Prevalence of structural central nervous system abnormalities in early-onset type 1 diabetes mellitus.

Abstract

OBJECTIVE:

To characterize the effects of severe hypoglycemia on the developing brain in children with early-onset type 1 diabetes mellitus (T1DM).

STUDY DESIGN:

Children diagnosed with T1DM before age 6 years were studied. Those with prospectively monitored severe hypoglycemia (coma/seizure; n = 32) were compared with age-matched peers (n = 30) with no history of such events using magnetic resonance imaging. Glycemic control (evaluated based on glycated hemoglobin [HbA(lc)] level), episodes of diabetic ketoacidosis (DKA), and clinical variables were monitored continuously since diagnosis in all subjects.

RESULTS:

Mean HbA(lc) from diagnosis and the duration of T1DM were similar in those with and without a history of severe hypoglycemia (9.0% +/- 0.9% vs 8.8% +/- 0.9%; 7.2 +/- 2.7 years vs 6.7 +/- 2.3 years). A high prevalence of central nervous system (CNS) structural abnormalities was detected (29%), and mesial temporal sclerosis (MTS) was detected in 16% of the total sample (n = 62). The presence of MTS was not associated with a history of severe hypoglycemia or DKA. Analysis of brain matter volumes suggested relatively less gray matter density in those subjects with a history of severe hypoglycemia.

CONCLUSIONS:

Early age of onset of T1DM per se is associated with a high incidence of CNS abnormalities, particularly MTS, suggesting hippocampal damage. Early-onset severe hypoglycemia may have an effect on gray matter volume.

• Authors: Margaret S Ho, Narelle J Weller, F Jay Ives, Christine L Carne, Katherine Murray, Rohan I Vanden Driesen, Thai P Nguyen, Peter D Robins, Max Bulsara, Elizabeth A Davis, Timothy W Jones
• Journal: The Journal of pediatrics (J Pediatr) Vol. 153 Issue 3 Pg. 385-90 (Sep 2008) ISSN: 1097-6833 [Electronic] United States
• PMID: 18534238 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Glycated Hemoglobin A

Topics

• Age of Onset
• Central Nervous System Diseases (diagnosis, epidemiology, etiology)
• Child
• Child, Preschool
• Diabetes Mellitus, Type 1 (blood, complications, epidemiology)
• Female
• Follow-Up Studies
• Glycated Hemoglobin (metabolism)
• Humans
• Magnetic Resonance Imaging
• Male
• Prevalence
• Prognosis
• Prospective Studies
• Risk Factors
• Time Factors
• Western Australia (epidemiology)