OBJECTIVE: Some children with type 1 diabetes may be at risk of cognitive impairments, but mechanisms of this effect have not been confirmed. The objective of this study was to determine whether severe hypoglycemia (SH) in children with type 1 diabetes is associated with cognitive decline over 18 months. RESEARCH DESIGN AND METHODS: A sample of 142 6- to 15-year-old children with type 1 diabetes (mean age 11.6 +/- 2.7 years) enrolled in a trial of intensive therapy (IT) or usual care (UC) were tested with the Das-Naglieri Cognitive Assessment System at baseline and after 9 and 18 months. Episodes of SH were recorded by parents and reported promptly for verification by study nurses. HbA(1c) was measured quarterly. RESULTS: Over 18 months, 58 of 142 patients (41%) experienced 111 SH episodes, with a RR of SH of 1.12 for IT over UC. Neither occurrence nor frequency of SH was associated with decline in full-scale intelligence quotient (IQ), standard scores for planning, attention, simultaneous processing, or successive processing, or scaled scores on any of eight subtests. The same findings emerged when only patients who had experienced hypoglycemic seizures or coma were included in the SH group for analyses. These effects persisted when the child's age, sex, type 1 diabetes duration, and age at diagnosis were controlled statistically. HbA(1c) during the trial was not associated with cognitive changes. CONCLUSIONS:SH did not induce adverse changes in the measures of cognitive function administered to 6- to 15-year-old children with type 1 diabetes in this study. Although SH should be avoided in all children with diabetes, these episodes did not have adverse effects on cognition in this age-group over 18 months.
RCT Entities:
OBJECTIVE: Some children with type 1 diabetes may be at risk of cognitive impairments, but mechanisms of this effect have not been confirmed. The objective of this study was to determine whether severe hypoglycemia (SH) in children with type 1 diabetes is associated with cognitive decline over 18 months. RESEARCH DESIGN AND METHODS: A sample of 142 6- to 15-year-old children with type 1 diabetes (mean age 11.6 +/- 2.7 years) enrolled in a trial of intensive therapy (IT) or usual care (UC) were tested with the Das-Naglieri Cognitive Assessment System at baseline and after 9 and 18 months. Episodes of SH were recorded by parents and reported promptly for verification by study nurses. HbA(1c) was measured quarterly. RESULTS: Over 18 months, 58 of 142 patients (41%) experienced 111 SH episodes, with a RR of SH of 1.12 for IT over UC. Neither occurrence nor frequency of SH was associated with decline in full-scale intelligence quotient (IQ), standard scores for planning, attention, simultaneous processing, or successive processing, or scaled scores on any of eight subtests. The same findings emerged when only patients who had experienced hypoglycemic seizures or coma were included in the SH group for analyses. These effects persisted when the child's age, sex, type 1 diabetes duration, and age at diagnosis were controlled statistically. HbA(1c) during the trial was not associated with cognitive changes. CONCLUSIONS: SH did not induce adverse changes in the measures of cognitive function administered to 6- to 15-year-old children with type 1 diabetes in this study. Although SH should be avoided in all children with diabetes, these episodes did not have adverse effects on cognition in this age-group over 18 months.
Authors: Anna Maria Patiño-Fernández; Alan M Delamater; E Brooks Applegate; Erika Brady; Margaret Eidson; Robin Nemery; Luis Gonzalez-Mendoza; Samuel Richton Journal: Pediatr Diabetes Date: 2010-04-23 Impact factor: 4.866
Authors: Julie M Silverstein; Daniel Musikantow; Erwin C Puente; Dorit Daphna-Iken; Adam J Bree; Simon J Fisher Journal: Neurosci Lett Date: 2011-01-25 Impact factor: 3.046
Authors: Michelle A Van Name; Marisa E Hilliard; Claire T Boyle; Kellee M Miller; Daniel J DeSalvo; Barbara J Anderson; Lori M Laffel; Stephanie E Woerner; Linda A DiMeglio; William V Tamborlane Journal: Pediatr Diabetes Date: 2017-04-21 Impact factor: 4.866
Authors: Alan M Jacobson; Gail Musen; Christopher M Ryan; Nancy Silvers; Patricia Cleary; Barbara Waberski; Amanda Burwood; Katie Weinger; Meg Bayless; William Dahms; Judith Harth Journal: N Engl J Med Date: 2007-05-03 Impact factor: 91.245
Authors: Erwin C Puente; Julie Silverstein; Adam J Bree; Daniel R Musikantow; David F Wozniak; Susan Maloney; Dorit Daphna-Iken; Simon J Fisher Journal: Diabetes Date: 2010-01-19 Impact factor: 9.461