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Neurocognitive deficits with type 1 diabetes could predict outcomes
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Neurocognitive deficits discovered in children and adolescents within days of receiving a type 1 diabetes diagnosis were associated with disease outcomes a year later, according to research published in Diabetes Care.
The impairment was observed mostly in psychomotor speed, which could potentially serve as an early marker for neurobehavioral vulnerability and also carry implications for managing the condition in the long term.
“The findings suggest that the visual-motor system may be especially vulnerable to early effects of type 1 diabetes,” the researchers wrote.
David D. Schwartz, PhD, of the department of pediatrics, section of psychology, Baylor College of Medicine, Houston, and colleagues looked at 147 children and adolescents aged 5 to 18 years who underwent neuropsychological testing during inpatient hospitalization for new-onset type 1 diabetes.
The researchers compared patients’ test scores with normative data using statistical hypothesis tests. Children with onset before aged 8 years were compared with those aged 9 to 18 years using analysis of variance. Regression analyses was used to find relationships between neurocognitive performance at diagnosis and glycemic control at 1 year.
On most neurocognitive measures, children with type 1 diabetes performed significantly below expectations (P<.0001 for those values). From the normative mean, diminishments were observed in psychomotor speed, visuomotor integration and phonemic fluency.
Scores less than second percentile, indicating high incidence of impairment, were evident on all tasks but digit span.
One year after diagnosis, dominant-hand psychomotor speed was significantly associated with poor glycemic control (HbA1c ≥9.5%, 80 mmol/mol; P=.032), with adjustments made for race and ethnicity, sex and reading ability; impaired psychomotor speed was associated with a mean HbA1c increase of 0.77%, or 8.4 mmol/mol.
“This study provides the first demonstration that type 1 diabetes-associated neurocognitive impairment can be detected at the time of diagnosis, supporting the possibility that deficits arise secondary to peri-onset effects,” the researchers wrote.
The findings offer clinical and theoretical implications, according to the study, including informing preventive interventions and correlating neuropsychological testing at diagnosis with neuroimaging.
“Implementing academic accommodations could minimize impact on school functioning,” the researchers wrote. “This could offer a powerful way to determine whether deficient neuropsychological performance represents underlying neurological pathology.”
Disclosure: The researchers report no relevant financial disclosures.
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