Importance of stabilizing Glycemic levels to reduce Neurocognitive Impact of Early-Onset Diabetes in children

The increasing prevalence of early-onset Type 1 diabetes poses significant challenges due to its long-term adverse effects. Diabetes not only has micro and macrovascular complications, but also neurocognitive impacts in children. Young children are particularly vulnerable to adverse neurocognitive effects due to brain immaturity and frequent glycemic fluctuations. In India, there is scarce of information on the cognitive impact of early childhood Type 1 diabetes, hindering effective interventions.

The researchers of the current article evaluated the effect of early-onset type 1 diabetes on cognitive function in children in Indian population, emphasizing the need for early identification and prevention. The outcomes of their study corroborated with the findings of earlier studies that associated diabetes with poorer cognitive outcomes, possibly due to structural brain changes and neuronal loss in younger children. 

Hypoglycemia has been regarded as a prominent cause of adverse cognitive outcomes in Type 1 diabetes, which has been established by the observations pf the meta-analysis that established the correlation between hypoglycemia episodes and lower cognitive scores. Poor glycemic control, indicated by higher HbA1C levels, also negatively impacts neuro-development, which warrants the need for strict glycemic control in the age group and the refrainment of higher cutoffs due to the irrational fear of hypoglycemia. 

Diabetic ketoacidosis (DKA) was found to be associated with cerebral edema, which play a crucial role in the pathogenesis of cognitive dysfunction in early-onset diabetes. In addition, a negative correlation was reported between the time since the last DKA episode and cognitive scores. Conversely, a positive link was found between the number of clinic visits and cognitive scores, focussing on the importance of regular clinic visits in attaining good long-term outcomes.

Thus, the study underscores the importance of regular follow-ups, avoiding extreme glycemic levels, and maintaining better glycemic control to mitigate cognitive effects in patient with early-onset diabetes. Moreover, there is a need to focus on reducing glycemic variability rather than just avoiding hypoglycemia. However, long-term studies are necessary to validate these findings and develop strategies to improve cognitive outcomes in children with early-onset diabetes.

Source: Das, S., Bajpai, A. Neurocognitive Effects of Early Onset Diabetes- Time to Bring Down the Highs and Lows. Indian J Pediatr (2024). https://doi.org/10.1007/s12098-024-05295-8.