Specific Intellectual Deficits in Children with Early Onset Diabetes Mellitus

Rovet, Joanne; Ehrlich, Robert; Hoppe, M. K.

doi:10.1111/j.1467-8624.1988.tb03211.x

Cited by 57 publications

(79 citation statements)

References 29 publications

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“…In other cognitive ability studies of children with type 1 diabetes, EOD onset has been variously defined as occurring anywhere from age 4 to age 7 years (1), with little reference for preferences (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Magnetic resonance imaging (MRI) neurodevelopmental studies have demonstrated that adult brain volumes are attained by age 7-10 years (17).…”

Section: Definition Of Eodmentioning

confidence: 99%

“…Ack et al (1) first identified an association between early-onset type 1 diabetes (EOD) and comparatively lower general intelligence test scores; children with diabetes averaged 10 IQ points lower than their siblings. Subsequent studies identified small-tomoderate permanent differences in nonverbal (2)(3)(4)(5) and verbal (6) intelligence, information processing (3,(7)(8)(9), visuospatial ability (3)(4)(5), attention (7)(8)(9)(10)(11), executive function (7,9,12), and learning and memory ability (2,3,7). Prospective evaluation has confirmed that EOD independently influences verbal and nonverbal intelligence, attention, psychomotor speed, and executive functions (6,9).…”

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Influence of an Early-Onset Age of Type 1 Diabetes on Cerebral Structure and Cognitive Function

et al. 2005

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OBJECTIVE -Children who develop type 1 diabetes before age 7 years (early-onset diabetes; EOD) have comparatively poorer cognitive abilities. Whether this relates to psychosocial consequences of chronic illness or organic factors related to diabetes and its complications remains unresolved. We hypothesized that if differences in neuroradiological structure and cognitive ability coexisted in those who had EOD, then an organic component to their etiology was likely. RESEARCH DESIGN AND METHODS-A cohort of 71 young adults with longduration type 1 diabetes diagnosed during childhood or adolescence participated in a crosssectional evaluation of cognitive ability (neuropsychological test battery) and brain structure (magnetic resonance imaging). Diabetes onset age, preceding severe hypoglycemia exposure, retinopathy status, and diabetes duration were examined as potential correlates of cognitive and neuroradiological differences. No participants had previous neuropsychological pathology.RESULTS -In EOD participants (n ϭ 26), current intellectual ability (Wechsler Adult Intelligence ScaleϪRevised performance IQ; P ϭ 0.03) and information processing ability (Choice Reaction Time; P ϭ 0.006) were comparatively poorer than was observed in those with lateronset diabetes (n ϭ 45). Furthermore, lateral ventricular volumes were 37% greater (P ϭ 0.002) and ventricular atrophy was more prevalent (61 vs. 20%; P ϭ 0.01) in the EOD group than in those who had later-onset type 1 diabetes.CONCLUSIONS -An early childhood onset of type 1 diabetes was associated with mild central brain atrophy and significant differences in intellectual performance in adulthood, implying that neurodevelopment may be adversely affected by EOD. The differences observed in brain structure support an organic contribution to their etiology but do not exclude a coexistent contribution of psychosocial factors. Diabetes Care 28:1431-1437, 2005O ptimal intellectual development may be compromised by early childhood onset type 1 diabetes. The diabetes-related factor most consistently related to later intellectual ability is the onset age of type 1 diabetes; children developing the disorder in early childhood are more likely to score relatively poorly on cognitive tests, independent of diabetes duration. Ack et al.(1) first identified an association between early-onset type 1 diabetes (EOD) and comparatively lower general intelligence test scores; children with diabetes averaged 10 IQ points lower than their siblings. Subsequent studies identified small-tomoderate permanent differences in nonverbal (2-5) and verbal (6) intelligence, information processing (3,7-9), visuospatial ability (3-5), attention (7-11), executive function (7,9,12), and learning and memory ability (2,3,7). Prospective evaluation has confirmed that EOD independently influences verbal and nonverbal intelligence, attention, psychomotor speed, and executive functions (6,9). Some researchers have suggested that the differences in intellectual ability may reflect chronic hyperglycemia, severe hypog...

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Section: Definition Of Eodmentioning

confidence: 99%

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confidence: 99%

Influence of an Early-Onset Age of Type 1 Diabetes on Cerebral Structure and Cognitive Function

et al. 2005

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“…A second aim of the current study is to determine whether some children with type 1 diabetes have an elevated risk of cognitive dysfunction. Earlier age of diabetes onset is identified in the literature as one of the strongest risk factors associated with disrupted cognitive functioning (3,4,5,6). To examine the impact of early-onset diabetes (EOD) on cognitive abilities, a second meta-analysis is conducted to compare children classified by authors as having earlier age at onset, which may range anywhere from 4 to 7 years depending on the author, to later age at onset (late-onset diabetes [LOD]).…”

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Cognitive Function in Children With Type 1 Diabetes

et al. 2008

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OBJECTIVE -To quantify the magnitude and pattern of cognitive difficulties in pediatric type 1 diabetes as well as the effects associated with earlier disease onset and severe hypoglycemia.RESEARCH DESIGN AND METHODS -Pediatric studies of cognitive function since 1985 were identified for study inclusion using MEDLINE and PsycInfo. Effect size (ES, Cohen's d) between the diabetic and control groups, expressed in SD units, were calculated within cognitive domains to standardize meta-analysis test performance. RESULTS -The meta-analysis sample of 2,144 children consisted of 1,393 study subjects with type 1 diabetes and 751 control subjects from 19 studies. Overall, type 1 diabetes was associated with slightly lower overall cognition (ES Ϫ0.13), with small differences compared with control subjects across a broad range of domains, excluding learning and memory, which were similar for both groups. Learning and memory skills, both verbal and visual (Ϫ0.28 and Ϫ0.25), were more affected for children with early-onset diabetes (EOD) than late-onset diabetes (LOD), along with attention/executive function skills (Ϫ0.27). Compared with nondiabetic control subjects, EOD effects were larger, up to one-half SD lower, particularly for learning and memory (Ϫ0.49). Generally, seizures were associated with a negligible overall cognition ES of Ϫ0.06, with slight and inconsistent cognitive effects found on some measures, possibly reflecting the opposing effects of poorer versus better metabolic control.CONCLUSIONS -Pediatric diabetes generally relates to mildly lower cognitive scores across most cognitive domains. Cognitive effects are most pronounced and pervasive for EOD, with moderately lower performance compared with control subjects. Seizures are generally related to nominal, inconsistent performance differences.

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“…5,14 However, these results have been contradictory; some studies have identified verbal and memory difficulties, whereas others have failed to find verbal difficulties and have instead identified visuospatial deficits. Neuropsychological deficits have been associated with a number of risk factors, most commonly onset of type 1 diabetes before the age of 7 5,7,10,11,15 and psychosocial factors such as increased school absences. 12,16 Ryan 17 noted that children with earlyonset diabetes tend to have spatial difficulties, whereas children with later onset have difficulties with verbal abilities, school achievement, and psychomotor skills.…”

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Effects of Diabetes on Learning in Children

et al. 2002

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ABSTRACT. Objective. Subtle neuropsychological deficits have been found in some children with type 1 diabetes. However, these data have been inconsistent, and it is not clear what the impact of these deficits might be on the learning of children with diabetes over time. The purpose of this study was to determine whether type 1 diabetes significantly interferes with the development of functional academic skills. It was hypothesized that 1) children with type 1 diabetes would demonstrate deficits in academic performance and behavior when compared with sibling or classmate control subjects and 2) that academic performance in children with type 1 diabetes would decline slightly but significantly over time whereas the performance of siblings or classmates would not.Methods. Three groups of children from 5 pediatric diabetes clinics in a primarily rural Midwestern state participated in this study: children with type 1 diabetes (n ‫؍‬ 244), a sibling control group (n ‫؍‬ 110), and an anonymous matched classmate control group (n ‫؍‬ 209). The mean age of the children with diabetes was 14.8 years (standard deviation: 3.2) and of the siblings was 14.6 years (3.2); the mean grades were 8.1 (2.9) for the children with diabetes and 7.9 (3.1) for the siblings. The Hollingshead 2-factor index revealed that the children were from primarily middle-to upper-middle-class families. The mean age of onset of diabetes for the children with diabetes was 8.3 years (3.7) with a mean disease duration of 7.1 years (3.9). Because the matched classmate data were obtained anonymously, demographic information was not available on this group. Academic achievement was measured using both standardized tests and data on classroom performance. The standardized test data included scores from the Iowa Tests of Basic Skills (ITBS) for grades 3 through 8 and the Iowa Tests of Educational Development (ITED) for grades 9 through 12. Scores in 3 broad academic areas that are obtained on children of all ages were examined: math, reading, and core total (a composite score of reading, language, and math). ITBS/ITED data were obtained on all participants. School data including the number of days absent, school years repeated, and grade point averages for math and reading were obtained on the children with diabetes and their siblings. A short, 50-item screening scale (PBS-50d), adapted from the longer 165 item Pediatric Behavior Scale (PBS), was completed by the parents to obtain information on the behavioral characteristics of the children with diabetes and their siblings. Diabetes variables measured included metabolic control (HbA1c), age at onset, and disease duration. This study looked at both the current academic performance of children with diabetes and their performance over time in relation to 2 control groups: siblings and matched classmates. A crosssectional approach was used to evaluate current performance. Statistical differences between groups were evaluated using matched t tests or McNemar's test for differences between related samples as appropr...

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Specific Intellectual Deficits in Children with Early Onset Diabetes Mellitus

Cited by 57 publications

References 29 publications

Influence of an Early-Onset Age of Type 1 Diabetes on Cerebral Structure and Cognitive Function

Influence of an Early-Onset Age of Type 1 Diabetes on Cerebral Structure and Cognitive Function

Cognitive Function in Children With Type 1 Diabetes

Effects of Diabetes on Learning in Children

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