New research led from UC Davis is part of a national consortium studying connections between Type 1 diabetes and cognitive decline in children.
With a $2.5 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases, Simona Ghetti, a professor of psychology in the College of Letters and Science, and Nicole Glaser, a pediatric endocrinologist at UC Davis Health, are building on their research on diabetic ketoacidosis in children.
“Well-controlled Type 1 diabetes does not necessarily result in cognitive difficulties,” said Ghetti, “but there are several complications of diabetes that might alter the brain metabolism to the point that it might really have long-term consequences.”
Type 1 diabetes in children and problems with cognition
Symptoms of diabetic ketoacidosis from Type 1 diabetes
In the U.S., Type 1 diabetes affects roughly 185,000 children and adolescents under 20 years old. Symptoms of Type 1 diabetes can come on quickly. Resulting diabetic ketoacidosis can be a life-threatening emergency with symptoms that include:
- Nausea or vomiting
- Stomach pain
- Breathing very rapidly/ feeling short of breath
- Being very tired and weak without an obvious cause
- Confusion or inability to think normally
- Dry skin and mouth
- Flushed (red) face
- Fruity-smelling breath
Type 1 diabetes is a medical condition in which the body can’t make the insulin it needs to move blood sugar into cells to use as energy. Instead, blood sugar stays in the bloodstream and causes damage to the body. People are born predisposed to this condition, but it develops sometime after birth, usually during childhood. It can’t be changed and requires synthetic insulin every day to stay healthy.
“Diabetes is a diagnosis that can be easily missed because early symptoms are so subtle,” said Glaser, a professor in the Department of Pediatrics at UC Davis health, where she is chief of the Division of Pediatric Endocrinology and Dean’s Endowed Professor for Childhood Diabetes Research.
Glaser said that parents should look out for increased thirst, increased urination, unexplained weight loss or a lack of weight gain.
Diabetic ketoacidosis is one way that Type 1 diabetes might hurt children’s cognitive function. This condition happens when the body breaks down fat for energy as a replacement for blood sugar and leaves behind a buildup of ketones, a type of acid. This ketone buildup might cause inflammation in the brain that changes the way it functions.
“If you don’t notice fruity breath or another symptom of diabetes, children may progress without getting insulin for weeks and can develop diabetic ketoacidosis, which can cause damage to the brain and be life-threatening,” said Ghetti.
A research consortium study to leave no stone unturned
Ghetti and Glaser are leading the new study as part of a national research consortium funded by the National Institute of Diabetes and Digestive and Kidney Diseases. UC Davis is one of 13 sites that will follow about 1,000 children from several children’s hospitals in the U.S. for two years.
The research teams are diverse and will explore factors that range from variability in blood sugar levels and changes in markers of inflammation to whether children get enough sleep or have access to diabetes care. Each aspect of the project will take a different approach to understanding how Type 1 diabetes contributes to neurocognitive difficulties in children. This will be the first large-scale study to follow children with Type 1 diabetes over time to see how they progress in their neuro-cognitive development.
“There's a lot of different expertise and hopefully we will not miss anything that is important,” said Ghetti. “When you do a study this big, you don't want to miss anything because this is a one-time opportunity.”
Ghetti and Glaser are building on their years of collaborative research related to diabetic ketoacidosis. In 2020, they published the results of a randomized controlled trial that included nearly 800 children from 6-18 years old to compare cognition between diabetic children with and without diabetic ketoacidosis.
Children with who experienced a single episode of diabetic ketoacidosis had a slightly lower intelligence quotient (IQ). They also had more trouble with a task remembering the colors of items and with remembering and repeating numbers back in order.
“Once we better understand these factors, we can develop ways to address them to prevent cognitive decline,” said Glaser.
A consortium of research on Type 1 diabetes and child cognition
This research is part of a national consortium funded by the National Institute of Diabetes and Digestive and Kidney Diseases and includes research teams from:
- Indiana University-Purdue University Indianapolis
- Joslin Diabetes Center
- Nemours Children’s Clinic
- New York University School of Medicine
- University of California, Davis
- University of Colorado Denver
- University of Minnesota
- University of North Carolina at Chapel Hill
- University of Florida
- University of Southern California
- Vanderbilt University Medical Center
- Washington University in St. Louis