Proteinuria Independently Related to Stroke in Type 1 Diabetes

Several possible illness-related neuropathological processes, including gliosis, demyelination, and altered osmolarity, can develop in young Type 1 diabetes patients 12 years after

Several possible illness-related neuropathological processes, including gliosis, demyelination, and altered osmolarity, can develop in young Type 1 diabetes patients 12 years after diagnosis.

Dr. Elisabeth A. Northam of the University of Melbourne, Australia, writes, “There is a growing body of literature documenting pathophysiological CNS changes and neurocognitive deficits in adults with Type 1 diabetes as sometimes, but not universally, linked to specific illness variables such as disease duration or history of severe hypoglycemia or chronic hyperglycemia.”

“Cognitive difficulties have also been reported in children, with deficits most evident in those with early-onset (<5 years old) disease," they note. "Neuroimaging studies of youth have been limited to date and understanding of the impact of Type 1 diabetes on neurodevelopment is still based largely on inferences drawn from neurocognitive studies and from adult neuroimaging reports."

The researchers previously identified neurocognitive deficits 6 years after the diagnosis of Type 1 diabetes onset in youth studied prospectively from diagnosis. In the current study, they reevaluated this cohort 12 years after study inception. Neurocognitive assessment and neuroimaging were used to examine brain function in 106 youth with Type 1 diabetes and 75 control subjects.

Verbal (p = 0.03) and full scale IQs (p = 0.05) were lower among patients with Type 1 diabetes than among controls. Compared with control subjects, those with Type 1 diabetes had lower N-acetylaspartate in frontal lobes and basal ganglia and higher myoinositol and choline in frontal and temporal lobes and basal ganglia.

Gray matter was decreased in bilateral thalami and right parahippocampal gyrus and insular cortex in diabetic subjects. Patients with diabetes also had decreased white matter in bilateral parahippocampi, left temporal lobe, and middle frontal area.

Among diabetics, there was an increase in T2 relaxation times in left superior temporal gyrus and a decrease in bilateral lentiform nuclei, caudate nuclei and thalami, and right insular area.

The investigators note that early-onset disease was predictive of lower performance IQ and full scale IQ. An association was observed between hypoglycemia and lower verbal IQ and reduced gray matter volume in the thalamus. Poor metabolic control predicted elevated myoinositol in basal ganglia and decreased T2 in the thalamus. Older age predicted volume loss and altered T2.

Dr. Northam’s team explained that, .”It is possible that specific illness variables exert different effects on the CNS, but inconsistent associations may also reflect difficulties in obtaining reliable and comprehensive metabolic control histories, including documentation of diabetes complications.”

Diabetes Care 2009;32:445-450.

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  and children of color are at higher risk, according to new research. Obese children are at risk for early onset of diabetes, fatty liver and musculoskeletal problems. Researchers calculated the body mass index from a sample of 8,550 Hispanic, black, white, Asian and Native American 4-year-olds. The children were born in 2001, and in 2005, their height and weight were measured — 18.4 percent of them were obese. “Significant differences in the prevalence of obesity between racial/ethnic groups were evident at 4 years of age. Using body mass index, they found that 31.2 percent of American Indian/Native Alaskans, 22 percent of Hispanics, 20.8 percent of blacks, 15.9 percent of whites and 12.8 percent of Asians were obese. According to data from the Centers for Disease Control and Prevention, adults fare no better. Approximately 45 percent of blacks, 36.8 percent of Mexican Americans and 30 percent of whites are obese.

Archives of Pediatrics and Adolescent Medicine, April, 2009.