Impact of Glucose Variability on Dynamic Cognitive Function in Youth with Type 1 Diabetes

血糖变异性对 1 型糖尿病青少年动态认知功能的影响

• 批准号: 10654542
• 负责人: Mary Katherine Osborn Ray
• 金额: $ 11.96万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10654542
• 关键词: Acute; Address; Affect; Biological; Blood Glucose; Brain; Childhood; Chronic; Cognition; Cognitive; Complications of Diabetes Mellitus; Continuous Glucose Monitor; Data; Data Collection; Development; Development Plans; Diabetes Mellitus; Diabetic Ketoacidosis; Disease; Event; Food; Future; Gestational Diabetes; Glucose; Goals; Health; Health Technology; Health behavior; Hyperglycemia; Hypoglycemia; Incidence; Individual; Insulin-Dependent Diabetes Mellitus; Laboratories; Learning; Life; Longevity; Measures; Methods; Non-Insulin-Dependent Diabetes Mellitus; Oxidative Stress; Participant; Patients; Pattern; Population; Prevalence; Quality of life; Recommendation; Research Personnel; Risk Factors; Short-Term Memory; Sleep Deprivation; Testing; Time; Time Series Analysis; Translating; Work; Youth; brain health; career development; cognitive function; cognitive performance; cognitive skill; cognitive testing; euglycemia; glycemic control; high standard; improved; innovation; mHealth; machine learning model; novel; peer; processing speed; rate of change; skills; smartphone application; type I and type II diabetes

PROJECT SUMMARY/ABSTRACT Type 1 diabetes (T1D) is one of the most common chronic childhood diseases and has a rapidly rising incidence and prevalence. Management of blood glucose is challenging and often leads to frequent and rapid swings between normal, high, and low glucose. This glucose variability has recently been identified as an independent risk factor for diabetic complications. One of the least studied and understood complications of T1D is altered cognition and its relationship to glucose variability. As the brain uses a substantial amount of the body’s glucose to support its functions, especially during dynamic periods of brain development, there are strong biological reasons for the potential vulnerability of youth with T1D. Several studies have shown lower cognitive scores in youth with T1D compared to their peers without T1D, and shown that poorer overall glycemic control as indicated by severe glycemic events (e.g., diabetic ketoacidosis) and chronic hyperglycemia, are associated with lower cognitive scores both acutely and long-term. However, these studies we conducted in a controlled, optimized laboratory settings at a single time point. Little is still known about how typical glucose fluctuations that occur daily in real-life settings affect cognitive function in the moment, particularly dynamic cognitive skills that are sensitive to environmental or physical conditions of the individual (e.g. sleep deprivation) and thus fluctuate throughout the day (e.g., working memory, processing speed). Determining the relationship between glycemic fluctuations and dynamic cognitive function is critically important in youth given that dynamic cognitive skills are fundamental for learning, integrating, and using novel information in their daily lives. Understanding how these skills are affected in daily life, how they relate to glycemic fluctuations, and any contributing factors, could motivate improvements in academic accommodations and T1D treatment recommendations. Importantly, this work could also be expanded to better understand the impact of glycemic variability on brain health throughout the lifespan in T1D and could be translated to other forms of diabetes (e.g., type 2 diabetes, gestational diabetes). The primary goal of this study is to determine if real-time, real-life glycemic variability predicts fluctuations in dynamic cognitive function in youth with T1D. A secondary goal is to determine whether dynamic cognitive function in youth with T1D differs from youth without T1D, independent of significant glycemic extremes. To address these questions, I will apply a unique and innovative combination of continuous health and cognitive data collection methods, multivariate time-series analyses, and machine learning models. This work, combined with a tailored career development plan, will form the basis of my future work as an independent investigator, which will expand to address how diabetes-related health behaviors (e.g., food choice) impact glucose fluctuations, and subsequent brain health (i.e., cognitive function), using novel mobile health (mHealth) technologies across different types of diabetes.

项目摘要/摘要 1型糖尿病（T1 D）是最常见的慢性儿童疾病之一， 发病率和患病率。血糖管理具有挑战性，通常会导致频繁和快速的 在正常血糖、高血糖和低血糖之间波动。这种葡萄糖变异性最近被确定为 糖尿病并发症的独立危险因素。最少研究和了解的并发症之一， T1 D是认知改变及其与葡萄糖变异性的关系。由于大脑使用了大量的 身体的葡萄糖来支持其功能，特别是在大脑发育的动态时期， 这是T1 D青年潜在脆弱性的强有力的生物学原因。多项研究表明， 与没有T1 D的同龄人相比，患有T1 D的青少年的认知得分更低， 严重血糖事件所指示的血糖控制（例如，糖尿病酮症酸中毒）和慢性 高血糖与急性和长期认知评分降低相关。但是这些研究 我们在受控的、优化的实验室设置中在单个时间点进行。我们对它是如何被发现的 在现实生活环境中每天发生的典型葡萄糖波动影响当前的认知功能， 特别是对个体的环境或身体状况敏感的动态认知技能 (e.g.睡眠剥夺）并因此在一天中波动（例如，工作记忆、处理速度）。 确定血糖波动和动态认知功能之间的关系至关重要 重要的是，在青年的动态认知技能是学习，整合， 在日常生活中使用新奇的信息。了解这些技能在日常生活中如何受到影响， 它们与血糖波动有关，以及任何促成因素，都可能促使学术水平的提高。 提供住宿和T1 D治疗建议。重要的是，这项工作还可以扩大到 更好地了解血糖变异性对T1 D患者整个生命周期内大脑健康的影响， 转化为其他形式的糖尿病（例如，2型糖尿病、妊娠糖尿病）。本研究的主要目标 是确定实时的，现实生活中的血糖变化是否预测了动态认知功能的波动， 青少年T1 D第二个目标是确定T1 D青少年的动态认知功能是否与 来自未患T1 D的年轻人，独立于显著的血糖极值。为了解决这些问题，我将申请 一个独特的和创新的组合，连续的健康和认知数据收集方法，多变量 时间序列分析和机器学习模型。这项工作，结合量身定制的职业发展 计划，将成为我未来作为独立调查员工作的基础，这将扩大到解决如何 糖尿病相关的健康行为（例如，食物选择）影响葡萄糖波动，以及随后的大脑健康 (i.e.,认知功能），在不同类型的糖尿病中使用新型移动的健康（mHealth）技术。