Effects of prior hypoglycemia and hyperglycemia on cognition in children with type 1 diabetes mellitus
Effects of prior hypoglycemia and hyperglycemia on cognition in children with type 1 diabetes mellitus
复制标题
DOI：
10.1111/j.1399-5448.2007.00274.x
复制
发表时间：
2008-04-01
影响因子：
3.4
通讯作者：
Hershey, Tamara
中科院分区：
文献类型：
--
作者：
Perantie, Dana C.;Lim, Audrey;Hershey, Tamara
目的：尽管普遍认为1型糖尿病（T1DM）青年患者可出现中度认知障碍，但关于严重低血糖（Hypo）和/或高血糖（Hyper）在产生这种障碍中的作用的争论仍在继续。我们的目的是确定大脑发育过程中的Hypo和Hyper如何预测青年T1DM患者随后的认知表现模式。方法：我们测试了5-16岁的青少年（T1DM, n = 117；非糖尿病同胞对照，n = 58）的认知任务（言语和空间智力、言语和空间记忆以及处理速度）。T1DM参与者被分类为经历过0次、1-2次、3次或3次以上（3+）次低血糖发作，在5岁之前或之后首次低血糖发作，以及早期（5岁之前）或晚期（5岁之后）糖尿病发病。根据每位受试者的糖尿病持续时间调整，用中位血红蛋白A1c估计高暴露。结果：T1DM组的语言智力低于兄弟姐妹对照组。在T1DM组中，言语智力随着过度暴露的增加而降低，而不是过度暴露。相比之下，空间智力和延迟回忆只有在反复出现Hypo时才会下降，特别是当Hypo发作发生在5岁之前时。发病年龄不能解释这些结果。结论：Hypo和Hyper对T1DM患者的认知功能有不同的影响，这部分取决于发育过程中暴露的时间，而与发病年龄无关。这一信息扩展了在儿童时期避免Hypo和慢性Hyper的已知益处，包括保存特定的认知技能。
Objective: Despite the general consensus that youth with type 1 diabetes mellitus (T1DM) can experience modest cognitive impairment, debate continues over the role of severe hypoglycemia (Hypo) and/or hyperglycemia (Hyper) in producing such impairment. Our aim was to determine how Hypo and Hyper experienced during brain development predict patterns of subsequent cognitive performance in youth with T1DM.Methods: We tested youth aged 5-16 yr (T1DM, n = 117; non-diabetic sibling controls, n = 58) on cognitive tasks (verbal and spatial intelligence, verbal and spatial memory, and processing speed). T1DM participants were categorized as having experienced 0, 1-2, or 3 or more (3+) Hypo episodes, as having their first Hypo episode before or after 5 yr of age and as having early (before age 5) or late (after age 5) diabetes onset. Hyper exposure was estimated with median hemoglobin A1c, adjusted for diabetes duration for each subject.Results: The group with T1DM had lower estimated verbal intelligence than sibling controls. Within the T1DM group, verbal intelligence was reduced with increased exposure to Hyper, not to Hypo. In contrast, spatial intelligence and delayed recall were reduced only with repeated Hypo, particularly when Hypo episodes occurred before the age of 5 yr. Age of onset did not explain these results.Conclusions: Hypo and Hyper have qualitatively different effects on cognitive function in T1DM that depend in part on the timing of exposure during development, independent of onset age. This information extends the known benefits of avoiding both Hypo and chronic Hyper during childhood to include preservation of specific cognitive skills.