Developmental Trajectory of Hypoglycemia’s Impact on Cognition and the Brain

Lay Summary

Does New Intensive Treatment for Juvenile Diabetes Affect Cognitive Development?

Juvenile (Type I) diabetes is an autoimmune disease in which the child’s immune system identifies pancreatic cells as foreign” and attacks them, making them less able to rid the body of excess sugar.  The newest treatment strategy of intensive therapy greatly reduces sugar levels, which has significant benefits for controlling diabetes in these children.  While some researchers consider the consequences of this severe hypoglycemia (low sugar level) to be negligible, the investigators hypothesize that it may present an increased risk for damage to the hippocampus, a region particularly sensitive to metabolic insults.  They predict that the hippocampus will be smaller in children with a history of repeated severe hypoglycemia, and that this atrophy will correlate with reduced long-term memory function.  Additionally, they anticipate that damage will be greater in younger, compared to older, children due to interruption of critical developmental processes or increased susceptibility for neuronal impact.

The researchers propose to test this hypothesis using MRI scans and cognitive testing in children with diabetes and in healthy controls, all aged 8 to 14.  They would measure hippocampal volumes using MRI and long-term memory using cognitive tests, and would compare the results in diabetic children with severe hypoglycemia at the younger versus older ages and compare both of these groups to age-matched healthy controls.  If there is an effect, this finding would be an important contribution to informing difficult treatment decisions.