Cognitive flexibility is associated with the age of onset and duration among patients with type 1 diabetes

Abstract

Cognitive impairment is a recognized risk in patients with type 1 diabetes, yet its contributing factors and overall impact remain insufficiently understood. This study aimed to explore the relationships between specific cognitive functions-namely memory, attention, and cognitive flexibility-and clinical characteristics, including age of onset and diabetes duration, as well as glycemic factors, such as glycemic control and extreme glycemic events, in a cohort of 331 patients with type 1 diabetes. Cognitive performance was assessed using the Wechsler Memory Scale, Wisconsin Card Sorting Test, and the Sustained Attention to Response Task. Network analysis revealed that age of onset and diabetes duration were central nodes in the network, strongly influencing cognitive flexibility. Additionally, age of onset was associated with a history of severe hypoglycemia, while diabetes duration was linked to visual memory decline. Significant differences were observed between the network structures of the adult-onset and childhood-onset groups, with the childhood-onset group showing greater interconnectedness. These findings emphasize the critical impact of age of onset and disease duration on cognitive outcomes in type 1 diabetes. Longitudinal studies are needed to further understand these relationships and guide targeted interventions to preserve cognitive function.

Keywords: Age of diabetes onset; Cognitive function; Duration; Glycemic fluctuation; Type 1 diabetes.

Fig. 1

The estimated network with cognitive functions and clinical-glycemic characteristics is shown (a). Each circular node represents a clinical-glycemic characteristics or a score of cognitive testing. The edge (line) connecting nodes represents partial polychoric correlations, with thicker, more saturated edges denoting stronger connections, blue edges denoting positive relationships, and red edges denoting negative relationships. The centrality indices, including strength and expected influence (EI), are shown as standardized z scores. (b). Nodes with high strength play a critical role in shaping the relationships among other nodes, while nodes with high expected influence have more positive connections to other nodes. The bridge strength and bridge expected influence of each node is shown as a standardized z score (c).

Fig. 2

Estimated networks with cognitive functions and diabetes-related variables are shown. (a: Childhood-onset group; b: Adult-onset group). The centrality indices, including strength and expected influence (EI), are shown as standardized z scores. (c: Blue-Childhood-onset group; Red-Adult-onset group). Each circular node represents a diabetes-related variable or a score of cognitive testing. The edge (line) connecting nodes represents partial polychoric correlations, with thicker, more saturated edges denoting stronger connections, blue edges denoting positive relationships, and red edges denoting negative relationships. Nodes with high strength play a critical role in shaping the relationships among other nodes, while nodes with highexpected influence have more positive connections to other nodes.

Fig. 3

Estimated networks with cognitive functions and diabetes-related variables are shown. (a: Child group; b: Adult group). The centrality indices, including strength and expected influence (EI), are shown as standardized z scores. (c: Blue-Child group; Red-Adult group). Each circular node represents a diabetes-related variable or a score of cognitive testing. The edge (line) connecting nodes represents partial polychoric correlations, with thicker, more saturated edges denoting stronger connections, blue edges denoting positive relationships, and red edges denoting negative relationships. Nodes with high strength play a critical role in shaping the relationships among other nodes, while nodes with high expected influence have more positive connections to other nodes.