Ghetti Simona, Kuppermann Nathan, Rewers Arleta, Myers Sage R, Schunk Jeff E, Stoner Michael J, Garro Aris, Quayle Kimberly S, Brown Kathleen M, Trainor Jennifer L, Tzimenatos Leah, DePiero Andrew D, McManemy Julie K, Nigrovic Lise E, Kwok Maria Y, Perry Clinton S, Olsen Cody S, Casper T Charles, Glaser Nicole S
Department of Psychology, University of California, Davis, Davis, CA
Center for Mind and Brain, University of California, Davis, Davis, CA.
Diabetes Care. 2020 Nov;43(11):2768-2775. doi: 10.2337/dc20-0187. Epub 2020 Sep 22.
This study assessed whether a single diabetic ketoacidosis (DKA) episode is associated with cognitive declines in children with newly diagnosed type 1 diabetes and whether the same is true in children who had previously been diagnosed after accounting for variations in glycemic control and other relevant factors.
We prospectively enrolled 758 children, 6-18 years old, who presented with DKA in a randomized multisite clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 430 children and mild in 328 children. A total of 392 children with DKA had new onset of type 1 diabetes, and the rest were previously diagnosed. Neurocognitive assessment occurred 2-6 months after the DKA episode. A comparison group of 376 children with type 1 diabetes, but no DKA exposure, was also enrolled.
Among all patients, moderate/severe DKA was associated with lower intelligence quotient (IQ) (β = -0.12, < 0.001), item-color recall (β = -0.08, = 0.010), and forward digit span (β = -0.06, = 0.04). Among newly diagnosed patients, moderate/severe DKA was associated with lower item-color recall (β = -0.08, = 0.04). Among previously diagnosed patients, repeated DKA exposure and higher HbA were independently associated with lower IQ (β = -0.10 and β = -0.09, respectively, < 0.01) and higher HbA was associated with lower item-color recall (β = -0.10, = 0.007) after hypoglycemia, diabetes duration, and socioeconomic status were accounted for.
A single DKA episode is associated with subtle memory declines soon after type 1 diabetes diagnosis. Sizable IQ declines are detectable in children with known diabetes, suggesting that DKA effects may be exacerbated in children with chronic exposure to hyperglycemia.
本研究评估单次糖尿病酮症酸中毒（DKA）发作是否与新诊断的1型糖尿病儿童的认知能力下降有关，以及在考虑血糖控制和其他相关因素的差异后，既往已确诊的儿童是否也如此。
我们前瞻性地招募了758名6至18岁的儿童，这些儿童在一项评估DKA治疗静脉输液方案的随机多中心临床试验中出现了DKA。430名儿童的DKA为中度/重度，328名儿童的DKA为轻度。共有392名DKA儿童为1型糖尿病新发病例，其余为既往已确诊病例。在DKA发作后2至6个月进行神经认知评估。还招募了376名1型糖尿病但未暴露于DKA的儿童作为对照组。
在所有患者中，中度/重度DKA与较低的智商（IQ）（β = -0.12，P < 0.001）、物品 - 颜色回忆（β = -0.08，P = 0.010）和顺背数字广度（β = -0.06，P = 0.04）相关。在新诊断的患者中，中度/重度DKA与较低的物品 - 颜色回忆（β = -0.08，P = 0.04）相关。在既往已确诊的患者中，在考虑低血糖、糖尿病病程和社会经济地位后，反复暴露于DKA和较高的糖化血红蛋白（HbA）分别独立与较低的智商相关（β分别为 -0.10和β = -0.09，P < 0.01），且较高的HbA与较低的物品 - 颜色回忆相关（β = -0.10，P = 0.007）。
单次DKA发作与1型糖尿病诊断后不久的细微记忆下降有关。在已知患有糖尿病的儿童中可检测到明显的智商下降，这表明长期暴露于高血糖的儿童中DKA的影响可能会加剧。
