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Changes in attention with hypo- and hyperglycaemia in children with insulin dependent diabetes mellitus
D Topitsch1, E Schober, E Wurst
1Universitätsklinik für Kinder- und Jugendheilkunde, Vienna, Austria.
Insights
Children with diabetes show reduced attention during mild hypoglycemia and low normal blood glucose. These attention deficits can occur before diabetic children recognize hypoglycemia symptoms.
Area of Science:
- Pediatric Endocrinology
- Neuropsychology
- Diabetes Research
Background:
- Insulin-dependent diabetes mellitus (IDDM) affects children globally.
- Blood glucose fluctuations are common in children with diabetes.
- Cognitive functions, particularly attention, may be impacted by glycemic variability.
Purpose of the Study:
- To investigate the effect of varying blood glucose levels on attention in children with IDDM.
- To compare attention test results in diabetic children with established norms.
- To determine if attention deficits occur at specific glycemic ranges.
Main Methods:
- Utilized the Test of Variables of Attention (TOVA), a computerized attention test.
- Assessed 38 children with IDDM across three blood glucose conditions: hypoglycemia (<3.3 mmol/l), normoglycemia (3.3-8.3 mmol/l), and hyperglycemia (>8.3 mmol/l).
- Analyzed attention measures including errors of omission and response time, comparing results to TOVA norms.
Main Results:
- Attention varied significantly with blood glucose levels (P=0.002).
- The highest number of errors and longest response times were observed during hypoglycemia.
- Attention was significantly reduced in diabetic children compared to TOVA norms, especially during mild hypoglycemia (P<0.001).
- Reaction time and its variability differed significantly between diabetic children and TOVA norms irrespective of blood glucose levels (P<0.01).
Conclusions:
- Children with diabetes exhibit reduced attention during mild hypoglycemia and low-normal blood glucose levels.
- Attention deficits in diabetic children can manifest before the onset of recognized hypoglycemic symptoms.
- Transient blood glucose lowering significantly impacts attention in pediatric diabetes patients.
Unlabelled:
We compared the results of a computerized attention test (TOVA) in 38 children with insulin dependent diabetes mellitus in relation to various spontaneously occurring blood glucose levels. Testing was performed at the following blood glucose levels: <3.3 mmol/1 (hypoglycaemia), 3.3-8.3 mmol/1 (normoglycaemia) and >8.3 mmol/1 (hyperglycaemia). The attention (sum of errors and response time) varied significantly with the blood glucose level (P = 0.002). The highest number of errors of omission and the longest response time was observed during the test run with hypoglycaemia. Age, sex, age at manifestation of the disease, metabolic control and the results of the intelligence test had no significant influence on these results. We found that attention in children with diabetes was significantly reduced compared to TOVA norms especially during mild hypoglycaemia (P < 0.001). Irrespective of the blood glucose levels, reaction time and the variability of the reaction time differed significantly between TOVA norms and diabetic children (P < 0.01).
Conclusion:
In children with diabetes mellitus a significant reduction in attention was found at mild hypoglycaemia but as well at low normal blood glucose levels. Attention deficits due to transient lowering of blood glucose may therefore occur in diabetic children even before they are aware of hypoglycaemic symptoms.