medwireNews: Research shows moderate or severe diabetic ketoacidosis (DKA) is associated with lower IQ and reduced short- and long-term memory in children with type 1 diabetes, with some impairment seen even in newly diagnosed children.
Simona Ghetti (University of California, Davis, USA) and co-researchers say their findings “emphasize the importance of prevention of DKA in children with known type 1 diabetes and of prompt diagnosis during new onset of type 1 diabetes before the development of DKA.”
The study included 430 children aged 6 to 18 years old who presented with moderate or severe DKA (pH ≤7.19 or bicarbonate concentration ≤9 mmol/L), 328 with mild DKA (pH 7.20–7.25 or bicarbonate 10–15 mmol/L), and 376 with type 1 diabetes and no history of DKA.
Just over half of the children with (51.7%) and without (52.9%) DKA had new-onset type 1 diabetes.
All of the children underwent a neurocognitive assessment 2–6 months after the index DKA episode. The researchers found that, overall, DKA status was significantly associated with lower IQ (β= –0.12), worse long-term memory as assessed by item-color recall (β= –0.08), and worse short-term memory as measured by forward digit span (β= –0.06).
They also note that children with previously diagnosed type 1 diabetes performed significantly worse on the IQ and item-color recall tests than those with new-onset diabetes.
Further analyses revealed that DKA status was significantly associated with lower item-color recall (β= –0.08) but not IQ or forward digit span among the newly diagnosed patients.
In addition, lower venous pH was associated with lower IQ in the patients with new-onset diabetes who presented with DKA, even after adjustment for sex, socioeconomic status (SES), and glucose level at the time of DKA diagnosis and neurocognitive testing.
“[T]hese findings suggest that DKA-related deficits are detectable soon after a single moderate/severe DKA episode,” Ghetti and co-authors remark in Diabetes Care.
Among the children with previously diagnosed diabetes, repeated DKA exposure was significantly associated with lower IQ, and higher glycated hemoglobin levels were significantly associated with lower IQ and item-color recall, each after adjusting for hypoglycemia, diabetes duration, and SES.
Ghetti and team also found that DKA severity was strongly associated with SES and poor glycemic control. This indicates “that measures of cumulative DKA exposure and glycemic control may capture much of the variance in behavioral performance and that patients with repeated DKA exposure and poorly controlled type 1 diabetes are at substantial risk of cognitive deficits,” they say.
The authors conclude: “Our findings confirm that subtle brain injuries may occur as a result of DKA, but the underlying mechanism is still unclear.”
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