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Lower IQ scores associated with diabetic ketoacidosis in young type 1 diabetes patients

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Results of the randomized, multi-site study demonstrated the importance of early diabetes detection, as a single episode of diabetic ketoacidosis (DKA) in young children with type 1 diabetes was associated with lower IQ scores soon after exposure.

Lower IQ scores associated with diabetic ketoacidosis in young type 1 diabetes patients | Image Credit: ©ibreakstock - © ibreakstock - stock.adobe.com.

Lower IQ scores associated with diabetic ketoacidosis in young type 1 diabetes patients | Image Credit: ©ibreakstock - © ibreakstock - stock.adobe.com.

An episode of diabetic ketoacidosis (DKA) was found to be associated with lower cognitive functioning in children aged 3 to 5 years with type 1 diabetes (T1D), no matter the severity, according to a study published in Endocrinology, Diabetes & Metabolism.

It is known, according to study investigators, that youth with T1D could have a high risk of cognitive decline after DKA exposure, but studies investigating this association are commonly conducted with school-age children. To further explore potential associations, investigators wanted to determine if a “single experience of DKA [was] associated with lower cognitive functioning in young children,” and prospectively enrolled 46 children aged 3 to 5 years. The patients were newly diagnosed with T1D and exhibited DKA at onset. The participants were from 12 sites participating in the Pediatric Emergency Care Applied Research Network (PECARN) Fluid Therapies Under Investigation in DKA (FLUID) trial.

Investigators differentiated moderate/severe DKA and mild DKA. Moderate/severe was characterized as; pH less than or equal to 7.19, or serum bicarbonate concentration less than or equal to 9 mmol/L. Mild DKA was characterized as a pH between 7.20 and 7.25, or serum biocarbonate concentration between 10 and 15 mmol/L. A recent diagnosis of T1D was characterized as less than 2 years. Participants with a recent T1D diagnosis but no DKA episodes were recruited from PECARN centers.

The English version of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) was administered. The measurement is validated for children between 2 years and 6 months to 7 years and 3 months (normed IQ M = 100; SD = 15). For children with DKA exposure, the measure was administered 1 time between 2 to 6 months after DKA exposure. For participants without exposure to DKA, the measure was administered soon after recruitment. Differences in frequency distribution of demographics as a function of DKA status were tested (severe/moderate DKA vs mild DKA, vs no DKA) using chi-squared tests. Differences of IQ scores as a function of DKA status were tested using variance tests analysis and investigators included ethnicity and socioeconomic status (SES) as covariants. Since IQ scores were age-normed, ages were not included in models.

In all, investigators analyzed 73 children. Twenty-two experienced moderate/severe DKA, 24 experienced mild DKA, and 27 did not experience DKA. Investigators noted that patient demographic variables had no statistical difference as a function of DKA status, but children that did experience DKA demonstrated “significantly lower IQ scores than children who did not experience DKA,” regardless of severity (F [2, 70] = 6.26; P = .003; partial n2 = .15).

Results demonstrated a single episode of DKA was associated with lower IQ scores and cognitive functioning in youth with T1D. The study authors concluded that these findings suggest, “young children may be particularly vulnerable to the negative effects of DKA, underscoring the importance of early detection of diabetes and prevention of DKA in young children.”

Reference:

Ghetti S, Kuppermann N, Rewers A, et al. Cognitive function following diabetic ketoacidosis in young children with type 1 diabetes. Endocrinol Diab Metab. 2023;6:e412. doi:10.1002/edm2.412

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