Neurological consequences of diabetic ketoacidosis at initial presentation of type 1 diabetes in a prospective cohort study of children
Open accessAbstract
OBJECTIVE: To investigate the impact of new-onset diabetic ketoacidosis (DKA) during childhood on brain morphology and function. RESEARCH DESIGN AND METHODS: Patients aged 6–18 years with and without DKA at diagnosis were studied at four time points: <48 h, 5 days, 28 days, and 6 months postdiagnosis. Patients underwent magnetic resonance imaging (MRI) and spectroscopy with cognitive assessment at each time point. Relationships between clinical characteristics at presentation and MRI and neurologic outcomes were examined using multiple linear regression, repeated-measures, and ANCOVA analyses. RESULTS: Thirty-six DKA and 59 non-DKA patients were recruited between 2004 and 2009. With DKA, cerebral white matter showed the greatest alterations with increased total white matter volume and higher mean diffusivity in the frontal, temporal, and parietal white matter. Total white matter volume decreased over the first 6 months. For gray matter in DKA patients, total volume was lower at baseline and increased over 6 months. Lower levels of N-acetylaspartate were noted at baseline in the frontal gray matter and basal ganglia. Mental state scores were lower at baseline and at 5 days. Of note, although changes in total and regional brain volumes over the first 5 days resolved, they were associated with poorer delayed memory recall and poorer sustained and divided attention at 6 months. Age at time of presentation and pH level were predictors of neuroimaging and functional outcomes. CONCLUSIONS: DKA at type 1 diabetes diagnosis results in morphologic and functional brain changes. These changes are associated with adverse neurocognitive outcomes in the medium term.
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A recent study by Cameron et al. demonstrated that impaired mental state in children with new-onset type 1 diabetes may be attributed to brain injury related to severe ketoacidosis.
“A recent study by Cameron at al. (29) demonstrated that impaired mental state in children with new-onset type 1 diabetes may be attributed to the brain injury related to severe ketoacidosis.”
From Risks of psychiatric disorders and suicide attempts in children and adolescents with type 1 diabetes: a population-based cohort study (2015) · cites this paper as [29]
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de Souza, L. C. V. F., Kraemer, G., Koliski, A., Carreiro, J. E., Cat, M. N. L., de Lacerda, L., & Nesi-França, S. (2019) · Revista Paulista de Pediatria · doi:10.1590/1984-0462/2020/38/2018204 · Cited by 40 · see citing works
Type 1 diabetes mellitus and educational attainment in childhood: a systematic review
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Screening and Prevention of Type 1 Diabetes: Where Are We?
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Respiratory failure in diabetic ketoacidosis
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Sodium-glucose cotransporter 2 inhibitors and neurological disorders: a scoping review
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Diagnosis, Therapy and Follow-up of Diabetes Mellitus in Children and Adolescents
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Challenges in the diagnosis of diabetes type in pediatrics
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Clinical trial of fluid infusion rates for pediatric diabetic ketoacidosis
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Screening children for type 1 diabetes‐associated antibodies at community health fairs
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Type 1 diabetes mellitus prevention: present and future
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Regional Brain Water Content and Distribution During Diabetic Ketoacidosis
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Acute and chronic neuroinflammation is triggered by diabetic ketoacidosis in a rat model
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Age of Childhood Onset in Type 1 Diabetes and Functional Brain Connectivity in Midlife
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Increased risk of severe diabetic ketoacidosis among Jewish ultra-orthodox children
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Diabetic ketoacidosis and electroencephalographic changes in newly diagnosed pediatric patients
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- Authors
- Cameron, F. J., Scratch, S. E., Nadebaum, C., Northam, E. A., Koves, I., Jennings, J., Finney, K., Neil, J. J., Wellard, R. M., Mackay, M., Inder, T. E., & on behalf of the DKA Brain Injury Study Group
- Affiliations
- Royal Children's Hospital (AU)
- Washington University in St. Louis (US)
- Queensland University of Technology (AU)
- Corresponding author
- Cameron, Fergus J.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2014-05-10
- Volume
- 37
- Issue
- 6
- Pages
- 1554-1562
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4179516
- OpenAlex
- W1584025224
- Cited by
- 241
- References
- 35
- Citations by year
- 2026: 10 · 2025: 19 · 2024: 14 · 2023: 25 · 2022: 27 · 2021: 35 · 2020: 24 · 2019: 17 · 2018: 19 · 2017: 13 · 2016: 15 · 2015: 19 · 2014: 4
- FWCI
- 13.67
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- QUT ePrints (Queensland University of Technology) (submittedVersion, cc-by-nc-nd)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc-nd)
- Institute of Health and Biomedical Innovation; Science & Engineering Faculty
- Funders
- Medical Research Council
- National Health and Medical Research Council (334354)
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (P30HD062171)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Neurological and metabolic disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- diabetic ketoacidosis, type 1 diabetes, children, brain structure, white matter volume, mean diffusivity, gray matter volume, N-acetylaspartate, neuropsychological outcomes, memory retrieval, attention, age at presentation, blood pH
- MeSH terms
- Adolescent, Aspartic Acid, Brain, Child, Cognition Disorders, Diabetes Mellitus, Type 1, Female, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Prospective Studies, Mental Recall, Linear Models, Diabetic Ketoacidosis
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