The Journal of Pediatrics
Volume 153, Issue 3 , Pages 385-390 , September 2008

Prevalence of Structural Central Nervous System Abnormalities in Early-Onset Type 1 Diabetes Mellitus

  • Margaret S. Ho, BA (Hons)

      Affiliations

    • Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia
    • Endocrinology and Diabetes Services, Princess Margaret Hospital, Perth, Australia
    • ,
  • Narelle J. Weller, BappSc

      Affiliations

    • Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia
    • Endocrinology and Diabetes Services, Princess Margaret Hospital, Perth, Australia
    • ,
  • F. Jay Ives, MBChB, FRANZCR

      Affiliations

    • SKG Radiology, Perth, Australia
    • ,
  • Christine L. Carne, BSc, PGDip (Paediatrics), GradCert (Diab Educ)

      Affiliations

    • Endocrinology and Diabetes Services, Princess Margaret Hospital, Perth, Australia
    • ,
  • Katherine Murray, BSc, PGDip HSc, GradDip (Diet)

      Affiliations

    • Endocrinology and Diabetes Services, Princess Margaret Hospital, Perth, Australia
    • ,
  • Rohan I. vanden Driesen, FRANZCR

      Affiliations

    • Department of Radiology, Sir Charles Gairdner Hospital, Perth, Australia
    • ,
  • Thai P. Nguyen, MBBS, FRANZCR

      Affiliations

    • Department of Diagnostic Imaging, Princess Margaret Hospital, Perth, Australia
    • ,
  • Peter D. Robins, MBBS

      Affiliations

    • SKG Radiology, Perth, Australia
    • St John of God HealthCare Subiaco, Perth, Australia
    • ,
  • Max Bulsara, MSc

      Affiliations

    • Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia
    • School of Population Health, University of Western Australia, Perth, Australia
    • ,
  • Elizabeth A. Davis, FRACP

      Affiliations

    • Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia
    • Endocrinology and Diabetes Services, Princess Margaret Hospital, Perth, Australia
    • ,
  • Timothy W. Jones, MD, FRACP

      Affiliations

    • Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia
    • Endocrinology and Diabetes Services, Princess Margaret Hospital, Perth, Australia
    • Corresponding Author InformationReprint requests: Timothy W. Jones, MD, Endocrinology and Diabetes Services, Department of Diabetes and Endocrinology, Princess Margaret Hospital, GPO Box D184, Perth, WA 6840, Australia

Received 16 November 2007 ,Revised 29 January 2008 ,Accepted 7 March 2008.

References 

  1. Hershey T, Craft S, Bhargava N, White NH. Memory and insulin-dependent diabetes mellitus (IDDM): effects of childhood onset and severe hypoglycemia. J Int Neuropsychol Soc. 1997;3:509–520
  2. Kaufman FR, Epport K, Engilman R, Halvorson M. Neurocognitive functioning in children diagnosed with diabetes before age 10 years. J Diabetes Complications. 1999;13:31–38
  3. Bober E, Buyukgebiz A. Hypoglycemia and its effects on the brain in children with type 1 diabetes mellitus. Pediatr Endocrinol Rev. 2005;2:378–382
  4. Traill Z, Squier M, Anslow P. Brain imaging in neonatal hypoglycaemia. Arch Dis Child Fetal Neonatal Ed. 1998;79:F145–F147
  5. Anderson JM, Milner RD, Strich SJ. Effects of neonatal hypoglycaemia on the nervous system: a pathological study. J Neurol Neurosurg Psychiatry. 1967;30:295–310
  6. Banker BQ. The neuropathological effects of anoxia and hypoglycemia in the newborn. Dev Med Child Neurol. 1967;9:544–550
  7. Spar JA, Lewine JD, Orrison WW. Neonatal hypoglycemia: CT and MR findings. AJNR Am J Neuroradiol. 1994;15:1477–1478
  8. Desrocher M, Rovet J. Neurocognitive correlates of type 1 diabetes mellitus in childhood. Child Neuropsychol. 2004;10:36–52
  9. Flykanaka-Gantenbein C. Hypoglycemia in childhood: long-term effects. Pediatr Endocrinol Rev. 2004;1(Suppl 3):530–536
  10. Ryan CM. Does moderately severe hypoglycemia cause cognitive dysfunction in children?. Pediatr Diabetes. 2004;5:59–62
  11. Kim M, Yu ZX, Fredholm BB, Rivkees SA. Susceptibility of the developing brain to acute hypoglycemia involving A1 adenosine receptor activation. Am J Physiol Endocrinol Metab. 2005;289:E562–E569
  12. Northam EA, Anderson PJ, Werther GA, Warne GL, Andrewes D. Predictors of change in the neuropsychological profiles of children with type 1 diabetes 2 years after disease onset. Diabetes Care. 1999;22:1438–1444
  13. Rovet JF, Ehrlich RM. The effect of hypoglycemic seizures on cognitive function in children with diabetes: a 7-year prospective study. J Pediatr. 1999;134:503–506
  14. Brands AM, Biessels GJ, de Haan EH, Kappelle LJ, Kessels RP. The effects of type 1 diabetes on cognitive performance: a meta-analysis. Diabetes Care. 2005;28:726–735
  15. Sommerfield AJ, Deary IJ, McAulay V, Frier BM. Short-term, delayed, and working memory are impaired during hypoglycemia in individuals with type 1 diabetes. Diabetes Care. 2003;26:390–396
  16. Northam EA, Anderson PJ, Jacobs R, Hughes M, Warne GL, Werther GA. Neuropsychological profiles of children with type 1 diabetes 6 years after disease onset. Diabetes Care. 2001;24:1541–1546
  17. Rovet J, Alvarez M. Attentional functioning in children and adolescents with IDDM. Diabetes Care. 1997;20:803–810
  18. Jones TW, Davis EA. Hypoglycemia in children with type 1 diabetes: current issues and controversies. Pediatr Diabetes. 2003;4:143–150
  19. Ryan CM, Becker DJ. Hypoglycemia in children with type 1 diabetes mellitus: risk factors, cognitive function, and management. Endocrinol Metab Clin North Am. 1999;28:883–900
  20. Delamater AM. Psychological issues in childhood diabetes mellitus. In:  Menon RK,  Sperling M editor. Pediatric Diabetes. Boston: Kluwer Academic Publishers; 2003;p. 480
  21. Rovet J, Fernandes C. Insulin-dependent diabetes mellitus. In:  Brown RT editors. Cognitive Aspects of Chronic Illness in Children. London: Guildford Press; 1999;
  22. Ryan CM. Why is cognitive dysfunction associated with the development of diabetes early in life? (The diathesis hypothesis). Pediatr Diabetes. 2006;7:289–297
  23. Schoenle EJ, Schoenle D, Molinari L, Largo RH. Impaired intellectual development in children with type I diabetes: association with HbA(1c), age at diagnosis and sex. Diabetologia. 2002;45:108–114
  24. Perros P, Deary IJ, Sellar RJ, Best JJ, Frier BM. Brain abnormalities demonstrated by magnetic resonance imaging in adult IDDM patients with and without a history of recurrent severe hypoglycemia. Diabetes Care. 1997;20:1013–1018
  25. Lunetta M, Damanti AR, Fabbri G, Lombardo M, Di Mauro M, Mughini L. Evidence by magnetic resonance imaging of cerebral alterations of atrophy type in young insulin-dependent diabetic patients. J Endocrinol Invest. 1994;17:241–245
  26. Ferguson SC, Blane A, Perros P, McCrimmon RJ, Best JJ, Wardlaw J, et al. Cognitive ability and brain structure in type 1 diabetes: relation to microangiopathy and preceding severe hypoglycemia. Diabetes. 2003;52:149–156
  27. Ferguson SC, Blane A, Wardlaw J, Frier BM, Perros P, McCrimmon RJ, et al. Influence of an early-onset age of type 1 diabetes on cerebral structure and cognitive function. Diabetes Care. 2005;28:1431–1437
  28. Gold SM, Dziobek I, Sweat V, Tirsi A, Rogers K, Bruehl H, et al. Hippocampal damage and memory impairments as possible early brain complications of type 2 diabetes. Diabetologia. 2007;50:711–719
  29. Haynes A, Bower C, Bulsara MK, Jones TW, Davis EA. Continued increase in the incidence of childhood type 1 diabetes in a population-based Australian sample (1985–2002). Diabetologia. 2004;47:866–870
  30. Davis EA, Keating B, Byrne GC, Russell M, Jones TW. Hypoglycemia: incidence and clinical predictors in a large population-based sample of children and adolescents with IDDM. Diabetes Care. 1997;20:22–25
  31. Bulsara MK, Holman CD, Davis EA, Jones TW. The impact of a decade of changing treatment on rates of severe hypoglycemia in a population-based cohort of children with type 1 diabetes. Diabetes Care. 2004;27:2293–2298
  32. Bigler ED, Anderson CV, Blatter DD. Temporal lobe morphology in normal aging and traumatic brain injury. AJNR Am J Neuroradiol. 2002;23:255–266
  33. Pfluger T, Weil S, Weis S, Vollmar C, Heiss D, Egger J, et al. Normative volumetric data of the developing hippocampus in children based on magnetic resonance imaging. Epilepsia. 1999;40:414–423
  34. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd edition. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988;p xxi, 567
  35. Cormack F, Gadian DG, Vargha-Khadem F, Cross JH, Connelly A, Baldeweg T. Extra-hippocampal grey matter density abnormalities in pediatric mesial temporal sclerosis. Neuroimage. 2005;27:635–643
  36. Bronen R. MR of mesial temporal sclerosis: how much is enough?. AJNR Am J Neuroradiol. 1998;19:15–18
  37. Ng YT, McGregor AL, Duane DC, Jahnke HK, Bird CR, Wheless JW. Childhood mesial temporal sclerosis. J Child Neurol. 2006;21:512–517
  38. Moore KR, Swallow CE, Tsuruda JS. Incidental detection of hippocampal sclerosis on MR images: is it significant?. AJNR Am J Neuroradiol. 1999;20:1609–1612
  39. Strange BA, Fletcher PC, Henson RN, Friston KJ, Dolan RJ. Segregating the functions of human hippocampus. Proc Natl Acad Sci U S A. 1999;96:4034–4039
  40. McCall AL. The impact of diabetes on the CNS. Diabetes. 1992;41:557–570
  41. Perantie DC, Wu J, Koller JM, Lim A, Warren SL, Black KJ, et al. Regional brain volume differences associated with hyperglycemia and severe hypoglycemia in youth with type 1 diabetes. Diabetes Care. 2007;30:2331–2337
  42. The Diabetes Control and Complications Trial Research Group. Hypoglycemia in the Diabetes Control and Complications Trial. Diabetes. 1997;46:271–286
  43. Bjorgaas M, Gimse R, Vik T, Sand T. Cognitive function in type 1 diabetic children with and without episodes of severe hypoglycaemia. Acta Paediatr. 1997;86:148–153
  44. Musen G, Lyoo IK, Sparks CR, Weinger K, Hwang J, Ryan CM, et al. Effects of type 1 diabetes on gray matter density as measured by voxel-based morphometry. Diabetes. 2006;55:326–333
  45. Wessels AM, Simsek S, Remijnse PL, Veltman DJ, Biessels GJ, Barkhof F, et al. Voxel-based morphometry demonstrates reduced grey matter density on brain MRI in patients with diabetic retinopathy. Diabetologia. 2006;49:2474–2480
  46. Ryan CM, Geckle MO, Orchard TJ. Cognitive efficiency declines over time in adults with type 1 diabetes: effects of micro- and macrovascular complications. Diabetologia. 2003;46:940–948
  47. Porter PA, Keating B, Byrne G, Jones TW. Incidence and predictive criteria of nocturnal hypoglycemia in young children with insulin-dependent diabetes mellitus. J Pediatr. 1997;130:366–372

 Supported by a Juvenile Diabetes Foundation International grant (1-1999-597).

PII: S0022-3476(08)00195-9

doi: 10.1016/j.jpeds.2008.03.005

The Journal of Pediatrics
Volume 153, Issue 3 , Pages 385-390 , September 2008

Article Tools