Cognitive Function in Children with Type 1 Diabetes: a Meta-analysis

Overview

Journal Diabetes Care

Specialty Endocrinology

Date 2008 Aug 30

PMID 18753668

Citations 112

Authors

Patricia A Gaudieri

Rusan Chen

Tammy F Greer

Clarissa S Holmes

Affiliations

Soon will be listed here.

Abstract

Objective: To quantify the magnitude and pattern of cognitive difficulties in pediatric type 1 diabetes as well as the effects associated with earlier disease onset and severe hypoglycemia.

Research Design And Methods: Pediatric studies of cognitive function since 1985 were identified for study inclusion using MEDLINE and PsycInfo. Effect size (ES, Cohen's d) between the diabetic and control groups, expressed in SD units, were calculated within cognitive domains to standardize meta-analysis test performance.

Results: The meta-analysis sample of 2,144 children consisted of 1,393 study subjects with type 1 diabetes and 751 control subjects from 19 studies. Overall, type 1 diabetes was associated with slightly lower overall cognition (ES -0.13), with small differences compared with control subjects across a broad range of domains, excluding learning and memory, which were similar for both groups. Learning and memory skills, both verbal and visual (-0.28 and -0.25), were more affected for children with early-onset diabetes (EOD) than late-onset diabetes (LOD), along with attention/executive function skills (-0.27). Compared with nondiabetic control subjects, EOD effects were larger, up to one-half SD lower, particularly for learning and memory (-0.49). Generally, seizures were associated with a negligible overall cognition ES of -0.06, with slight and inconsistent cognitive effects found on some measures, possibly reflecting the opposing effects of poorer versus better metabolic control.

Conclusions: Pediatric diabetes generally relates to mildly lower cognitive scores across most cognitive domains. Cognitive effects are most pronounced and pervasive for EOD, with moderately lower performance compared with control subjects. Seizures are generally related to nominal, inconsistent performance differences.

Citing Articles

Age at type 1 diabetes onset does not influence attained brain volume.

Claesson T, Mutter S, Putaala J, Salli E, Gordin D, Groop P BMC Endocr Disord. 2025; 25(1):43.

PMID: 39966749 PMC: 11834590. DOI: 10.1186/s12902-025-01868-6.

Assessing Dynamic Cognitive Function in the Daily Lives of Youths With and Without Type 1 Diabetes: Usability Study.

Ray M, Fleming J, Aschenbrenner A, Hassenstab J, Redwine B, Burns C JMIR Form Res. 2025; 9:e60275.

PMID: 39935012 PMC: 11835789. DOI: 10.2196/60275.

Neuroeconomically dissociable forms of mental accounting are altered in a mouse model of diabetes.

Nwakama C, Durand-de Cuttoli R, Oketokoun Z, Brown S, Haller J, Mendez A Commun Biol. 2025; 8(1):102.

PMID: 39838110 PMC: 11751097. DOI: 10.1038/s42003-025-07500-6.

Safety and Efficacy of Using Advanced Hybrid Closed Loop Off-Label in an Infant Diagnosed with Permanent Neonatal Diabetes Mellitus: A Case Report and a Look to the Future.

Pezzotta F, Sarale N, Spacco G, Tantari G, Bertelli E, Bracciolini G Children (Basel). 2024; 11(10).

PMID: 39457190 PMC: 11506781. DOI: 10.3390/children11101225.

Eighteen-Month Hybrid Closed-Loop Use in Very Young Children With Type 1 Diabetes: A Single-Arm Multicenter Trial.

Ware J, Allen J, Boughton C, Wilinska M, Hartnell S, Thankamony A Diabetes Care. 2024; 47(12):2189-2195.

PMID: 39418532 PMC: 11655413. DOI: 10.2337/dc24-1313.

References

Wysocki T, Harris M, Mauras N, Fox L, Taylor A, Jackson S . Absence of adverse effects of severe hypoglycemia on cognitive function in school-aged children with diabetes over 18 months. Diabetes Care. 2003; 26(4):1100-5. DOI: 10.2337/diacare.26.4.1100. View

Desrocher M, Rovet J . Neurocognitive correlates of type 1 diabetes mellitus in childhood. Child Neuropsychol. 2004; 10(1):36-52. DOI: 10.1076/chin.10.1.36.26241. View

Strudwick S, Carne C, Gardiner J, Foster J, Davis E, Jones T . Cognitive functioning in children with early onset type 1 diabetes and severe hypoglycemia. J Pediatr. 2005; 147(5):680-5. DOI: 10.1016/j.jpeds.2005.06.010. View

Hershey T, Lillie R, Sadler M, White N . Severe hypoglycemia and long-term spatial memory in children with type 1 diabetes mellitus: a retrospective study. J Int Neuropsychol Soc. 2003; 9(5):740-50. DOI: 10.1017/S1355617703950077. View

Rovet J, Ehrlich R, Hoppe M . Specific intellectual deficits in children with early onset diabetes mellitus. Child Dev. 1988; 59(1):226-34. DOI: 10.1111/j.1467-8624.1988.tb03211.x. View

Jacobson A, Musen G, Ryan C, Silvers N, Cleary P, Waberski B . Long-term effect of diabetes and its treatment on cognitive function. N Engl J Med. 2007; 356(18):1842-52. PMC: 2701294. DOI: 10.1056/NEJMoa066397. View

Holmes C, Richman L . Cognitive profiles of children with insulin-dependent diabetes. J Dev Behav Pediatr. 1985; 6(6):323-6. View

Hannonen R, Tupola S, Ahonen T, Riikonen R . Neurocognitive functioning in children with type-1 diabetes with and without episodes of severe hypoglycaemia. Dev Med Child Neurol. 2003; 45(4):262-8. DOI: 10.1017/s0012162203000501. View

Holmes C, Chen R, Streisand R, Marschall D, Souter S, Swift E . Predictors of youth diabetes care behaviors and metabolic control: a structural equation modeling approach. J Pediatr Psychol. 2005; 31(8):770-84. DOI: 10.1093/jpepsy/jsj083. View

10.

Fox M, Chen R, Holmes C . Gender differences in memory and learning in children with insulin-dependent diabetes mellitus (IDDM) over a 4-year follow-up interval. J Pediatr Psychol. 2003; 28(8):569-78. DOI: 10.1093/jpepsy/jsg047. View

11.

Kaufman F, Epport K, Engilman R, Halvorson M . Neurocognitive functioning in children diagnosed with diabetes before age 10 years. J Diabetes Complications. 1999; 13(1):31-8. DOI: 10.1016/s1056-8727(98)00029-4. View

12.

Ryan C, Vega A, DRASH A . Cognitive deficits in adolescents who developed diabetes early in life. Pediatrics. 1985; 75(5):921-7. View

13.

Holmes C, Dunlap W, Chen R, Cornwell J . Gender differences in the learning status of diabetic children. J Consult Clin Psychol. 1992; 60(5):698-704. DOI: 10.1037//0022-006x.60.5.698. View

14.

Perantie D, Lim A, Wu J, Weaver P, Warren S, Sadler M . Effects of prior hypoglycemia and hyperglycemia on cognition in children with type 1 diabetes mellitus. Pediatr Diabetes. 2008; 9(2):87-95. DOI: 10.1111/j.1399-5448.2007.00274.x. View

15.

McCarthy A, Lindgren S, Mengeling M, Tsalikian E, Engvall J . Effects of diabetes on learning in children. Pediatrics. 2002; 109(1):E9. DOI: 10.1542/peds.109.1.e9. View

16.

Ryan C . Why is cognitive dysfunction associated with the development of diabetes early in life? The diathesis hypothesis. Pediatr Diabetes. 2006; 7(5):289-97. DOI: 10.1111/j.1399-5448.2006.00206.x. View

17.

Crawford S, Kaplan B, Field L . Absence of an association between insulin-dependent diabetes mellitus and developmental learning difficulties. Hereditas. 1995; 122(1):73-8. DOI: 10.1111/j.1601-5223.1995.00073.x. View

18.

Reich J, KASPAR J, Puczynski M, Puczynski S, Cleland J, DellAngela K . Effect of a hypoglycemic episode on neuropsychological functioning in diabetic children. J Clin Exp Neuropsychol. 1990; 12(4):613-26. DOI: 10.1080/01688639008401005. View

19.

Northam E, Anderson P, Jacobs R, Hughes M, Warne G, Werther G . Neuropsychological profiles of children with type 1 diabetes 6 years after disease onset. Diabetes Care. 2001; 24(9):1541-6. DOI: 10.2337/diacare.24.9.1541. View

20.

Rovet J, Ehrlich R, Czuchta D . Intellectual characteristics of diabetic children at diagnosis and one year later. J Pediatr Psychol. 1990; 15(6):775-88. DOI: 10.1093/jpepsy/15.6.775. View