Ferguson Stewart C, Blane Annette, Wardlaw Joanna, Frier Brian M, Perros Petros, McCrimmon Rory J, Deary Ian J
Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, Scotland, U.K.
Diabetes Care. 2005 Jun;28(6):1431-7. doi: 10.2337/diacare.28.6.1431.
Children who develop type 1 diabetes before age 7 years (early-onset diabetes; EOD) have comparatively poorer cognitive abilities. Whether this relates to psychosocial consequences of chronic illness or organic factors related to diabetes and its complications remains unresolved. We hypothesized that if differences in neuroradiological structure and cognitive ability coexisted in those who had EOD, then an organic component to their etiology was likely.
A cohort of 71 young adults with long-duration type 1 diabetes diagnosed during childhood or adolescence participated in a cross-sectional evaluation of cognitive ability (neuropsychological test battery) and brain structure (magnetic resonance imaging). Diabetes onset age, preceding severe hypoglycemia exposure, retinopathy status, and diabetes duration were examined as potential correlates of cognitive and neuroradiological differences. No participants had previous neuropsychological pathology.
In EOD participants (n = 26), current intellectual ability (Wechsler Adult Intelligence Scale-Revised performance IQ; P = 0.03) and information processing ability (Choice Reaction Time; P = 0.006) were comparatively poorer than was observed in those with later- onset diabetes (n = 45). Furthermore, lateral ventricular volumes were 37% greater (P = 0.002) and ventricular atrophy was more prevalent (61 vs. 20%; P = 0.01) in the EOD group than in those who had later-onset type 1 diabetes.
An early childhood onset of type 1 diabetes was associated with mild central brain atrophy and significant differences in intellectual performance in adulthood, implying that neurodevelopment may be adversely affected by EOD. The differences observed in brain structure support an organic contribution to their etiology but do not exclude a coexistent contribution of psychosocial factors.
7岁前患1型糖尿病的儿童（早发性糖尿病；EOD）认知能力相对较差。这是与慢性病的心理社会后果相关，还是与糖尿病及其并发症的器质性因素相关，仍未明确。我们推测，如果EOD患者同时存在神经放射学结构差异和认知能力差异，那么其病因可能存在器质性成分。
一组71名在儿童期或青少年期被诊断为长期1型糖尿病的年轻成年人参与了认知能力（神经心理测试组）和脑结构（磁共振成像）的横断面评估。研究考察了糖尿病发病年龄、既往严重低血糖暴露情况、视网膜病变状态和糖尿病病程，作为认知和神经放射学差异的潜在相关因素。所有参与者既往均无神经心理病理学病史。
在EOD参与者（n = 26）中，当前智力能力（韦氏成人智力量表修订版操作智商；P = 0.03）和信息处理能力（选择反应时；P = 0.006）相较于晚发性糖尿病患者（n = 45）相对较差。此外，EOD组的侧脑室容积比晚发性1型糖尿病患者大37%（P = 0.002），脑室萎缩更普遍（61%对20%；P = 0.01）。
儿童期早发性1型糖尿病与成年期轻度脑中央萎缩及智力表现的显著差异相关，这意味着神经发育可能受到EOD的不利影响。观察到的脑结构差异支持其病因存在器质性因素，但不排除心理社会因素的共存作用。
