Early Diabetic Ketoacidosis may Impact Brain Development

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In very young children with type 1 diabetes, even a single episode of moderate/severe diabetic ketoacidosis (DKA) can potentially have long-term effects on cognitive abilities and brain growth, a study shows.

Multiple studies have reported cognitive differences in children with type 1 diabetes, particularly in those diagnosed before 5 years old. While the mechanisms for these differences are unknown, the severity of DKA at diagnosis may be a contributing factor, particularly since the incidence of severe DKA is higher in children younger than 5 years old.

This is the first study to specifically examine the after effects of moderate/severe DKA in young children and its effect on brain development and cognitive brain function longitudinally. Led by Tandy Aye, M.D., of Stanford University School of Medicine, the study was published in the March issue of Diabetes Care.

Researchers analyzed cognitive and brain imaging data from 144 children with type 1 diabetes, ages 4-10 years old who participated in the Diabetes Research in Children Network study. Participants were divided into two subgroups according to the severity of the past DKA event: 86 individuals with none; 12 individuals with mild past events; 18 moderate cases; and, 12 with severe past events.

Data for neurocognitive testing were available for 137 subjects, with anatomical and diffusion-weighted images analyzed for 128 subjects. Compared with the none/mild DKA group, the moderate/severe DKA group gained more total and regional white and gray matter volume over the observed 18 months. Participants in the moderate/severe DKA subgroup were also observed to have significantly lower Full Scale Intelligence Quotient (IQ) scores and cognitive performance compared with the none/mild DKA subgroup.

For the subgroups matched for age and glycemic HbA1c exposure, growth difference in total and regional gray matter volume and white matter volume became even more prominent relative to the overall sample. The same was true for the performance differences in cognitive scores.

“These structural and cognitive results for the matched subgroups suggest that DKA severity, rather than onset age or 18-month HbA1c exposure, contributes to the observed group differences,” the researchers conclude. “Our data indicate that even a single episode of moderate/severe DKA in very young children with type 1 diabetes can potentially have long-term effects.”

REFERENCES
Aye T, Mazaika P, Mauras N, et al. “Impact of Early Diabetic Ketoacidosis on the Developing Brain.” Diabetes Care. March 2019. DOI: 10.2337/dc18-1405