Melanie Grosnick Is neurocognitive functioning decreased with the prevalence of Type 1 Diabetes Mellitus and glycemic control in children

younger than 12? Type 1 Diabetes Mellitus can have numerous effects on diagnosed individuals, especially those who are underdeveloped. More than 15,000 children are diagnosed with type 1 diabetes mellitus in the United States (4). The rate for estimated increase in prevalence in children is 3% annually (4). Neurocognitive functioning in children is one debated side effect of Type 1 Diabetes (T1DM). Glycemic extremes and episodes of severe hypoglycemia have shown to lead to cognitive impairment in many studies, along with some mixed findings. Early-onset of the disease is another possible cause for a decrease in neurocognitive functioning. These research studies collectively assess the possible causes for weaker neurocognitive abilities. Preschool-aged children with T1DM and decreases in neurocognitive functioning Preschool-aged children were targeted because very few studies have included this age group in its research. By using such a young age group, it could be determine whether cognitive impairments were present early in life and analyze factors enabling the decrease. Glycemic control could also be evaluated to determine its role in impairment. The researchers compared the neurocognitive abilities of healthy children to those with the disease by having the children perform a series of tests. These tests evaluated their cognitive abilities in three main categories: cognitive ability, language, and fine motor functioning. Results showed that the mean scores for both groups were within normal ranges, concluding that simply having T1DM did not put children at a

disadvantage cognitively. Other results revealed that mothers with higher education had children that scored higher in overall cognitive functioning, as well as expressive vocabulary. Girls performed better on the DAS, a test that assessed cognitive functioning and verbal and nonverbal reasoning abilities. When analyzing the role of glycemic control, children with higher blood glucose levels at the time of testing had lower receptive language scores. Higher HbA1c was related to lower general cognitive abilities, slower dominant handed fine motor speed and lower receptive language scores. Cognitive impairment in children with episodes of severe hypoglycemia and T1DM By looking at a broader age range of children, the effects of specifically severe hypoglycemic episodes could be analyzed. Using 21children with T1DM and 10 healthy children, the diabetic children were then divided into two groups: those that had had at least one severe hypoglycemic episode and children that had never experienced an episode. The three groups were matched for sex, age, and parents educational level. Data regarding the childrens episodes was collected from parent and child recollection, as well as hospital records. With the approval of the hospitals ethics committee, all the children participated in numerous tests evaluating their abilities in attention/executive functions, language, sensorimotor functions, visuospatial processing, and memory and learning. Researchers discovered that 64% of the diabetic children with severe hypoglycemic episodes had significant difficulties in language or executive functions, while only 30% of non-hypoglycemic diabetic children and none of the healthy children expressed the same qualities. The hypoglycemic diabetic children showed lower

standard language sores that then control group, with only slightly lower verbal IQ scores than the non-hypoglycemic children. Researchers determined that parental education was not a significant covariate. They also recognized that In children with diabetes, neurocognitive functioning is in most cases normally developed... (2) Long term complications of T1DM in neurocognitive functioning of children By performing a 12 year study, researchers could determine variables decreasing a childs cognitive ability over time. 133 newly diagnosed children participated in the study, along with 126 healthy control subjects. 79% of the diabetic children agreed participate 12 years later with 60% of the healthy children. After performing several tests assessing their neurocognitive abilities, children with a history of hypoglycemia showed lower verbal IQ score. The diabetic children had lower verbal and full scale IQ and MRI scans showed less gray and white matter volume in their brains. Although differences in IQ were evident, all individuals with T1DM performed well within the average range in general functioning. With a young age and an earlier onset of diabetes, lower performance IQ and full scale IQ were shown. When collectively analyzing the results of the studies, there are common trends to be observed. It is not correct to simply say that diabetic children are at a disadvantage neurocognitively. Researchers have noticed that diabetic children might be performing slightly worse than healthy children when being tested, but are still performing within the national average for children nationwide. Another trend observed in these studies is the importance of glycemic control. Diabetic children with frequent hypoglycemic episodes completed cognitive tests with lower scores than not only

healthy children but also diabetic children with less frequent or no hypoglycemic episodes. Overall, the only results that differed were the studies that included parental education as a factor to varied cognitive abilities. This is understandable because when evaluated younger children, they cannot fully understand the effects of lack of glycemic control. Therefore, they depend on their parents to manage their glycemic index. When parents are undereducated, whether it is about the subject of glycemic control or education in general, they cannot comprehend the importance of glycemic control either. The children in the study analyzing hypoglycemic episodes were ages 5 to 11. At this age, children are starting to better understand T1DM and can help manage the disease with parental guidance. Or this might mean that results varied when taking parental education into consideration. When studies have a very small sample size, data can be inaccurate (2). Although results agreed with other studies, it is hard to deem their outcomes credible. When only children from one country are evaluated (2,3), limitations in studies can also be found. Without recognizing differences in cultural background, these lifestyles, eating habits, and ways of living cannot be considered common for children from other countries as well. But when studies include ethnically diverse participants (1), results can be considered more accurate. Therefore when doctors give recommendations and guidance to patients, they can look to evidence-based research that includes diverse participants with similar backgrounds as their patients. By having the support of

hospitals, clinically reliable sources and numerous matching criteria of participants (2), a study can also become more credible. Additionally, research with specific aged groups can be beneficial when no other studies have been done with the same participants (1). Conclusion In conclusion, all three studies (1-3) showed evidence that neurocognitive functioning is decreased with lack of glycemic control. They also all supported the theory that T1DM children are not at a disadvantage cognitively. With adequate education for parents, young children can have consistent control over glycemic index (1). Further research can always be done to reinforce evidence that has been shown in these studies. If age groups and specific factors can be targeted, doctors can gain a better understanding of how to treat type 1 diabetes mellitus and allow all children to easily experience beneficial learning opportunities throughout childhood.

References: 1. Patia-Fernndez AM, Delamater AM, Applegate EB, et al. Neurocognitive functioning in preschool-aged children with Type 1 Diabetes Mellitus. Pediatric Diabetes. 2010, 11: 424-430 2. Hannonen R, Tupola S, Ahonen T, Riikonen R. Neurocognitive functioning in children with type-1 diabetes with and without episodes of severe hypoglycemia. Developmental Medicine & Child Neurology. 2008, 45: 262-268 3. Northam EA, Rankins D, Lin A, et al. Central nervous system function in youth with type 1 diabetes 12 years after disease onset. Diabetes Care. 2009, 32: 445450. 4. Type 1 Diabetes Facts. JDRF: Improving lives, curing type 1 diabetes. 2013. Available at: http://jdrf.org/about-jdrf/fact-sheets/type-1-diabetes-facts/. Accessed May 3, 2013.