title: Severity of clinical presentation in youth with type 1 diabetes is associated with differences in brain structure.
abstract: OBJECTIVE
  Differences in cognition and brain structure have been found in youth with type 1 diabetes compared with controls, even after relatively short disease duration. To determine whether severity of clinical presentation contributes to these differences, we obtained structural magnetic resonance imaging (MRI) scans in youth ages 7-17 who were either newly diagnosed with type 1 diabetes (<3.5 months from diagnosis, n  = 46) or a sibling without diabetes (n = 28).
  
  
  METHODS
  Severity of presentation was measured by the presence of diabetic ketoacidosis (DKA) and degree of hyperglycemia exposure [hemoglobin A1c (HbA1c)] at diagnosis. MRI were obtained using T1-weighted, T2-weighted, and diffusion-weighted sequences.
  
  
  RESULTS
  Within the group with type 1 diabetes, 12 subjects presented in DKA and 34 did not. After controlling for age, sex, and multiple comparisons, the type 1 diabetes group had lower volume in the left temporal-parietal-occipital cortex compared with controls. Within the type 1 diabetes group, DKA at presentation was associated with lower radial, axial, and mean diffusivity (MD) throughout major white matter tracts and higher HbA1c was associated with lower hippocampal, thalamic, and cerebellar white matter volumes, lower right posterior parietal cortical thickness, and greater right occipital cortical thickness.
  
  
  CONCLUSIONS
  These data suggest that severity of clinical presentation is an important factor in predicting brain structural differences in youth with type 1 diabetes approximately 3 months after diagnosis.
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Alejandro F
authors.initials: AF
authors.lastname: Siller
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Heather
authors.initials: H
authors.lastname: Lugar
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Jerrel
authors.initials: J
authors.lastname: Rutlin
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Koller
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Katherine
authors.initials: K
authors.lastname: Semenkovich
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.|Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.|St. Louis Children's Hospital, St. Louis, Missouri.
authors.forename: Neil H
authors.initials: NH
authors.lastname: White
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.|St. Louis Children's Hospital, St. Louis, Missouri.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Arbelaez
authors.affiliation: Department of Radiology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Joshua
authors.initials: J
authors.lastname: Shimony
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.|St. Louis Children's Hospital, St. Louis, Missouri.|Department of Neurology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Tamara
authors.initials: T
authors.lastname: Hershey
mesh_terms: D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D016022:Case-Control Studies; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D016883:Diabetic Ketoacidosis / Q000209:etiology / Q000473:pathology*; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male
keywords: brain structure; diabetic ketoacidosis; type 1 diabetes