Suchy Yana, Queen Tara L, Huntbach Bryce, Wiebe Deborah J, Turner Sara L, Butner Jonathan, Kelly Caitlin S, White Perrin C, Murray Mary, Swinyard Michael, Berg Cynthia A
1Department of Psychology,University of Utah,Salt Lake City,Utah.
2Psychological Sciences,University of California,Merced,California.
J Int Neuropsychol Soc. 2017 Mar;23(3):204-213. doi: 10.1017/S135561771600103X. Epub 2017 Jan 9.
Good glycemic control is an important goal of diabetes management. Late adolescents with type 1 diabetes (T1D) are at risk for poor glycemic control as they move into young adulthood. For a subset of these patients, this dysregulation is extreme, placing them at risk for life-threatening health complications and permanent cognitive declines. The present study examined whether deficiency in emotional decision making (as measured by the Iowa Gambling Task; IGT) among teens with T1D may represent a neurocognitive risk factor for subsequent glycemic dysregulation.
As part of a larger longitudinal study, a total of 241 high-school seniors (147 females, 94 males) diagnosed with T1D underwent baseline assessment that included the IGT. Glycated hemoglobin (HbA1c), which reflects glycemic control over the course of the past 2 to 3 months, was also assessed at baseline. Of the 241,189 (127 females, 62 males, mean age=17.76, mean HbA1c=8.11) completed HbA1c measurement 1 year later.
Baseline IGT performance in the impaired range (per norms) was associated with greater dysregulation in glycemic control 1 year later, as evidenced by an average increase in HbA1c of 2%. Those with normal IGT scores (per norms) exhibited a more moderate increase in glycemic control, with an HbA1c increase of 0.7%. Several IGT scoring approaches were compared, showing that the total scores collapsed across all trials was most sensitive to change in glycemic control.
IGT assessment offers promise as a tool for identifying late adolescents at increased risk for glycemic dysregulation. (JINS, 2017, 23, 204-213).
良好的血糖控制是糖尿病管理的重要目标。1型糖尿病（T1D）的青少年晚期患者在步入青年期时存在血糖控制不佳的风险。对于这些患者中的一部分人来说，这种调节异常非常严重，使他们面临危及生命的健康并发症和永久性认知衰退的风险。本研究调查了T1D青少年中情绪决策缺陷（通过爱荷华赌博任务；IGT测量）是否可能是随后血糖调节异常的神经认知风险因素。
作为一项更大规模纵向研究的一部分，共有241名被诊断为T1D的高中毕业生（147名女性，94名男性）接受了包括IGT在内的基线评估。在基线时还评估了糖化血红蛋白（HbA1c），它反映了过去2至3个月期间的血糖控制情况。在这241名患者中，189名（127名女性，62名男性，平均年龄=17.76，平均HbA1c=8.11）在1年后完成了HbA1c测量。
基线时IGT表现处于受损范围（根据标准）与1年后血糖控制的更大失调相关，糖化血红蛋白平均增加2%就证明了这一点。IGT评分正常（根据标准）的患者血糖控制的增加更为适度，糖化血红蛋白增加了0.7%。比较了几种IGT评分方法，结果表明所有试验的总分对血糖控制变化最为敏感。
IGT评估有望成为识别血糖调节异常风险增加的青少年晚期患者的一种工具。（《神经心理学杂志》，2017年，23卷，204 - 213页）
