Skip to main content

Advertisement

SpringerLink
Log in

The Neurocognitive Effects of Type 1 Diabetes Mellitus in Children and Young Adults With and Without Hypoglycemia

  • Review Article
  • Published:
Journal of Developmental and Physical Disabilities Aims and scope Submit manuscript

Abstract

Type 1 Diabetes Mellitus is one of the most common illnesses found in children under the age of 18 as well as in young adults. Symptoms of this disease, including those with and without severe hypoglycemia, create abnormal blood glucose levels along with abnormal insulin levels. These abnormal chemical levels have been associated with neurocognitive deficits in memory, attention, motor skills, visuospatial abilities and executive functioning. In this paper, available literature on the central nervous system changes associated with the effects of insulin-dependent diabetes on school-aged children and young adults is reviewed. Implications for learning as well as a neurobiological cause of executive function deficits are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Auer, R. N., & Siesjo, B. K. (1988). Biological differences between ischemia, hypoglycemia, and epilepsy. Annals of Neurology, 24, 699–707.

    Article  PubMed  Google Scholar 

  • Bax, M., Tydeman, C., & Flodmark, O. (2006). Clinical and MRI correlates of cerebral palsy. Journal of the American Medical Association, 296, 1602–1608.

    Article  PubMed  Google Scholar 

  • Bjorgass, M., Ganse, R., Vik, T., & Sand, T. (1997). Cognitive function in Type 1 children with diabetes with and without episodes of severe hypoglycaemia. Acta Paediatrica, 86, 148–153.

    Article  Google Scholar 

  • Brady, F. (2000). Cognitive and psychosocial functioning in preschool-aged children with T1DM. Diabetes, 5, 49.

    Google Scholar 

  • Davis, E. A., Trundle, C. L., Ives, J., Robins, P. D., & Jones, T. W. (2002). High prevalence of structural CNS abnormalities in children with early onset diabetes. Diabetes, 51, A3.

    Article  Google Scholar 

  • Deary, I. J., Sommerfield, A. J., McAuley, V., & Frier, B. M. (2003). Moderate hypoglycaemia obliterates working memory in humans with and without insulin treated diabetes. Journal of Neurology, Neurosurgery and Psychiatry, 74, 278–279.

    Article  Google Scholar 

  • Desrocher, M., & Rovet, J. (2004). Neurocognitive correlates of Type 1 Diabetes Mellitus in childhood. Child Neuropsychology, 10, 36–52.

    PubMed  Google Scholar 

  • Diabetes Control and Complications Trial Research Group. (1996). Effects of intensive diabetes therapy on neuropsychological functions in adults in the diabetes control and complications trial. Annals of Internal Medicine, 124, 379–388.

    Google Scholar 

  • Ferguson, S. C., Blane, A., Perros, P., McCrimmon, R. J., Best, J. J. K., Wardlaw, J., et al. (2003). Cognitive ability and brain structure in Type 1 diabetes: relation to microangiopathy and preceding severe hypoglycemia. Diabetes, 52, 149–156.

    Article  PubMed  Google Scholar 

  • Ferguson, S. C., Blane, A., Wardlaw, J., Frier, B. M., Perros, P., McCrimmon, R. J., & Ceary, I. J. (2005). Influence of an early-onset age of Type 1 diabetes on cerebral structure and cognitive function. Diabetes Care, 28, 1431–1437.

    Google Scholar 

  • Fox, M. A., Chen, R. S., & Holmes, C. S. (2003). Gender differences in memory and learning in children with insulin-dependent diabetes mellitus (IDDM) over a 4-year follow-up interval. Journal of Pediatric Psychology, 28, 569–578.

    Article  PubMed  Google Scholar 

  • Frier, B. (2001). Hypoglycemia—Clinical consequences and morbidity. International Journal of Clinical Psychology: Supplement, 11(3), 51–55.

    Google Scholar 

  • Gabrielli, J. D. E., Brewer, J. B., Desmond, J. E., & Glover, G. H. (1997). Separate neural bases of two fundamental memory processes in the human medial temporal lobe. Science, 276, 264–266.

    Article  Google Scholar 

  • Geschwind, N., & Galaburda, A. M. (1985). Cerebral lateralization: Biological mechanisms, associations, and pathology. Boston: MIT.

    Google Scholar 

  • Golden, M. P., Ingersoll, G. M., Brack, C. J., Russell, B. A., Wright, J. C., & Huberty, J. C. (1989). Longitudinal relationship of asymptomatic hyperglycemia to cognitive functioning in IDDM. Diabetes Care, 12, 89–93.

    Article  PubMed  Google Scholar 

  • Gschwend, S., Ryan, C., Atchison, J., Arslanian, S., & Becker, D. (1995). Effects of acute hypoglycemia on mental efficiency and counterregulatory hormones in adolescents with insulin-dependent diabetes mellitus. Journal of Pediatrics, 126, 178–184.

    Article  PubMed  Google Scholar 

  • Hagen, J. W., Barclay, C. R., Anderson, B. J., Freeman, D. J., Segal, S. S., Brown, G., et al. (1990). Intellective functioning and strategy use in children with insulin-dependent diabetes mellitus. Child Development, 61, 1714–1727.

    Article  PubMed  Google Scholar 

  • Hannonen, R., Tupola, S., Ahonen, T., & Riikonen, R. (2003). Neurocognitive functioning in children with type-1 diabetes with and without severe hypoglycemia. Developmental Medicine & Child Neurology, 45, 262–268.

    Article  Google Scholar 

  • Hershey, T., Craft, S., Bhargava, N., & White, N. H. (1997). Memory and insulin-dependent diabetes mellitus (IDDM)): effects of childhood onset and severe hypoglycemia. Journal of the International Neuropsychological Society, 3, 509–520.

    PubMed  Google Scholar 

  • Hershey, T., Bhargava, N., Sadler, M., White, N. H., & Craft, S. (1999). Conventional vs. intensive diabetes therapy in children with type 1 diabetes mellitus: effects on memory and motor speed. Diabetes Care, 22, 1318–1324.

    Article  PubMed  Google Scholar 

  • Hershey, T., Lillie, R., Sadler, M., & White, N. H. (2003). Severe hypoglycemia and long-term spatial memory in children with type 1 diabetes mellitus: a retrospective study. Journal of the International Neuropsychological Society, 9, 740–750.

    Article  PubMed  Google Scholar 

  • Hershey, T., Lillie, R., Sadler, M., & White, N. H. (2004). A prospective study of severe hypoglycemia and long-term spatial memory in children with type 1 diabetes. Pediatric Diabetes, 5, 63–71.

    Article  PubMed  Google Scholar 

  • Hershey, T., Perantie, D. C., Warren, S. L., Zimmerman, E. C., Sadler, M., & White, N. H. (2005). Frequency and timing of severe hypoglycemia affects spatial memory in children with type 1 diabetes. Diabetes Care, 28, 2372–2378.

    Article  PubMed  Google Scholar 

  • Holmes, C. S. (1990). Neuropsychological and behavioral aspects of diabetes. New York: Springer-Verlag.

    Google Scholar 

  • Holmes, C. S., & Richman, L. C. (1985). Cognitive profiles of children with insulin-dependent diabetes mellitus. Journal of Developmental and Behavioral Pediatrics, 6, 323–326.

    PubMed  Google Scholar 

  • Holmes, C. S., Hayford, J. T., Gonzalez, J. L., & Weydert, J. A. (1983). A survey of cognitive functioning at different glucose levels in diabetic persons. Diabetes Care, 6, 180–185.

    Article  PubMed  Google Scholar 

  • Holmes, C. S., Koepke, K. M., Thompson, R. G., Gyves, P. W., & Weydert, J. A. (1984). Verbal fluency and naming performance in T1DM at different blood glucose concentrations. Diabetes Care, 7, 454–459.

    Article  PubMed  Google Scholar 

  • Holmes, C. S., Cornwell, J., Dunlap, W. P., Chen, R. S., & Lee, C. Y. (1992a). Anomalous factor structure of the WISC-R for diabetic children. Neuropsychology, 6, 341–350.

    Article  Google Scholar 

  • Holmes, C. S., Dunlap, W. P., Chen, R. S., & Cornwell, J. M. (1992b). Gender differences in the learning status of diabetic children. Journal of Consulting and Clinical Psychology, 60, 698–704.

    Article  Google Scholar 

  • Holmes, C. S., Cant, M. C., Fox, M. A., Lampert, N. L., & Greer, T. (1999). Disease and demographic risk factors for disrupted cognitive functioning in children with insulin-dependent diabetes mellitus (IDDM). School Psychology Review, 28, 215–227.

    Google Scholar 

  • Kaufmann, F. R., Epport, K., Engilman, R., & Halvorson, M. (1999). Neurocognitive functioning in children diagnosed with diabetes before age 10 years. Journal of Diabetes and its Complications, 13, 31–38.

    Article  Google Scholar 

  • Lobnig, B. M., Kromeke, O., Optenhostert-Porst, C., & Wolf, O. T. (2005). Hippocampal volume and cognitive performance in long-standing Type 1 diabetic patients without macrovascular complications. Diabetic Medicine, 23, 32–39.

    Google Scholar 

  • Lunnetta, M., Damanti, A. R., Fabbri, G., Lombardo, M., Di Mauro, M., & Mughini, L. (1994). Evidence by magnetic resonance imaging of cerebral alterations of atrophy type in young insulin-dependent diabetic patients. Journal of Endocrinology Investigations, 17, 241–245.

  • Lynch, P. A., Chen, R., & Holmes, C. S. (2004). Factor structure of the wide range assessment of memory and learning (WRAML) in children with insulin dependent diabetes mellitus (IDDM). Child Neuropsychology, 10, 306–317.

    PubMed  Google Scholar 

  • McCall, A. L. (1992). The impact of diabetes on the CNS. Diabetes, 31, 557–570.

    Article  Google Scholar 

  • McNay, E. C., Williamson, A., McCrimmon, R. J., Sherwin, R. S. (2006). Cognitive and neural hippocampal effects of long-term moderate recurrent hypoglycemia. Diabetes, 55, 1088–1095.

    Google Scholar 

  • Menni, F., DeLonlay, P., Sevin, C., Touati, G., Peigne, C., & Barbier, V. (2001). Neurologic outcomes of 90 neonates and infants with persistent hyperinsulinemic hypoglycemia. Pediatrics, 107, 476–479.

    Article  PubMed  Google Scholar 

  • Northam, E., Anderson, P. J., Werther, G., Adler, R., & Andrews, D. (1995). Neuropsychological complications of insulin dependent diabetes mellitus in children. Child Neuropsychology, 1, 74–87.

    Article  Google Scholar 

  • Northam, D., Anderson, P. J., Werther, G., Warner, G. L., & Andrewes, D. (1999). Predictors of change in the neuropsychological profiles of children with type 1 diabetes 2 years after disease onset. Diabetes Care, 22, 1438–1444.

    Article  PubMed  Google Scholar 

  • Northam, E., Anderson, P. J., Jacobs, R., Hughes, M., Warne, G. L., & Werther, G. A. (2001). Neuropsychological profiles of children with T1DM 6 years after disease onset. Diabetes Care, 24, 1772–1787.

    Article  Google Scholar 

  • Perantie, D. C., Wu, J., Koller, J. M., Lim, A., Warren, S. L., Black, K. J., Sadler, M., White, N. H., & Hershey, T. (2007). Regional brain volume differences associated with hyperglycemia and severe hypoglycemia in youth with Type 1 diabetes. Diabetes Care, 30, 2331–2337.

    Google Scholar 

  • Reich, J. N., Kasper, J. C., Puczynski, M. S., Puczynski, S., Cleland, J., Dell’Angela, K., et al. (1990). Effects of a hypoglycemic episode on neuropsychological functioning in children with diabetes. Journal of Clinical and Experimental Neuropsychology, 12, 613–626.

    Article  PubMed  Google Scholar 

  • Rovet, J. F. (1999). Neurological sequelae of pediatric diabetes. In K. O. Yeates, M. D. Ris & H. G. Taylor (Eds.), Pediatric neuropsychology: Research, theory, and practice. New York: Guilford.

    Google Scholar 

  • Rovet, J. F., & Alvarez, M. (1997). Attentional functioning in children and adolescents with IDDM. Diabetes Care, 20, 803–810.

    Article  PubMed  Google Scholar 

  • Rovet, J. F., Ehrlich, R. M., & Hoppe, M. (1988). Specific intellectual deficits in children with early onset diabetes mellitus. Diabetes Care, 10, 510–515.

    Article  Google Scholar 

  • Rovet, J. F., Czuchta, D., & Ehrlich, R. (1990). Intellectual characteristics of diabetic children at diagnosis and one year later. Journal of Pediatric Psychology, 15, 775–788.

    Article  PubMed  Google Scholar 

  • Rovet, J. F., Ehrlich, R. M., Czuchta, D., & Akler, M. (1993). Psychoeducational characteristics of children and adolescents with insulin-dependent diabetes mellitus. Journal of Learning Disabilities, 26, 7–22.

    Article  PubMed  Google Scholar 

  • Ryan, C. M. (1990). Neuropsychological consequences and correlates of diabetes in childhood. In C. S. Holmes (Ed.), Neuropsychological and behavioral aspects of diabetes (pp. 58–84). New York: Springer-Verlag.

    Google Scholar 

  • Ryan, C. M. (2004). Does moderately severe hypoglycemia cause cognitive dysfunction in children? Pediatric Diabetes, 5, 59–62.

    Article  PubMed  Google Scholar 

  • Ryan, C. M., Vega, A., & Drash, A. (1985). Cognitive deficits in adolescents who developed diabetes early in life. Pediatrics, 75, 921–927.

    PubMed  Google Scholar 

  • Ryan, C. M., Atchison, J., Puczynski, S., Puczynski, M., Arslanian, S., & Becker, D. (1990). Mild hypoglycemia associated with deterioration of mental efficiency in children with insulin-dependent diabetes mellitus. Journal of Pediatrics, 117, 32–38.

    Article  PubMed  Google Scholar 

  • Ryan, C. M., Williams, T. M., Finegold, D. N., & Orchard, T. J. (1993). Cognitive dysfunction in adults with type 1 insulin-dependent diabetes mellitus of long duration: effects of recurrent hypoglycaemia and other chronic complications. Diabetologia, 36, 329–334.

    Article  PubMed  Google Scholar 

  • Sansbury, L., Brown, R. T., & Meacham, L. (1997). Predictors of cognitive functioning in children and adolescents with insulin-dependent diabetes mellitus: a preliminary investigation. Children’s Health Care, 26, 197–210.

    Article  Google Scholar 

  • Schwartz, R., & Teramo, K. A. (2000). Effects of diabetic pregnancy on the fetus and newborn. Semin Perinatol, 24, 120–135.

    Article  PubMed  Google Scholar 

  • Sommerfield, A. J., Deary, I. J., McAulay, V., & Frier, B. M. (2003). Moderate hypoglycemia impairs memory functions in healthy adults. Neuropsychology, 17, 125–132.

    Article  PubMed  Google Scholar 

  • Strudwick, S. K., Carne, C., Gardiner, J., Foster, J. K., Davis, E. A., & Jones, T. W. (2005). Cognitive functioning in children with early onset type 1 diabetes and severe hypoglycemia. Journal of Pediatrics, 147, 680–685.

    Article  PubMed  Google Scholar 

  • Topitsch, D., Schober, E., Wurst, E., & Kryspin-Exner, I. (1998). Changes in attention with hypo- and hyperglycaemia in children with insulin dependent diabetes mellitus. European Journal of Pediatrics, 157, 802–805.

    Article  PubMed  Google Scholar 

  • Warach, S., Gur, R. C., Gur, R. E., Skolnick, B. E., Obrist, W. D., & Reivich, M. (1992). Decreases in frontal and parietal lobe regional cerebral blood flow related to habituation. Journal of Cerebral Blood Flow and Metabolism, 12, 546–553.

    PubMed  Google Scholar 

  • Warren, R. E., & Frier, B. M. (2005). Hypoglycaemia and cognitive function. Diabetes, Obesity and Metabolism, 7, 493–503.

    Article  PubMed  Google Scholar 

  • Wirsen, A., Tallroth, G., Londgren, M., & Agardh, C. (1992). Neuropsychological performance different between Type 1 diabetic and normal men during insulin-induced hypoglycaemia. Diabetic Medicine, 9, 156–165.

    Article  PubMed  Google Scholar 

  • Wolters, C. A., Yu, S. L., Hagen, J. W., & Kail, R. (1996). Short-term memory and strategy use in children with insulin-dependent diabetes mellitus. Journal of Consulting and Clinical Psychology, 64, 1397–1405.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Arizona, Tucson, USA

    Priscilla A. Bade-White & John E. Obrzut

Authors
  1. Priscilla A. Bade-White
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John E. Obrzut
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John E. Obrzut.

Additional information

Note

Send reprint requests to: John E. Obrzut, PhD, Department of Special Education, Rehabilitation, and School Psychology, College of Education, University of Arizona, Tucson, AZ 85721.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bade-White, P.A., Obrzut, J.E. The Neurocognitive Effects of Type 1 Diabetes Mellitus in Children and Young Adults With and Without Hypoglycemia. J Dev Phys Disabil 21, 425–440 (2009). https://doi.org/10.1007/s10882-009-9151-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10882-009-9151-y

Keywords

Search

Navigation