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Investigators have found that young children with type 1 diabetes (T1D) have slower brain growth compared to children without diabetes. A new study, published in the December issue of Diabetes, now available ahead of print, suggests that continued exposure to hyperglycemia, or high blood sugars, may be detrimental to the developing brain. The research was supported by the National Institutes of Health (NIH).
“Our results show the potential vulnerability of young developing brains to abnormally elevated glucose levels, even when the diabetes duration has been relatively brief,” said Nelly Mauras, MD, Chief, Division of Endocrinology, Diabetes & Metabolism at Nemours Children’s Clinic in Jacksonville, Fla., and lead author of the study.
Mauras and colleagues across the Diabetes Research in Children Network (DirecNet) of five clinical pediatric diabetes centers and a coordinating center, studied brain development in children ages four to nine years old with T1D using structural magnetic resonance imaging (MRI) and cognitive tests to determine if abnormal blood glucose levels impact brain structure and function at a young age. Children with T1D also underwent blood sugar monitoring using continuous glucose sensors.
The researchers found that the brains of children with diabetes showed slower overall and regional growth of gray and white matter compared to children without diabetes. These changes were associated with higher and more variable blood sugar levels. Although there were no significant differences in cognitive function between groups at 18-months, the brain imaging results suggest that the children with T1D had differences in brain maturation compared to children without diabetes. Some of the brain regions impacted are involved in visual-spatial processing, executive functions and working memory.
“Despite the best efforts of parents and diabetes care team, about 50 percent of all blood glucose concentrations during the study were measured in the high range. Remarkably, the cognitive tests remained normal, but whether these observed changes will ultimately impact brain function will need further study,” said Mauras. “As better technology develops, we hope to determine if the differences observed with brain imaging can improve with better glucose control”
“This is the thing that parents always worry about when it comes to a child with a chronic illness,” study co-author Karen Winer, MD, pediatric endocrinologist at the National Institutes of Health's Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in the press release. “Does it affect their brain? The good news here is that there may be some viable solutions on the horizon that parents should be aware of.”
The National Institute of Child Health & Human Development (NICHD) of the NIH will be continuing to fund this research through an RO1 grant. This funding will allow the investigators to follow these same children through puberty using similar glucose monitoring, cognitive testing and MRI scans, including evaluation of brain function with functional MRI.
Nemours Children’s Clinic serves as the Clinical Coordinating Center for the research. At Nemours, Dr. Mauras, co-principal investigator of the new grant, works closely with team members Kimberly Englert, RN, BSN, CDE, Kaitlin Sikes, ARNP, Allison Cato, PhD and Larry Fox, MD. Other clinical pediatric diabetes centers involved in the consortium include Stanford University, Washington University- St Louis, University of Iowa and Yale University, with the imaging and data coordinating center at Stanford University.