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Re: [IP] Re: Type I diabetes may affect learning

Someone recently sent me this article.  Don't know if anyone else had
read it, or has any info to contradict.    I still think this is
dependent on the person and their variables.

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Diabetes Care 

Neuropsychological Profiles of Children With
Type 1 Diabetes 6 Years After Disease

Elisabeth A. Northam, PHD, Peter J. Anderson, BA, GRAD DIP (APP
PSYCH), Rani Jacobs, BSC, GRAD DIP, Matthew Hughes, BBUS,
GRAD DIP, Department of Psychology, Royal Children's Hospital,
Melbourne and Murdoch Children's Research Institute, Royal
Children's Hospital, Melbourne; Garry L Warne, MBBS, MD, George
A. Werther, MBBS, MD, Department of Endocrinology/Diabetes,
Royal Children's Hospital, Melbourne, Australia 


Objective: To describe neuropsychological profiles and their
relationship to metabolic control in children with type 1 diabetes 6
years after the onset of disease.
Research design and methods: Children with type 1 diabetes (n = 90),
aged 617 years, who had previously been assessed soon after
diagnosis and 2 years later, were reevaluated 6 years after the onset of
disease. Their neuropsychological profiles were compared with those
of individuals in a community control group (n = 84), who had been
assessed at similar intervals. Relationships between illness variables,
such as age at the onset of disease and metabolic control history, and
neuropsychological status were also examined.
Results: Six years after onset of disease, children with type 1 diabetes
performed more poorly than control subjects on measures of
intelligence, attention, processing speed, long-term memory, and
executive skills. Attention, processing speed, and executive skills were
particularly affected in children with onset of disease before 4 years
age, whereas severe hypoglycemia was associated with lower verbal
and full-scale intelligence quotient scores.
Conclusions: Neuropsychological profiles of children with type 1
diabetes 6 years after the onset of disease are consistent with subtle
compromise of anterior and medial temporal brain regions. Severe
hypoglycemia, particularly in very young children, is the most
plausible explanation for neuropsychological deficits, but the
contributory role of chronic hyperglycemia warrants further
exploration. [Diabetes Care 24(9):1541-1546, 2001. ) 2001 American
Diabetes Association, Inc.] 


A constant supply of glucose is critical for normal cerebral metabolism.
Therefore, it is not surprising that functional and structural changes
within the central nervous system have been documented in patients
with type 1 diabetes[1,2]. In adults, neuropsychological deficits are
most evident in those with the biomedical complications associated
with chronic hyperglycemia[3]. Findings from large-scale prospective
studies[4] suggest that adults are resilient to hypoglycemia-related
effects on neuropsychological functions, although this point is still
debated. In children, early age at onset of illness and a history of
severe hypoglycemia have emerged as the most consistent risk factors
for neuropsychological sequelae in children[2,5,6,7,8,9]. However, the
specific cognitive skills affected have varied across studies, and the
timing, severity, and frequency of hypoglycemic insult required to
inflict permanent cerebral dysfunction have yet to be defined. 

Ryan and Becker[2] have suggested that the "early onset" effect is a
surrogate for the impact of hypoglycemia on an immature brain. They
point out that very young children are more likely to experience serious
hypoglycemia because they lack the ability to perceive and
communicate early symptoms and their food intake and activity levels
are unpredictable. In addition, young children may be more sensitive
than adults to glucose deprivation because of heightened energy
requirements related to brain growth and development. Rovet et al.[6,8]
agree that there may be a critical period of increased cerebral
sensitivity to the effects of type 1 diabetes but have suggested an
alternative, but not mutually exclusive, hypothesis that chronic
hyperglycemia may disrupt myelin formation and neurotransmitter
regulation in the developing brain. 

Small and unrepresentative samples, retrospective collection of
metabolic control history, and cross-sectional designs that provide no
information about cognitive status before exposure to adverse
metabolic events limit the conclusions that can be drawn from previous
studies. Rovet and Ehrlich[7] followed children during a 7-year period
from diagnosis, but the sample size was small (n = 16). An increased
incidence of hypoglycemic seizures in very young children has made it
difficult to establish whether early onset and hypoglycemia act
synergistically or independently to compromise neuropsychological
functions. The possible impact of chronic hyperglycemia on
prepubertal children has never been tested adequately, because most
studies have used a single concurrent measure of HbA1c as the index
of hyperglycemia. This provides no information about metabolic
control history beyond the previous 23 months. 

This study reports findings of a 6-year follow-up of a large and
representative cohort of children with type 1 diabetes who were
assessed serially on neuropsychological measures since onset of
illness. Sample characteristics and neuropsychological profiles of the
clinical and control subjects at diagnosis and 2 years later have been
described in previous reports[10,11,12]. Duration of illness and
procedures were controlled because clinical care was provided at a
single tertiary center, with all children enrolled at diagnosis and
followed at specified intervals. Metabolic control variables were
recorded prospectively. Neuropsychological test selection focused on
measures of attention, processing speed, memory, new learning, and
executive functions, because it has been shown that the prefrontal
cortex and medial temporal regions of the brain are particularly
by abnormal blood glucose levels[1,2]. Furthermore, measures of
attention, processing speed, and memory are sensitive to subtle
decrements in cognitive function[13]. The neuropsychological profile of
children with type 1 diabetes did not differ from that of a community
control group when assessed soon after diagnosis[10]. Two years later,
children with type 1 diabetes tended to show more negative change in
measures of general intelligence and performed more poorly on
processing speed and learning[11]. Early age of onset predicted
negative change on measures of intelligence quotient (IQ), whereas
both recurrent severe hypoglycemia and chronic hyperglycemia were
associated with reduced memory and learning capacity[12]. This report
describes neuropsychological profiles after 6 years of exposure to the
metabolic perturbations associated with type 1 diabetes. 


Address correspondence and reprint requests to Elisabeth Northam,
Department of Psychology, Royal Children's Hospital, Parkville,
Victoria, 3052, Australia. E-mail: email @ redacted 

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Darrin Parker wrote:
> >I was diagnosed before kindergarten at age 5 1/2, graduated with an A/B
> >average with honors, 54th out of a class of 500.  Then not only became a
> >registered pharmacist, but also spent 17 years doing volunteer work as an
> >EMT/Paramedic.  Don't ever let anyone tell you that diabetes will negatively
> >affect learning.  BTW, I was never in good control until I started pumping 2
> >years ago at the age of 36!!
> >
> >Cheryl
> >aka Mouse
> I disagree 100%.  This may be a "YMMV" issue but bg stability
> directly affected my ability to learn and perform in grade school and
> does affect my "intellect" and mood to this day.  I know this is true
> for many if not most others as has been posted here on numerous
> occasions.
> At age 15 Ii was put on two injections per day up form one and this
> dramatically improved the bg's.  It dropped A1c's down to only 15-18!
> At higher levels on a daily basis my average was in the 60's and upon
> getting on two injections per day and the A1C down to 15 I was on the
> honour role in one year with no effort.
> bg control directly affects one's ability to learn and to cognitively
> function in most cases if not all.  Period.
> --
> Darrin Parker - Canada!
> ------------------------------------
> I use the insulin infusion thanks to the support of wonderful
> internet friends & the http://www.Insulin-Pumpers.org
> The Insulin Infusion Pump instantly gave me better control than I had
> achieved in 27 years of MDI!  To date:  50% improvement in average
> bg's & fewer hypos.
> Best pre-pump HeA1c = 9.2.  1st & 2nd post-pump HeA1c = 5.1 &  7.0
> ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> send a DONATION http://www.Insulin-Pumpers.org/donate.shtml
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
send a DONATION http://www.Insulin-Pumpers.org/donate.shtml