Longitudinal Relationship of Asymptomatic Hypoglycemia to Cognitive Function in IDDM

Golden, Michael P.; Ingersoll, Gary M.; Brack, Catherine J.; Russell, B; Wright, James C.; Huberty, Thomas J.

doi:10.2337/diacare.12.2.89

Cited by 96 publications

(52 citation statements)

References 3 publications

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“…The evaluation confirms previous reports that intellectual deficits are more pronounced in children who developed diabetes at preschool age [8,10]. However our results support young age as a risk factor only in males and indicate a major role of long-term metabolic control.…”

Section: Discussionsupporting

confidence: 91%

Impaired intellectual development in children with Type I diabetes: association with HbA 1 c , age at diagnosis and sex

et al. 2002

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Treatment, and even more so, care of children with Type I (insulin-dependent) diabetes mellitus is a difficult and demanding task for parents as well as for health professionals. Aiming for good metabolic control is often hindered by the dynamics of the disease, an insufficiency of insulin therapy, the impossibility of an exact control of carbohydrate intake and the irregularities of daily life. The knowledge of the risk of long-term vascular complications and the permanent uncertainty of threatening hypoglycaemia as an immediate complication, is a great burden for the responsible paediatric diabetologist and thus narrows his or her therapeutic possibilities.There is now clear evidence that poor long-term metabolic control is the crucial factor for developing late vascular complications [1 ± 3]. In addition, there is growing evidence that the quality of metabolic control even during pre-pubertal years greatly influences Diabetologia (2002) Abstract Aims/hypothesis. Good metabolic control in diabetic children is already crucial before puberty to prevent diabetic complications later in life. However, tight metabolic control could increase the risk of severe hypoglycaemia, which might be responsible for impaired intellectual performance later in life. The purpose of this prospective longitudinal study was to evaluate the relevance of long-term metabolic control and hypoglycaemia possibly affecting the intellectual development of young children with Type I (insulin-dependent) diabetes mellitus.Methods. The intellectual development in 64 diabetic children between the ages of 7 and 16 years was assessed at least four times using the German version of the Hamburg Wechsler intelligence scale for preschool children, Children-Revised and by the ªAdap-tives Intelligenz Diagnostikumº (Adaptive Intelligence Diagnosticum). Data were analysed longitudinally compared with a control group.Results. A significant decline in performance by age 7 and in verbal intelligence quotient between age 7 and 16 years was observed in diabetic boys diagnosed before the age of 6 but not in those diagnosed later and not in diabetic girls. The deterioration of intellectual performance in boys diagnosed at a very young age was not associated with the occurrence of severe hypoglycaemic episodes but was correlated with the degree of metabolic deterioration at diagnosis and with high long-term average of glycated haemoglobin. Conclusion/interpretation. Our study in diabetic children shows that the male sex, diagnosis at a young age, metabolic condition at diagnosis and long-term metabolic control, rather than experienced hypoglycaemic attacks are risk factors for intellectual development. [Diabetologia (2002) 45: 108±114]

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Section: Discussionsupporting

confidence: 91%

Impaired intellectual development in children with Type I diabetes: association with HbA 1 c , age at diagnosis and sex

et al. 2002

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“…[Diabetologia (2003) Poor academic performance in diabetic children and memory impairment in adults with diabetes are viewed as increasing public health concerns. These problems are typically thought to result from hypoglycaemic attacks [1,2], which occur more frequently during intensive insulin therapy [3]. Although insulininduced hypoglycaemia could contribute to learning problems [4], one recent prospective study did not find a relationship between severe hypoglycaemic events and cognitive impairment [5], raising the possibility that the diabetic condition alone might adversely affect learning and memory.…”

Section: Introductionmentioning

confidence: 99%

Effects of insulin on long-term potentiation in hippocampal slices from diabetic rats

et al. 2003

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Aims/Hypothesis. Cognitive deficits occur commonly in diabetic patients. It is unclear whether these impairments result from hypoglycaemia during intensive insulin therapy, or from the diabetes itself. The aim of this study was to examine if impaired energy utilization resulting from insulin deficiency contributes to impaired long-term potentiation (reflecting impaired synaptic plasticity). As long-term potentiation is considered a candidate cellular mechanism underlying learning and memory, understanding how diabetes alters long-term potentiation may provide insight into mechanisms producing cognitive deficits in diabetes. Methods. Electrophysiologic recordings were used to study long-term potentiation in the CA1 region of hippocampal slices from healthy rats and rats with streptozotocin-induced diabetes.Results. Long-term potentiation was difficult to induce in slices from diabetic rats in standard recording buffer (contains 10 mmol/l glucose). In slices from diabetic rats, increasing extracellular glucose failed to recover long-term potentiation induction, but 10 mmol/l pyruvate added to standard buffer enabled long-term potentiation induction. Moreover, incubation of slices from diabetic rats with insulin enabled long-term potentiation induction in standard buffer. Acute administration of streptozotocin alone did not impair long-term potentiation in slices from healthy animals, and changing extracellular glucose concentrations over the range of 5 mmol/l to 30 mmol/l did not alter long-term potentiation in slices from control rats. Conclusions/interpretation. These observations suggest that impaired energy utilization from insulin deficiency, rather than the accompanying hyperglycaemia, impair long-term potentiation in diabetes. Impaired hippocampal synaptic plasticity could contribute to learning and cognitive impairment in diabetic patients. [Diabetologia (2003) Poor academic performance in diabetic children and memory impairment in adults with diabetes are viewed as increasing public health concerns. These problems are typically thought to result from hypoglycaemic attacks [1,2], which occur more frequently during intensive insulin therapy [3]. Although insulininduced hypoglycaemia could contribute to learning problems [4], one recent prospective study did not find a relationship between severe hypoglycaemic events and cognitive impairment [5], raising the possibility that the diabetic condition alone might adversely affect learning and memory. Experimental evidence supporting an independent effect of diabetes upon

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“…Studies of children with type 1 diabetes generally report that these children have intelligence within the normal range; however, there are several reports of neuropsychological deficits observed in children with diabetes. Difficulties with verbal intelligence (1), memory (2,3), timed motor tasks (4), visuospatial abilities (4 -7), abstract/ visual reasoning (8), speed of processing (1,5), and attention (3) have all been reported. These findings have been contradictory; some studies have identified verbal and memory difficulties, whereas others have identified visuospatial deficits.…”

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confidence: 99%

Factors Associated With Academic Achievement in Children With Type 1 Diabetes

et al. 2003

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OBJECTIVE -To examine academic achievement in children with diabetes and to identify predictors of achievement. RESULTS -Reading scores and GPA were lower for children with poor metabolic control than for children with average control. Children with hospitalizations for hyperglycemia had lower overall achievement scores than children with better metabolic control and fewer hospitalizations for hyperglycemia. The small group of children with tight metabolic control and hypoglycemic hospitalizations scored particularly low on the ITBS/ITED. Other variables had less clear relationships with academic achievement. Neither early onset of diabetes nor frequent school absence was associated with lower scores on the ITBS/ITED. Sex comparisons found that boys performed better than girls only in math. Socioeconomic status and parent ratings of behavior problems were significantly correlated with academic achievement, but medical variables added only slightly to predictive precision. RESEARCH DESIGN AND METHODSCONCLUSIONS -For most children with diabetes, medical variables are not as strongly associated with academic achievement as are factors such as socioeconomic status and behavioral factors. Poor metabolic control and serious hypoglycemia, however, are a potential concern for a subset of these children.

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Longitudinal Relationship of Asymptomatic Hypoglycemia to Cognitive Function in IDDM

Cited by 96 publications

References 3 publications

Impaired intellectual development in children with Type I diabetes: association with HbA 1 c , age at diagnosis and sex

Impaired intellectual development in children with Type I diabetes: association with HbA 1 c , age at diagnosis and sex

Effects of insulin on long-term potentiation in hippocampal slices from diabetic rats

Factors Associated With Academic Achievement in Children With Type 1 Diabetes

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