T1D treatment methods are not well understood.
Purpose of the Study:
- To analyze brain development using MRI in children with T1D.
- To compare the effects of Multiple Daily Injections (MDI) versus Continuous Subcutaneous Insulin Infusion (CSII) on brain structure and function.
- To investigate the relationship between HbA1c levels, brain imaging findings, and executive-working memory performance.
Main Methods:
- Multimodal MRI (structural, diffusion, resting-state fMRI) was used in 16 children with T1D (8 MDI, 8 CSII) and 8 controls.
- Machine learning (U-RFE) identified key brain features (gray matter, white matter, functional connectivity) differentiating groups.
- Regression analyses linked these features to HbA1c, and cognitive tests (NEPSY-II Word List Interference) assessed executive-working memory.
Main Results:
- Functional MRI features were more effective than structural features in distinguishing groups (balanced accuracy 0.83 vs 0.67).
- MDI treatment was associated with reduced gray/white matter integrity and altered brain connectivity compared to CSII and controls.
- Right inferior frontal gyrus volume correlated with HbA1c and predicted poorer executive-working memory, mediating the effect of HbA1c on cognition. CSII group showed better metabolic control and cognitive performance.
Conclusions:
- Pediatric T1D is linked to brain alterations that vary by insulin treatment type.
- Continuous Subcutaneous Insulin Infusion (CSII) may offer neuroprotective advantages through improved metabolic control and preserved brain connectivity.
- The right inferior frontal gyrus volume serves as a potential imaging biomarker connecting metabolic health to executive-working memory deficits in T1D.
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