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Type 2 diabetes may diminish adolescent brain development, cognitive performance

Yau PL. Diabetologia. 2010;doi:10.1007/s00125-010-1857-y.

Obese adolescents with type 2 diabetes may have diminished cognitive performance and subtle brain abnormalities, according to results of a new study.

“This is the first study that shows that children with type 2 diabetes have more cognitive dysfunction and brain abnormalities than equally obese children who did not yet have marked metabolic dysregulation from their obesity,” Antonio Convit, MD, professor of psychiatry and medicine at New York University Langone Medical Center and the Nathan S. Kline Institute for Psychiatric Research, said in a press release.

Researchers matched 18 obese adolescents who had type 2 diabetes with an equal number of obese controls who had no signs of insulin resistance. Cognitive and MRI testing was performed.

Adolescents with diabetes preformed worse than their healthy counterparts in all cognitive areas tested. Areas showing significant differences between the cohorts included: estimated intellectual functioning; verbal memory; and psychomotor efficiency. Trends, but not statistical significance, were observed in executive function, reading and spelling.

MRI brain structural analysis results showed that adolescents with diabetes had reduced white matter volume and a greater amount of cerebrospinal fluid space compared with adolescents without diabetes.

Convit and colleagues previously found brain abnormalities in adults with type 2 diabetes, but hypothesizes that it was related to vascular disease.

“Now, we see that subtle changes in white matter of the brain in adolescents may be a result of the abnormal physiology that accompanies type 2 diabetes. If we can improve insulin sensitivity and help children through exercise and weight loss, perhaps we can reverse these deficits,” Convit said in the release.

The findings from this study are of critical importance for pediatric endocrinologists as they suggest that the metabolic perturbations associated with type 2 diabetes — even possibly prediabetes — can cause damage to the developing brain. This study emphasizes the critical need for children with pre-type 2 diabetes to adhere to lifestyle modifications and lose weight in order to reverse insulin resistance, dyslipidemia, hypertension and inflammation, as these may all be factors that impair cognitive function and also damage the brain in these children if not quickly addressed and resolved.

–Jennifer Miller, MD

Assistant Professor, Department of Pediatrics, University of Florida

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