Establishing a Cohort to Clarify Risk Factors for Neurocognitive Complications of Pediatric Type 1 Diabetes (T1D)

January 2022 Council

Lead Division/Office

DEM

Point(s) of Contact

Karen L. Teff, Ph.D.

Executive Summary

Adults with childhood-onset Type 1 Diabetes (T1D) have significant cognitive impairment compared to comparably aged individuals without diabetes. Impaired cognition may exacerbate difficulties associated with long-term diabetes management. Early disease onset appears to be a major risk factor for cognitive impairment as the metabolic insult of hyperglycemia to the developing brain may delay brain growth, decrease brain volume and neurocognition. Diabetic ketoacidosis (DKA) at the time of diagnosis, sustained hyperglycemia or repeated episodes of severe hypoglycemia may be additional important risk factors for predicting impairments to brain structure and function in children with T1D. To date, studies have been limited by their small sample size, lack of control groups and short length of follow-up. This FOA will solicit applications for a clinical consortium to establish a prospective, longitudinal observational cohort study to identify risk factors contributing to diminished neurocognition and changes in brain structure and function in pediatric patients with T1D. The proposed study is expected to include clinically significant outcomes such as intelligence quotient, other measures of cognition related to daily functioning (memory, executive function), measures of brain structure and function and metrics associated with continuous glucose monitor (CGM) usage. Identifying those children at greatest risk for neurocognitive dysfunction is critical for optimizing clinical care.