ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2021) 18 10.12 | DOI: 10.1530/ey.18.10.12

Diabetes Care. 2020;43(11):2768–2775. doi: 10.2337/dc20-0187.

In this observational analysis of a patient cohort, a single diabetic ketoacidosis (DKA) episode was associated with lower cognition and memory both in children with newly diagnosed T1D and in children with known T1D.

Children (N=758) were 6-18 years old, taking part in a multisite randomized trial evaluating different DKA intravenous fluid protocols. Of these, 392 children had DKA at T1D onset. DKA was moderate/severe in 430 children and mild in 328 children. Neurocognitive assessment was carried out 2–6 months after the DKA episode. The controls were 376 children with T1D, who had no previous DKA exposure. Models were adjusted for hypoglycemia, diabetes duration, and socioeconomic status.

Across all patients, moderate/severe DKA was associated with lower intelligence quotient (IQ) (β=−0.12, P < 0.001), item-color recall (β=−0.08, P=0.010), and forward digit span (β=−0.06, P=0.04). Among newly diagnosed patients, moderate/severe DKA was associated with lower item-color recall (β=−0.08, P=0.04). Among previously diagnosed patients, repeated DKA exposure and higher HbA1c were independently associated with lower IQ (β=−0.10 and β=−0.09, respectively, P < 0.01) and higher HbA1c was associated with lower item-color recall (β=−0.10, P=0.007).

The surprising findings indicate that even one single DKA episode is associated with lower IQ and memory soon after T1D onset. Similar reductions were detectable in children with known diabetes, suggesting that DKA and putatively other diabetes related disturbances may influence cognition and that these may be exacerbated in children with chronic hyperglycemia. A limitation of the study design is that cognition and memory were not assessed prior to DKA – it is possible that reductions were pre-existing and potentially contributed to their higher risk of DKA and high HbA1c.

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