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Therapy Insight: the impact of type 1 diabetes on brain development and function

Abstract

The CNS is one of the main organ systems that is affected in type 1 diabetes, as both cerebral glucose and insulin levels are frequently abnormal, even when the diabetes is well-controlled. Literature is emerging that documents pathophysiological CNS changes and neurocognitive deficits in both adults and children with type 1 diabetes, but empirical findings to date have often been inconsistent and difficult to interpret. This article provides a comprehensive review of current knowledge about the impact of type 1 diabetes on brain development and function, focusing particularly on the evidence for specific illness-related risk factors for CNS sequelae. We argue that clinical management of young patients with type 1 diabetes should take into account current knowledge of the relative risks of hypoglycemia and hyperglycemia to the developing brain.

Key Points

  • Type 1 diabetes mellitus is one of the most common chronic diseases of childhood and adolescence

  • In younger patients, attention has recently focused on the impact of diabetes on neurocognitive functioning and academic achievement

  • A recent meta-analysis of neurocognitive functioning in adults with type 1 diabetes provided convincing evidence of subtle cerebral impairment

  • Neurocognitive deficits, including effects on language, attention, memory, information-processing speed and executive functions, are apparent in children with diabetes, but the pattern of deficit varies across studies and patient subgroups

  • There is evidence that severe hypoglycemia and diabetic ketoacidosis have an impact on the immature CNS, and chronic hyperglycemia early in life is another possible risk factor for neurocognitive impairment

  • Intensified treatment protocols reduce the incidence and severity of microvascular complications, but should be introduced cautiously in children if they are associated with hypoglycemia-related CNS impairment

  • The current practice of tolerating some hyperglycemia to minimize the risk of hypoglycemia in the very young child might require modification if elevated blood glucose levels are shown to affect the developing brain

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Figure 1: Model of the relationship between illness variables and CNS changes in type 1 diabetes.

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Correspondence to Elisabeth A Northam.

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Fergus Cameron has received honoraria for speaking engagements from Novo Nordisk.

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Northam, E., Rankins, D. & Cameron, F. Therapy Insight: the impact of type 1 diabetes on brain development and function. Nat Rev Neurol 2, 78–86 (2006). https://doi.org/10.1038/ncpneuro0097

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