The Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, VIC, Australia; The Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia.
The School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Lancet Child Adolesc Health. 2019 Jun;3(6):427-436. doi: 10.1016/S2352-4642(19)30055-0. Epub 2019 Apr 12.
The effect of type 1 diabetes on the developing brain is a topic of primary research interest. A variety of potential dysglycaemic insults to the brain can cause cellular and structural injury and lead to altered neuropsychological outcomes. These outcomes might be subtle in terms of cognition but appear to persist into adult life. Age and circumstance at diagnosis appear to play a substantial role in potential CNS injury. A history of diabetic ketoacidosis and chronic hyperglycaemia appear to be more injurious than previously suspected, whereas a history of severe hypoglycaemia is perhaps less injurious. Neurocognitive deficits manifest across multiple cognitive domains, including executive function and speed of information processing. Some evidence suggests that subtle brain injury might directly contribute to psychological and mental health outcomes. Impaired executive function and mental health, in turn, could affect patients' adherence and the ability to make adaptive lifestyle choices. Impaired executive functioning creates a potential feedback loop of diabetic dysglycaemia leading to brain injury, further impaired executive function and mental health, which results in suboptimal adherence, and further dysglycaemia. Clinicians dealing with patients with suboptimal glycaemic outcomes should be aware of these potential issues.
1 型糖尿病对大脑发育的影响是主要的研究关注点。多种潜在的血糖紊乱对大脑的影响可能导致细胞和结构损伤，并导致神经心理学结果的改变。这些结果在认知方面可能很细微，但似乎会持续到成年期。诊断时的年龄和情况似乎在潜在的中枢神经系统损伤中起着重要作用。糖尿病酮症酸中毒和慢性高血糖的病史似乎比以前认为的更具危害性，而严重低血糖的病史则可能危害较小。神经认知缺陷表现在多个认知领域，包括执行功能和信息处理速度。有证据表明，轻微的脑损伤可能直接导致心理和心理健康结果受损。执行功能受损和心理健康不良反过来又会影响患者的依从性和适应生活方式选择的能力。执行功能受损会产生一个潜在的糖尿病血糖紊乱导致脑损伤、进一步的执行功能和心理健康受损、导致依从性不佳、以及进一步的血糖紊乱的反馈循环。处理血糖控制不佳的患者的临床医生应该意识到这些潜在问题。
