Cognitive function following diabetic ketoacidosis in young children with type 1 diabetes

Abstract

Introduction: Young children with type 1 diabetes (T1D) may be at particularly high risk of cognitive decline following diabetic ketoacidosis (DKA). However, studies of cognitive functioning in T1D typically examine school-age children. The goal of this study was to examine whether a single experience of DKA is associated with lower cognitive functioning in young children. We found that recently diagnosed 3- to 5-year-olds who experienced one DKA episode, regardless of its severity, exhibited lower IQ scores than those with no DKA exposure.

Methods: We prospectively enrolled 46 3- to 5-year-old children, who presented with DKA at the onset of T1D, in a randomized multi-site clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 22 children and mild in 24 children. Neurocognitive function was assessed once 2-6 months after the DKA episode. A comparison group of 27 children with T1D, but no DKA exposure, was also assessed. Patient groups were matched for age and T1D duration at the time of neurocognitive testing.

Results: Children who experienced DKA, regardless of its severity, exhibited significantly lower IQ scores than children who did not experience DKA, F(2, 70) = 6.26, p = .003, partial η² = .15. This effect persisted after accounting for socioeconomic status and ethnicity.

Conclusions: A single DKA episode is associated with lower IQ scores soon after exposure to DKA in young children.

Keywords: cognitive function; diabetic ketoacidosis; early childhood; intelligence; type 1 diabetes.

FIGURE 1

Intellectual quotient (IQ) score as a function of DKA status. Mean levels and standard errors around the means are reported. Children who did not experience DKA exhibited significantly higher IQ scores than children who experienced either mild or moderate/severe DKA (ps < .05). This analysis adjusts for SES and ethnicity.