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Impact of Early Diabetic Ketoacidosis on the Developing Brain

Aye, Tandy, Mazaika, Paul K., Mauras, Nelly, Marzelli, Matthew J., Shen, Hanyang, Hershey, Tamara, Cato, Allison, Weinzimer, Stuart A. +45 more·2019·Diabetes Care
DOI 10.2337/dc18-1405PMC PMC6385695
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Abstract

OBJECTIVE: This study examined whether a history of diabetic ketoacidosis (DKA) is associated with changes in longitudinal cognitive and brain development in young children with type 1 diabetes. RESEARCH DESIGN AND METHODS: Cognitive and brain imaging data were analyzed from 144 children with type 1 diabetes, ages 4 to <10 years, who participated in an observational study of the Diabetes Research in Children Network (DirecNet). Participants were grouped according to history of DKA severity (none/mild or moderate/severe). Each participant had unsedated MRI scans and cognitive testing at baseline and 18 months. RESULTS: In 48 of 51 subjects, the DKA event occurred at the time of onset, at an average of 2.9 years before study entry. The moderate/severe DKA group gained more total and regional white and gray matter volume over the observed 18 months compared with the none/mild group. When matched by age at time of enrollment and average HbA1c during the 18-month interval, participants who had a history of moderate/severe DKA compared with none/mild DKA were observed to have significantly lower Full Scale Intelligence Quotient scores and cognitive performance on the Detectability and Commission subtests of the Conners’ Continuous Performance Test II and the Dot Locations subtest of the Children’s Memory Scale. CONCLUSIONS: A single episode of moderate/severe DKA in young children at diagnosis is associated with lower cognitive scores and altered brain growth. Further studies are needed to assess whether earlier diagnosis of type 1 diabetes and prevention of DKA may reduce the long-term effect of ketoacidosis on the developing brain.

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  • DKA is associated with significant risk of acute morbidity and mortality, may cause long-term morbidity, and entails a substantial healthcare cost.

    “Since DKA is associated with significant risk of acute morbidity and mortality, may cause long‐term morbidity, and entails a substantial healthcare cost, it is nonetheless imperative to keep the incidence rate of DKA as low as possible. 27 , 28 , 29”

    From Insulin pump therapy is associated with higher rates of mild diabetic ketoacidosis compared to injection therapy: A 2‐year Swedish national survey of children and adolescents with type 1 diabetes (2022) · cites this paper as [27]

    The Introduction describes DKA as a leading acute cause of morbidity and mortality in youth with type 1 diabetes and associates it with long-term adverse cognitive effects. The Conclusions also say that a single moderate or severe episode in young children can potentially have long-term effects. The paper does not substantiate the claim about substantial healthcare cost (searched: healthcare costs, hospitalization, economic cost, cost). (LLM, conf=0.90)

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Authors
Aye, T., Mazaika, P. K., Mauras, N., Marzelli, M. J., Shen, H., Hershey, T., Cato, A., Weinzimer, S. A., White, N. H., Tsalikian, E., Jo, B., Reiss, A. L., Diabetes Research in Children Network (DirecNet) Study Group, Tsalikian, E., Tansey, M. J., Coffey, J., Cabbage, J., Salamati, S., Mauras, N., Fox, L. A., Cato, A., Englert, K., Sikes, K., Buckingham, B. A., Wilson, D. M., Aye, T., Caswell, K., Ambers, E., Weinzimer, S. A., Tamborlane, W. V., Steffen, A., Weyman, K., Zgorski, M., Ambrosino, J., White, N. H., Arbelaez, A. M., Levandoski, L., Starnes, A., Hershey, T., Reiss, A. L., Barnea-Goraly, N., Marzelli, M. J., Mazaika, P. K., Peng, D. X., Beck, R., Kollman, C., Ruedy, K., Winer, K., Sperling, M., Becker, D. M., Cleary, P., Greenbaum, C., & Moran, A.
Affiliations
Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2018-12-20
Volume
42
Issue
3
Pages
443-449
ISSN
  • 0149-5992
  • 1935-5548
DOI
10.2337/dc18-1405
PMC
PMC6385695
Cited by
124
References
2
Language
en
Licence
www.diabetesjournals.org/content/license (vor, 62 d)
Funders
National Institute of Child Health and Human Development (DIRECNET HD-41906, HD-41908, HD-41915, HD-41918, HD-56526, R01-HD-078463, U54-HD-087011, UL1-RR-024992)

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