title: Longitudinal assessment of neuroanatomical and cognitive differences in young children with type 1 diabetes: association with hyperglycemia.
abstract: Significant regional differences in gray and white matter volume and subtle cognitive differences between young diabetic and nondiabetic children have been observed. Here, we assessed whether these differences change over time and the relation with dysglycemia. Children ages 4 to <10 years with (n = 144) and without (n = 72) type 1 diabetes (T1D) had high-resolution structural MRI and comprehensive neurocognitive tests at baseline and 18 months and continuous glucose monitoring and HbA1c performed quarterly for 18 months. There were no differences in cognitive and executive function scores between groups at 18 months. However, children with diabetes had slower total gray and white matter growth than control subjects. Gray matter regions (left precuneus, right temporal, frontal, and parietal lobes and right medial-frontal cortex) showed lesser growth in diabetes, as did white matter areas (splenium of the corpus callosum, bilateral superior-parietal lobe, bilateral anterior forceps, and inferior-frontal fasciculus). These changes were associated with higher cumulative hyperglycemia and glucose variability but not with hypoglycemia. Young children with T1D have significant differences in total and regional gray and white matter growth in brain regions involved in complex sensorimotor processing and cognition compared with age-matched control subjects over 18 months, suggesting that chronic hyperglycemia may be detrimental to the developing brain.
authors.affiliation: Division of Endocrinology, Diabetes & Metabolism, Nemours Children's Clinic, Jacksonville, FL nmauras@nemours.org.
authors.forename: Nelly
authors.initials: N
authors.lastname: Mauras
authors.affiliation: Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
authors.forename: Paul
authors.initials: P
authors.lastname: Mazaika
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Buckingham
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
authors.forename: Stuart
authors.initials: S
authors.lastname: Weinzimer
authors.affiliation: Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Neil H
authors.initials: NH
authors.lastname: White
authors.affiliation: Pediatric Endocrinology, University of Iowa, Iowa City, IA.
authors.forename: Eva
authors.initials: E
authors.lastname: Tsalikian
authors.affiliation: Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Tamara
authors.initials: T
authors.lastname: Hershey
authors.affiliation: Division of Neurology, Nemours Children's Clinic, Jacksonville, FL.
authors.forename: Allison
authors.initials: A
authors.lastname: Cato
authors.affiliation: Jaeb Center for Health Research, Tampa, FL.
authors.forename: Peiyao
authors.initials: P
authors.lastname: Cheng
authors.affiliation: Jaeb Center for Health Research, Tampa, FL.
authors.forename: Craig
authors.initials: C
authors.lastname: Kollman
authors.affiliation: Jaeb Center for Health Research, Tampa, FL.
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.affiliation: Jaeb Center for Health Research, Tampa, FL.
authors.forename: Katrina
authors.initials: K
authors.lastname: Ruedy
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
authors.forename: Tandy
authors.initials: T
authors.lastname: Aye
authors.affiliation: Division of Endocrinology, Diabetes & Metabolism, Nemours Children's Clinic, Jacksonville, FL.
authors.forename: Larry
authors.initials: L
authors.lastname: Fox
authors.affiliation: Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Arbelaez
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
authors.forename: Darrell
authors.initials: D
authors.lastname: Wilson
authors.affiliation: Pediatric Endocrinology, University of Iowa, Iowa City, IA.
authors.forename: Michael
authors.initials: M
authors.lastname: Tansey
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
authors.forename: William
authors.initials: W
authors.lastname: Tamborlane
authors.affiliation: Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Peng
authors.affiliation: Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA Department of Bioengineering, Stanford University School of Medicine, Stanford, CA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Marzelli
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Winer
authors.affiliation: Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA Department of Pediatrics, Stanford University School of Medicine, Stanford, CA Department of Radiology, Stanford University School of Medicine, Stanford, CA.
authors.forename: Allan L
authors.initials: AL
authors.lastname: Reiss
mesh_terms: D000375:Aging; D001786:Blood Glucose / Q000502:physiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism / Q000473:pathology*; D005260:Female; D066128:Gray Matter / Q000033:anatomy & histology*; D006801:Humans; D006943:Hyperglycemia / Q000378:metabolism / Q000473:pathology*; D007361:Intelligence Tests; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology*; D066127:White Matter / Q000033:anatomy & histology*
chemical_list: D001786:Blood Glucose