P DKA X COGNITIVE OUTCOME

Impact of Early Diabetic Ketoacidosis on the Developing Brain

Diabetes Care

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• In this study of children with type 1 diabetes (N = 144), the authors evaluated MRI scans and cognitive tests in patients experiencing moderate/severe DKA compared with patients experiencing none/mild DKA. After adjusting for age and average HbA1c, patients with a history of moderate/severe DKA had significantly lower scores on a variety of cognitive tests.
• The authors concluded that even a single episode of moderate/severe DKA can affect cognitive function and brain growth in children. They suggest further studies to identify strategies to prevent long-term effects of DKA in young patients with type 1 diabetes.

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, 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.