Identifying Modifiable Risk and Protective Factors for Neurocognitive Complications of Pediatric Type 1 Diabetes

确定儿童 1 型糖尿病神经认知并发症的可改变风险和保护因素

• 批准号: 9913817
• 负责人: Sarah Sanders Jaser
• 金额: $ 36.87万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-20 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9913817
• 关键词: Academic Medical Centers; Address; Adolescence; Adolescent; Adult; Age; Age of Onset; Area; Award; Behavioral Research; Brain; Car Phone; Caregivers; Cerebral Infarction; Child; Child Care; Child Welfare; Childhood; Childhood diabetes; Chronic; Clinical; Clinical Research; Cognitive deficits; Collaborations; Computer software; Contracts; Data; Data Science; Development; Devices; Diabetes Mellitus; Diabetic Ketoacidosis; Diffuse; Distress; Ecological momentary assessment; Endocrinologist; Enrollment; Exposure to; Future; Health; Hybrids; Hyperglycemia; Hypoglycemia; Image; Insulin; Insulin-Dependent Diabetes Mellitus; Interdisciplinary Study; Intervention; Learning; Life; Longitudinal cohort study; Longitudinal observational study; Measurement; Measures; Memory; Mental Depression; Methods; Neurocognitive; Neurocognitive Deficit; Neurologist; Pediatric Neurology; Population; Population Heterogeneity; Preventive Intervention; Prospective Studies; Protocols documentation; Psychologist; Recording of previous events; Research; Research Personnel; Research Training; Resources; Risk; Risk Factors; Sample Size; Sampling; School-Age Population; Science; Severities; Site; Sleep; Sleep disturbances; Structure; System; Time; Visit; Work; Youth; anxiety symptoms; base; brain health; brain volume; clinical care; clinical research site; cognitive development; cohort; comparison group; critical period; depressive symptoms; design; diabetes management; executive function; experience; externalizing behavior; follow-up; glucose monitor; glycemic control; improved; insulin dependent diabetes mellitus onset; modifiable risk; multidisciplinary; neurocognitive test; neuroimaging; novel; patient population; peer; programs; prospective; protective factors; secondary outcome; sex; skills; sleep quality; tool; white matter

PROJECT SUMMARY Meta-analytic studies have identified small but significant deficits in neurocognitive functioning in children with type 1 diabetes (T1D) compared to their peers without diabetes, especially in the areas of memory, learning, and executive function skills. Further, neuroimaging studies consistently observe differences in brain structures and brain development in children with T1D, particularly brain white matter microstructure. Evidence suggests that factors such as age of onset, diabetic ketoacidosis (DKA) at time of onset, and exposure to chronic hyperglycemia or severe hypoglycemia may increase risk or severity of these deficits but findings are mixed, and many studies were limited by the inclusion of older adolescents or adults with T1D, small samples or cross-sectional designs. Thus, a large prospective study of young children with T1D followed over time with rigorous assessment and follow-up is needed to identify modifiable risk and protective factors for neurocognitive complications in this population. This U34 planning award will provide the time and resources needed to prepare for an observational, longitudinal cohort study of young children with T1D (age 6 to 10 years at enrollment), and a comparison group of children without diabetes. We will establish contracts with other clinical research centers, obtain data needed to develop neuroimaging harmonization plans, and finalize the protocols, including neuroimaging and neurocognitive testing. Our multidisciplinary team includes a pediatric psychologist, a pediatric neurologist, a pediatric endocrinologist, and a pediatric neuroradiologist; experts in imaging science and harmonization of imaging data, as well as a biostatistician experienced in analyses with imaging data, and a researcher using a novel mobile phone-based method to capture child function in real- time, called ecological momentary assessment. The Children's Diabetes Program (CDP) Vanderbilt University Medical Center serves a large, diverse population of children with T1D and has a strong history of multicenter collaborations with other pediatric diabetes centers. The proposed project will assess hypothesized risk factors (age of onset, DKA at presentation and glycemic control), as well as potentially modifiable protective factors (child sleep quality, caregiver distress, and use of diabetes devices). In addition, we will optimize imaging protocols and processing tools to allow for harmonization of neuroimaging data across sites and scanners for the most robust analysis. This project has the potential to influence standards of clinical care for children with T1D and to pinpoint critical periods for prevention and intervention to improve brain health and function.

项目摘要 荟萃分析研究已经确定 与没有糖尿病的同龄人相比，1型糖尿病（T1D），尤其是在记忆，学习的领域 和执行功能技能。此外，神经成像研究始终观察到大脑结构的差异 T1D儿童，尤其是脑白质微观结构的大脑发育。有证据表明 诸如发病年龄，发病时糖尿病性酮症酸中毒（DKA）等因素 高血糖或严重的低血糖可能会增加这些缺陷的风险或严重程度，但发现混合在一起， 许多研究受到限制，包括年龄较大的青少年或具有T1D的成年人，小样本或 横截面设计。因此，随着时间的推移，对T1D的幼儿进行了大量前瞻性研究 需要进行严格的评估和随访，以确定可修改的风险和保护因素 该人群中的神经认知并发症。该U34计划奖将为时间和资源提供 需要为T1D的幼儿进行观察，纵向队列研究（6至10岁 入学时），一个没有糖尿病的儿童比较组。我们将与其他其他合同 临床研究中心，获得制定神经影像协调计划所需的数据，并确定 方案，包括神经影像学和神经认知测试。我们的多学科团队包括儿科 心理学家，儿科神经科医生，儿科内分泌学家和儿科神经放射科医生；专家 成像科学和成像数据的协调，以及在分析中经历的生物统计学家 成像数据，以及使用一种新型的基于手机的新方法来捕获儿童功能的研究人员 时间，称为生态瞬间评估。儿童糖尿病计划（CDP）范德比尔特大学 医疗中心为有T1D的大量儿童提供服务，并拥有多中心的历史 与其他儿科糖尿病中心的合作。拟议的项目将评估假设的风险因素 （发病年龄，表现时DKA和血糖控制）以及潜在的可修改保护因素 （儿童睡眠质量，护理人员的困扰以及糖尿病设备的使用）。此外，我们将优化成像 协议和处理工具，允许跨站点和扫描仪的神经影像学协调 最强大的分析。该项目有可能影响患有儿童的临床护理标准 T1D并查明预防和干预以改善大脑健康和功能的关键时期。