Longitudinal Evaluation of Cognitive Functioning in Young Children with Type 1 Diabetes over 18 Months

M. Allison Cato, Nelly Mauras, Paul Mazaika, Craig Kollman, Peiyao Cheng, Tandy Aye, Jodie Ambrosino, Roy W. Beck, Katrina J. Ruedy, Allan L. Reiss, Michael Tansey, Neil H. White, Tamara Hershey, E. Tsalikian, J. Coffey, J. Cabbage, S. Salamati, A. Conrad, L. A. Fox, K. EnglertK. Sikes, T. Ewen, B. A. Buckingham, D. M. Wilson, T. Aye, K. Caswell, K. Schleifer, C. Ambler, S. A. Weinzimer, W. V. Tamborlane, A. Steffen, K. Weyman, M. Zgorski, J. Ambrosino, A. M. Arbelaez, L. Levandoski, A. Starnes, R. W. Beck, J. Ruedy, C. Kollman, P. Cheng, B. Stevens, N. Njeru, R. Chapman, T. J. Mouse, N. Barnea-Goraly, M. J. Marzelli, D. X. Peng, E. Bihun, A. Al-Lozi, A. Bischoff, M. Cuneo, A. Bondurant, M. Sperling, D. M. Becker, P. Cleary, C. Greenbaum, A. Moran

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Objectives: Decrements in cognitive function may already be evident in young children with type 1 diabetes (T1D). Here we report prospectively acquired cognitive results over 18 months in a large cohort of young children with and without T1D. Methods: A total of 144 children with T1D (mean HbA1c: 7.9%) and 70 age-matched healthy controls (mean age both groups 8.5 years; median diabetes duration 3.9 years; mean age of onset 4.1 years) underwent neuropsychological testing at baseline and after 18-months of follow-up. We hypothesized that group differences observed at baseline would be more pronounced after 18 months, particularly in those T1D patients with greatest exposure to glycemic extremes. Results: Cognitive domain scores did not differ between groups at the 18 month testing session and did not change differently between groups over the follow-up period. However, within the T1D group, a history of diabetic ketoacidosis (DKA) was correlated with lower Verbal IQ and greater hyperglycemia exposure (HbA1c area under the curve) was inversely correlated to executive functions test performance. In addition, those with a history of both types of exposure performed most poorly on measures of executive function. Conclusions: The subtle cognitive differences between T1D children and nondiabetic controls observed at baseline were not observed 18 months later. Within the T1D group, as at baseline, relationships between cognition (Verbal IQ and executive functions) and glycemic variables (chronic hyperglycemia and DKA history) were evident. Continued longitudinal study of this T1D cohort and their carefully matched healthy comparison group is planned.

Original languageEnglish (US)
Pages (from-to)293-302
Number of pages10
JournalJournal of the International Neuropsychological Society
Issue number3
StatePublished - Jan 28 2016

Bibliographical note

Funding Information:
The authors thank the children and their families as well as the clinical and imaging staff at all of the investigator sites. We also thank our external collaborators for use of their imaging facilities, including University of California at San Francisco, El Camino Hospital, and University of Florida & Shands Jacksonville. We are also grateful to Karen Winer, MD, and Ellen Leschek, MD, at NIDDK for advice and support. This research was supported by funding from the NIH (DIRECNET R01 HD078463 U01 HD41890, HD41906-10, HD41908-10, HD41915, HD41918, HD56526) and UL1 RR024992. A. Cato, N. Mauras, P. Mazaika, C. Kollman, P. Cheng, T. Aye, J. Ambrosino, R. Beck, K. Ruedy, A. Reiss, M. Tansey, and T. Hershey report no conflict of interest. N.H. White reports receiving payment for consultancy from Novo Nordisk and Daiichi Sankyo and payments to his institution from Bristol-Myers Squibb for a research grant. The DirecNet Study Group: Clinical Centers: (Personnel are listed as (PI) for Principal Investigator, (I) for co-Investigator, (C) for Coordinators, and (PM) for Psychometrician.) Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA: Eva Tsalikian, MD (PI); Michael J. Tansey,MD(I); Julie Coffey, MSN (C); Joanne Cabbage (C); Sara Salamati (C); Amy Conrad, PhD (PM); Nemours Children’s Health System, Jacksonville, FL: Nelly Mauras, MD (PI); Larry A. Fox, MD (I); Allison Cato, PhD (I); Kim Englert, RN, BSN, CDE (C); Kaitlin Sikes, ARNP, MSN (C); Tina Ewen (C); Division of Pediatrics Endocrinology and Diabetes, Stanford University, Stanford, CA: Bruce A. Buckingham, MD(PI); Darrell M. Wilson, MD (I); Tandy Aye, MD (I); Kimberly Caswell, ARNP (C); Kristin Schleifer (PM); Christian Ambler (PM); Department of Pediatrics, Yale University School of Medicine, New Haven, CT: Stuart A. Weinzimer, MD (PI); William V. Tamborlane, MD (I); Amy Steffen, BS (C); Kate Weyman, MSN (C); Melinda Zgorski, BSN (C); Jodie Ambrosino, PhD (I); Washington University in St. Louis, St. Louis,MO: Neil H. White, MD, CDE (PI); Ana Maria Arbelaez, MD, (I); Lucy Levandoski, PA-C (C); Angie Starnes, RN, BSN, CDE (C), Tamara Hershey, PhD (I). Coordinating Center: Jaeb Center for Health Research, Tampa, FL: Roy W. Beck, MD, PhD; Katrina J. Ruedy, MSPH; Craig Kollman, PhD; Peiyao Cheng, MPH; Beth Stevens; Nelly Njeru; Ryan Chapman, TJ Mouse. Image Coordinating Center: Allan L. Reiss, MD; Naama Barnea- Goraly, MD; Matthew J. Marzelli, BS; Paul M. Mazaika, PhD; Daniel X. Peng, BS. Cognitive Core: Tamara Hershey, PhD; Allison Cato, PhD; Emily Bihun, MA; Amal Al-Lozi, BA; Allison Bischoff, BA; Michaela Cuneo, BA; Aiden Bondurant, BA. Data and Safety Monitoring Board: Mark Sperling, MD; Dorothy M. Becker, MBBCh; Patricia Cleary, MS; Carla Greenbaum, MD; Antoinette Moran, MD.

Publisher Copyright:
© Copyright The International Neuropsychological Society 2016.


  • Children
  • Cognition
  • Early onset
  • Hyperglycemia
  • Longitudinal
  • T1D


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