Understanding the Diabetic Brain: New Technologies but Old Challenges
- 1Department of Psychology, Royal Children’s Hospital, Melbourne, Australia
- 2Murdoch Childrens Research Institute, Melbourne, Australia
- 3Department of Psychology, The University of Melbourne, Melbourne, Australia
- 4Department of Endocrinology and Diabetes, Royal Children’s Hospital, Melbourne, Australia
- 5Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Corresponding author: Elisabeth A. Northam, .
Does type 1 diabetes damage the developing brain or not? If so, how and when does this occur, and which brain regions are most vulnerable? These questions have come under increasing scrutiny in the last 20 years as improved technologies and greater success in reducing traditional diabetes complications have allowed us to broaden our therapeutic goals. Many (including the authors) would argue that optimal neural ontogeny is the primary developmental task of childhood and adolescence, as this more than anything else defines our adulthood. The brain is not included in that long list of organ systems that can be repaired or transplanted. Thus, arguably the preeminent measure of the impact of any chronic disease is how it may affect the brain. All the more so when that disease disrupts glucose homeostasis and interferes with the brain’s primary metabolic fuel supply.
Recent meta-analysis reviews (1,2) have confirmed subtle decrements in overall IQ in children with type 1 diabetes, as well as in specific skills such as attention, information processing speed, and higher-order executive skills, which are most evident in those with early-onset (<5 years of age) disease. Lower academic achievement in children with type 1 diabetes compared with healthy peers highlights the functional implications of these cognitive deficits (3,4). Thus, although there is now reasonable consensus that cognitive deficits do …