Effects of prior hypoglycemia and hyperglycemia on cognition in children with type 1 diabetes mellitus
Open accessAbstract
OBJECTIVE: Despite the general consensus that youth with type 1 diabetes mellitus (T1DM) can experience modest cognitive impairment, debate continues over the role of severe hypoglycemia (Hypo) and/or hyperglycemia (Hyper) in producing such impairment. Our aim was to determine how Hypo and Hyper experienced during brain development predict patterns of subsequent cognitive performance in youth with T1DM. METHODS: We tested youth aged 5-16 yr (T1DM, n = 117; non-diabetic sibling controls, n = 58) on cognitive tasks (verbal and spatial intelligence, verbal and spatial memory, and processing speed). T1DM participants were categorized as having experienced 0, 1-2, or 3 or more (3+) Hypo episodes, as having their first Hypo episode before or after 5 yr of age and as having early (before age 5) or late (after age 5) diabetes onset. Hyper exposure was estimated with median hemoglobin A1c, adjusted for diabetes duration for each subject. RESULTS: The group with T1DM had lower estimated verbal intelligence than sibling controls. Within the T1DM group, verbal intelligence was reduced with increased exposure to Hyper, not to Hypo. In contrast, spatial intelligence and delayed recall were reduced only with repeated Hypo, particularly when Hypo episodes occurred before the age of 5 yr. Age of onset did not explain these results. CONCLUSIONS: Hypo and Hyper have qualitatively different effects on cognitive function in T1DM that depend in part on the timing of exposure during development, independent of onset age. This information extends the known benefits of avoiding both Hypo and chronic Hyper during childhood to include preservation of specific cognitive skills.
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Children who experience hypoglycemia before the age of 5 years seem to be more affected in cognitive function and cerebral structure than those who do not have hypoglycemia until later.
“Recent studies have examined the impact of hypoglycemia on cognitive function and cerebral structure in children and found that those who experience this complication before the age of 5 years seem to be more affected than those who do not have hypoglycemia until later (7).”
From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [7]
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- Authors
- Perantie, D. C., Lim, A., Wu, J., Weaver, P., Warren, S. L., Sadler, M., White, N. H., & Hershey, T.
- Affiliations
- Washington University in St. Louis (US)
- University of Illinois Urbana-Champaign (US)
- St. Louis Children's Hospital (US)
- Corresponding author
- Hershey, Tamara
- Venue
- Pediatric Diabetes
- Publisher
- Hindawi Limited
- Published
- 2008-04
- Volume
- 9
- Issue
- 2
- Pages
- 87-95
- ISSN
- 1399-543X (ISSN-L)
- 1399-5448
- OpenAlex
- W2161158307
- Cited by
- 237
- References
- 34
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 14 · 2023: 8 · 2022: 12 · 2021: 9 · 2020: 8 · 2019: 12 · 2018: 14 · 2017: 10 · 2016: 25 · 2015: 16 · 2014: 23 · 2013: 20 · 2012: 13
- FWCI
- 10.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Pediatric Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Foundation for the National Institutes of Health
- Dana Foundation
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-64832, R01DK064832)
- National Center for Research Resources (RR.00036)
- NIH Clinical Center
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- type 1 diabetes, severe hypoglycemia, hyperglycemia, cognitive impairment, children, verbal intelligence, spatial ability, memory, processing speed, HbA1c, glycemic control, brain development
- MeSH terms
- Adolescent, Awareness, Blood Glucose, Child, Child, Preschool, Cognition, Diabetes Mellitus, Type 1, Female, Humans, Hyperglycemia, Hypoglycemia, Intelligence, Male, Memory, Thinking, Patient Selection, Siblings
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