Kirchhoff Brenda A, Jundt Dustin K, Doty Tasha, Hershey Tamara
Department of Psychology, Saint Louis University, Missouri.
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
Pediatr Diabetes. 2017 Sep;18(6):443-449. doi: 10.1111/pedi.12414. Epub 2016 Jul 22.
Cross-sectional studies find altered cognition in youth with type 1 diabetes mellitus (T1DM). However, few longitudinal studies have examined the trajectories of their cognitive performance over time. The aims of this study were to explore longitudinal change in cognitive function in youth with T1DM as compared with nondiabetic sibling controls, and how glycemic control and age of onset influence cognitive performance over time.
We assessed crystallized intelligence, visual-spatial ability, delayed memory, and processing speed at 3 time points using the same cognitive tasks in youth with T1DM and sibling controls. Hierarchical linear modeling examined relationships between diabetes, hyperglycemia (HbA1c values), age of onset, and cognition over 5.5 y.
Youth with diabetes performed worse than controls on visual-spatial ability and memory tasks over time, and did not improve as much in processing speed. Greater hyperglycemia was associated with lower crystallized intelligence and slower processing speed but better memory across all time points. There was a stronger negative relationship between hyperglycemia and visual-spatial ability for youth with earlier compared with later onset diabetes. Importantly, within-person decreases in hyperglycemia between time points were associated with improved visual-spatial ability and faster processing speed.
On average, differences in cognitive function between youth with T1DM and nondiabetic relatives are maintained or increase during childhood and adolescence. Hyperglycemia and age of onset can have negative effects on the developmental trajectories of cognitive processes in youth with T1DM. However, treatments that lower hyperglycemia may lead to improved cognitive function in youth with T1DM.
横断面研究发现1型糖尿病（T1DM）青少年存在认知改变。然而，很少有纵向研究考察其认知表现随时间的变化轨迹。本研究的目的是探讨与非糖尿病同胞对照相比，T1DM青少年认知功能的纵向变化，以及血糖控制和发病年龄如何随时间影响认知表现。
我们使用相同的认知任务，在3个时间点评估了T1DM青少年及其同胞对照的晶体智力、视觉空间能力、延迟记忆和处理速度。分层线性模型研究了糖尿病、高血糖（糖化血红蛋白值）、发病年龄与5.5年期间认知之间的关系。
随着时间的推移，患有糖尿病的青少年在视觉空间能力和记忆任务上的表现比对照组差，并且在处理速度上的改善也不如对照组。更高的高血糖与更低的晶体智力、更慢的处理速度相关，但在所有时间点的记忆更好。与发病较晚的青少年相比，发病较早的青少年高血糖与视觉空间能力之间的负相关更强。重要的是，时间点之间个体内高血糖的降低与视觉空间能力的改善和处理速度的加快相关。
平均而言，T1DM青少年与非糖尿病亲属之间的认知功能差异在儿童期和青少年期保持或增加。高血糖和发病年龄可能对T1DM青少年认知过程的发育轨迹产生负面影响。然而，降低高血糖的治疗可能会导致T1DM青少年认知功能的改善。
