Cognitive function following diabetic ketoacidosis in young children with type 1 diabetes

Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group

doi:10.1002/edm2.412

Cognitive function following diabetic ketoacidosis in young children with type 1 diabetes

Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group

Pediatrics

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

Introduction: Young children with type 1 diabetes (T1D) may be at particularly high risk of cognitive decline following diabetic ketoacidosis (DKA). However, studies of cognitive functioning in T1D typically examine school-age children. The goal of this study was to examine whether a single experience of DKA is associated with lower cognitive functioning in young children. We found that recently diagnosed 3- to 5-year-olds who experienced one DKA episode, regardless of its severity, exhibited lower IQ scores than those with no DKA exposure. Methods: We prospectively enrolled 46 3- to 5-year-old children, who presented with DKA at the onset of T1D, in a randomized multi-site clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 22 children and mild in 24 children. Neurocognitive function was assessed once 2–6 months after the DKA episode. A comparison group of 27 children with T1D, but no DKA exposure, was also assessed. Patient groups were matched for age and T1D duration at the time of neurocognitive testing. Results: Children who experienced DKA, regardless of its severity, exhibited significantly lower IQ scores than children who did not experience DKA, F(2, 70) = 6.26, p =.003, partial η² =.15. This effect persisted after accounting for socioeconomic status and ethnicity. Conclusions: A single DKA episode is associated with lower IQ scores soon after exposure to DKA in young children.

Original language	English (US)
Article number	e412
Journal	Endocrinology, Diabetes and Metabolism
Volume	6
Issue number	3
DOIs	https://doi.org/10.1002/edm2.412
State	Published - May 2023

Funding

This study was supported by grant U01HD062417 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development. This project was also supported in part by the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), Emergency Medical Services for Children (EMSC) Network Development Demonstration Program under cooperative agreement number U03MC00008, U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC22684 and U03MC22685. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the US Government. The funding agencies had no role in the study design and conduct.

Keywords

cognitive function
diabetic ketoacidosis
early childhood
intelligence
type 1 diabetes

ASJC Scopus subject areas

Endocrinology, Diabetes and Metabolism

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/edm2.412

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@article{a30fb8dfd8604e59b80fc755b0fdaa20,

title = "Cognitive function following diabetic ketoacidosis in young children with type 1 diabetes",

abstract = "Introduction: Young children with type 1 diabetes (T1D) may be at particularly high risk of cognitive decline following diabetic ketoacidosis (DKA). However, studies of cognitive functioning in T1D typically examine school-age children. The goal of this study was to examine whether a single experience of DKA is associated with lower cognitive functioning in young children. We found that recently diagnosed 3- to 5-year-olds who experienced one DKA episode, regardless of its severity, exhibited lower IQ scores than those with no DKA exposure. Methods: We prospectively enrolled 46 3- to 5-year-old children, who presented with DKA at the onset of T1D, in a randomized multi-site clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 22 children and mild in 24 children. Neurocognitive function was assessed once 2–6 months after the DKA episode. A comparison group of 27 children with T1D, but no DKA exposure, was also assessed. Patient groups were matched for age and T1D duration at the time of neurocognitive testing. Results: Children who experienced DKA, regardless of its severity, exhibited significantly lower IQ scores than children who did not experience DKA, F(2, 70) = 6.26, p =.003, partial η2 =.15. This effect persisted after accounting for socioeconomic status and ethnicity. Conclusions: A single DKA episode is associated with lower IQ scores soon after exposure to DKA in young children.",

keywords = "cognitive function, diabetic ketoacidosis, early childhood, intelligence, type 1 diabetes",

author = "{Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group} and Simona Ghetti and Nathan Kuppermann and Arleta Rewers and Myers, {Sage R.} and Schunk, {Jeff E.} and Stoner, {Michael J.} and Aris Garro and Quayle, {Kimberly S.} and Brown, {Kathleen M.} and Trainor, {Jennifer L.} and Leah Tzimenatos and DePiero, {Andrew D.} and McManemy, {Julie K.} and Nigrovic, {Lise E.} and Kwok, {Maria Y.} and Olsen, {Cody S.} and Casper, {T. Charles} and Glaser, {Nicole S.} and Roger Lewis and Jeffrey Blumer and Andrew Bremer and Thomas Cook and Beth Slomine and Kathleen Meert and Jerry Zimmerman and Robert Hickey",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors. Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd.",

year = "2023",

month = may,

doi = "10.1002/edm2.412",

language = "English (US)",

volume = "6",

journal = "Endocrinology, Diabetes and Metabolism",

issn = "2398-9238",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "3",

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TY - JOUR

T1 - Cognitive function following diabetic ketoacidosis in young children with type 1 diabetes

AU - Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group

AU - Ghetti, Simona

AU - Kuppermann, Nathan

AU - Rewers, Arleta

AU - Myers, Sage R.

AU - Schunk, Jeff E.

AU - Stoner, Michael J.

AU - Garro, Aris

AU - Quayle, Kimberly S.

AU - Brown, Kathleen M.

AU - Trainor, Jennifer L.

AU - Tzimenatos, Leah

AU - DePiero, Andrew D.

AU - McManemy, Julie K.

AU - Nigrovic, Lise E.

AU - Kwok, Maria Y.

AU - Olsen, Cody S.

AU - Casper, T. Charles

AU - Glaser, Nicole S.

AU - Lewis, Roger

AU - Blumer, Jeffrey

AU - Bremer, Andrew

AU - Cook, Thomas

AU - Slomine, Beth

AU - Meert, Kathleen

AU - Zimmerman, Jerry

AU - Hickey, Robert

PY - 2023/5

Y1 - 2023/5

N2 - Introduction: Young children with type 1 diabetes (T1D) may be at particularly high risk of cognitive decline following diabetic ketoacidosis (DKA). However, studies of cognitive functioning in T1D typically examine school-age children. The goal of this study was to examine whether a single experience of DKA is associated with lower cognitive functioning in young children. We found that recently diagnosed 3- to 5-year-olds who experienced one DKA episode, regardless of its severity, exhibited lower IQ scores than those with no DKA exposure. Methods: We prospectively enrolled 46 3- to 5-year-old children, who presented with DKA at the onset of T1D, in a randomized multi-site clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 22 children and mild in 24 children. Neurocognitive function was assessed once 2–6 months after the DKA episode. A comparison group of 27 children with T1D, but no DKA exposure, was also assessed. Patient groups were matched for age and T1D duration at the time of neurocognitive testing. Results: Children who experienced DKA, regardless of its severity, exhibited significantly lower IQ scores than children who did not experience DKA, F(2, 70) = 6.26, p =.003, partial η2 =.15. This effect persisted after accounting for socioeconomic status and ethnicity. Conclusions: A single DKA episode is associated with lower IQ scores soon after exposure to DKA in young children.

AB - Introduction: Young children with type 1 diabetes (T1D) may be at particularly high risk of cognitive decline following diabetic ketoacidosis (DKA). However, studies of cognitive functioning in T1D typically examine school-age children. The goal of this study was to examine whether a single experience of DKA is associated with lower cognitive functioning in young children. We found that recently diagnosed 3- to 5-year-olds who experienced one DKA episode, regardless of its severity, exhibited lower IQ scores than those with no DKA exposure. Methods: We prospectively enrolled 46 3- to 5-year-old children, who presented with DKA at the onset of T1D, in a randomized multi-site clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 22 children and mild in 24 children. Neurocognitive function was assessed once 2–6 months after the DKA episode. A comparison group of 27 children with T1D, but no DKA exposure, was also assessed. Patient groups were matched for age and T1D duration at the time of neurocognitive testing. Results: Children who experienced DKA, regardless of its severity, exhibited significantly lower IQ scores than children who did not experience DKA, F(2, 70) = 6.26, p =.003, partial η2 =.15. This effect persisted after accounting for socioeconomic status and ethnicity. Conclusions: A single DKA episode is associated with lower IQ scores soon after exposure to DKA in young children.

KW - cognitive function

KW - diabetic ketoacidosis

KW - early childhood

KW - intelligence

KW - type 1 diabetes

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JO - Endocrinology, Diabetes and Metabolism

JF - Endocrinology, Diabetes and Metabolism

IS - 3

M1 - e412

ER -

Cognitive function following diabetic ketoacidosis in young children with type 1 diabetes

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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