Editor: David L. Joffe, BSPharm, CDE, FACA
Author: Alayna Marteal Wyre, Pharm. D. Candidate, South College School of Pharmacy
The growing brain is more susceptible to adverse effects from glucose variability, making cognitive function impairment a concern for children with type 1.
Type 1 diabetes may be considered among the most serious conditions detected in children, adolescents, and teens. Although insulin amounts can be heavily regulated, younger patients with T1D face challenges when attempting to keep blood glucose levels regulated. Younger children are continuously in a developmental cycle in which the brain and other acute organs are considered environmental sponges. These organs are still evolving, and because of this, they are more susceptible to interference with glucose production and metabolic breakdown, which has several adverse effects. Glucose in the brain is highly essential to its proper functioning. The brain requires glucose to incite and feed brain cells. Previous studies highlight the need to research how brain functioning causes impairment with younger children’s task performance.
Study-related information was collected from over 150 children with signed consent for the intent to participate in the study. This group of children contained constituents both with and without type 1 diabetes. Evaluations through MRI screenings and additional behavioral related information were compiled to aid research. A few MRI scans from the non-diabetes group and ten scans from the group with T1D were not included in study results because they were low in quality or because of non-cooperation to set guidelines. A measurement of the final number of individuals participating in the study left 93 individuals with T1D and 57 persons without diabetes.
Implementation of a large multi-site study framework was used to display investigated reoccurring patterns using functional magnetic resonance imaging (fMRI). Children were scanned in addition to experiencing cognitive and clinical assessments at health environment sites. Age, gender, and MRI scan site selection all play significant parts in gathering related data. Results were consistent in showing that, “despite equivalent task performance between the two groups, children with T1D exhibited increased activation in executive control regions (e.g., dorsolateral prefrontal and supramarginal gyri; p = 0.010) and reduced suppression of activation in the posterior node of the default mode network (DMN; p = 0.006)”. Additional testing methods yield results indicating a relationship between activation patterns, behavioral development, and exposure to the clinical disease course. Increases in hyperactivation pinpointed to overpower risk factors amongst patients with type 1 diabetes corresponded with improved task performance and improvement in brain functioning within the study group participants (r values < −0.29, 95% CIs −0.47 to −0.08, p-values < 0.007). Deficiencies in patients with T1D were also shown to be elevated and seemed to be in conjunction with age as a determining factor.
A collection of other study results found T1D and brain dysfunction in children directly linked by fluctuating glucose levels. Children are considered as more susceptible patrons for brain-dysfunction associated risks due to their underdevelopment. Thus, there is a higher level of concern surrounding the need for more in-depth research into why glucose production levels are inconsistent in children with T1D, and to evaluate the severity of the impact glucose levels have on the child‘s brain and on child behavior.
The implications of this study are that, although overall functioning levels between patients with and without T1D were equal, children with T1D had higher activation levels in the brain when carrying out individual tasks. Significantly elevated activation levels in these patients display a clear non-beneficial relationship between dysglycemia and the functioning of the control mechanics within the brain. The magnitude of these increases was significantly correlated with deficits in the deactivation of the posterior node of the DMN, suggesting a putative compensatory role of brain function in T1D, whereby higher activation in task-relevant regions acts both to offset T1D-related impairments in DMN function and to facilitate behavioral performance levels equivalent to those of their non-diabetic peers. Future studies that examine whether these patterns change as a function of improved glycemic control are needed. Limitations are prevalent within this study. Excluding clamp blood glucose in testing methods resulted in findings that call for additional research to be done. Further research should aim to correctly pinpoint the effects of chronic dysglycemia against previously reported findings. Studies should also investigate activation levels in persons with and without T1D to determine whether activation levels rely on genetic and environmental factors.
Practice Pearls:
- A collection of results found the connection between T1D and brain dysfunction in children directly linked to fluctuating glucose levels.
- Levels of overall functioning between patients with and without T1D were equal; however, children with T1D had higher brain activation levels when carrying out individual tasks.
- Studies should examine more beneficial ways to repair and resolve glycemic control to improve young children’s overall condition with T1D.
Reference for “Impaired Cognitive Function in Children With Type 1 Diabetes “:
Foland-Ross, L. C., Buckingam, Diabetes Research in Children Network (DirecNet) (2019). Executive task-based brain function in children with type 1 diabetes: An observational study. PLoS medicine,
Alayna Marteal Wyre, Pharm. D. Candidate, South College School of Pharmacy
See more about cognitive function in children and adults with diabetes.
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Impaired Cognitive Function in Children With Type 1 Diabetes - Diabetes In Control
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