Cognitive function in Indonesian children with type 1 diabetes mellitus
Abstract
Background Children with type 1 diabetes mellitus (T1DM) are at risk of cognitive impairment. While the pathophysiology is still unclear, cognitive impairment in children with T1DM can result in significant negative effects on quality of life.
Objective to evaluate the cognitive function of Indonesian children with T1DM and its association with glycemic control and to identify factors affecting cognitive function in children with T1DM.
Methods The cognitive function of children aged 6 years or older with T1DM was measured using the Wechsler Intelligence Scale for Children-Revised (WISC-R). We analyzed for potential associations between cognitive function and glycemic control based on mean HbA1c levels and other factors, such as the age of onset, duration of illness, and maternal educational attainment. We also identified failure to achieve age-appropriate results on any of the WISC-R subtests (cognitive impairment) and associated factors.
Results A total of 46 subjects were included in this study, with a mean age of 12.8 (SD 3.4) years. There were 27 (58.7%) girls and 19 (41.3%) boys. Subjects’ mean full-scale IQ (FSIQ) was 91.35 (SD 11.43). A moderate negative correlation was found between FSIQ and mean HbA1c levels (r=-0.43; P<0.01). Children with mothers who had university degrees had significantly higher IQs (mean difference 7.39; 95%CI 3.10 to 13.66; P=0.02) than those with mothers without degrees. Failure of any WISC-R subtest was noted in 34 subjects, consisting of 17 verbal, 1 performance, and 34 verbal and performance subtests. A higher proportion of those with cognitive impairment had mean HbA1c >10%. However, compared to those with mean HbA1c ?10, the difference did not reach a statistical significance (OR 5.0; 95%CI 0.95 to 26.31; P=0.50)
Conclusion Glycemic control and maternal educational attainment are associated with cognitive function in Indonesian children with T1DM. Poor glycemic control is also associated with a higher risk of cognitive impairment.
References
2. Ogle GD, James S, Dabelea D, Pihoker C, Svennson J, Maniam J, et al. Global estimates of incidence of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Atlas, 10th edition. Diabetes Res Clin Pract. 2022;183:109083. DOI: https://doi.org/10.1016/j.diabres.2021.109083
3. Abo-el-Asrar M, Andrawes NG, Rabie MA, El-Gabry DA, Khalifa AG, El-Sherif M, et al. Cognitive functions in children and adolescents with early-onset diabetes mellitus in Egypt. Appl Neuropsychol Child. 2018;7:21–30. DOI: https://doi.org/10.1080/21622965.2016.1224186
4. He J, Ryder AG, Li S, Liu W, Zhu X. Glycemic extremes are related to cognitive dysfunction in children with type 1 diabetes: A meta-analysis. J Diabetes Investig. 2018;9(6):1342–53. DOI: https://doi.org/10.1111/jdi.12840
5. Cato A, Hershey T. Cognition and type 1 diabetes in children and adolescents. Diabetes Spectr. 2016;29:197–202. DOI: https://doi.org/10.2337/ds16-0036
6. Blasetti A, Chiuri RM, Tocco AM, Di Giulio C, Mattei PA, Ballone E, et al. The effect of recurrent severe hypoglycemia on cognitive performance in children with type 1 diabetes: A meta-analysis. J Child Neurol. 2011;26:1383–91. DOI: https://doi.org/10.1177/0883073811406730
7. Gaudieri PA, Chen R, Greer TF, Holmes CS. Cognitive function in children with type 1 diabetes. Diabetes Care. 2008;31:1892–7. DOI: https://doi.org/10.2337/dc07-2132
8. Tonoli C, Heyman E, Roelands B, Pattyn N, Buyse L, Piacentini MF, et al. Type 1 diabetes-associated cognitive decline: A meta-analysis and update of the current literature. J Diabetes. 2014;6:499–513. DOI: https://doi.org/10.1111/1753-0407.12193
9. Nevo-Shenker M, Shalitin S. The impact of hypo- and hyperglycemia on cognition and brain development in young children with type 1 diabetes. Horm Res Paediatr. 2021;94:115–23. DOI: https://doi.org/10.1159/000517352
10. Mauras N, Buckingham B, White NH, Tsalikian E, Weinzimer SA, Jo B, et al. Impact of Type 1 Diabetes in the Developing Brain in Children: A Longitudinal Study. Diabetes Care. 2021;44:983–92. DOI: https://doi.org/10.2337/dc20-2125
11. Kaufman AS, Lembaga Pengembangan Sarana Pengukuran dan Pendidikan Psikologi (LPSP3) Universitas Indonesia. Manual Wechsler Intelligence Scale for Children-Revised. Jakarta: LPSP3 Universitas Indonesia; 1998.
12. Gubernur Sumatera Selatan. Keputusan Gubernur Sumatera Selatan Nomor 602/KTPS/Disnakertrans/2020 tentang upah minimum Provinsi Sumatera Selatan Tahun 2021. 2 November 2021.
13. Shalimova A, Graff B, Gasecki D, Wolf J, Sabisz A, Szurowska E, et al. Cognitive dysfunction in type 1 diabetes mellitus. J Clin Endocrinol Metab. 2019;104:2239–49. DOI: https://doi.org/10.1210/jc.2018-01315
14. Kaufman FR, Epport K, Engilman R, Halvorson M. Neurocognitive functioning in children diagnosed with diabetes before age 10 years. J Diabetes Complications. 1999;13:31–8. DOI: https://doi.org/10.1016/s1056-8727(98)00029-4
15. Cato MA, Mauras N, Mazaika P, Kollman C, Cheng P, Ambrosino J, et al. Longitudinal evaluation of cognitive functioning in young children with type 1 diabetes over 18 months. J Int Neuropsychol Soc. 2016;22:293–302. DOI: https://doi.org/10.1017/S1355617715001289
16. Northam EA, Anderson PJ, Werther GA, Warne GL, Adler RG, Andrewes D. Neuropsychological complications of IDDM in children 2 years after disease onset. Diabetes Care, 1998;21:379–84. DOI: https://doi.org/10.2337/diacare.21.3.379
17. Yu K. The effect of family environment on children intelligence. Adv Soc Sci Ed Humanit Res. 2020;496:334-8. DOI: https://doi.org/10.2991/assehr.k.201214.519
18. Rindermann H, Ceci SJ. Parents’ education is more important than their wealth in shaping their children’s intelligence: Results of 19 samples in seven countries at different developmental levels. J Educ Gift. 2018;41:298–326. DOI: https://doi.org/10.1177/0162353218799481
19. da Rosa Piccolo L, Arteche AX, Fonseca RP, Grassi-Oliveira R, Salles JF. Influence of family socioeconomic status on IQ, language, memory and executive functions of Brazilian children. Psicol Reflex e Crit. 2016;29:23. DOI: https://doi.org/10.1186/s41155-016-0016-x
20. Alassaf A, Odeh R, Gharaibeh L, Ibrahim S, Ajlouni K. Impact of socioeconomic characteristics on metabolic control in children with type 1 diabetes in a developing country. J Clin Res Pediatr Endocrinol. 2019;11:358–65. DOI: https://doi.org/10.4274/jcrpe.galenos.2019.2019.0014
21. Al-Odayani AN, Alsharqi OZ, Ahmad AMK, Khalaf Ahmad AM, Al-Borie HM, Qattan AMN. Children’s glycemic control: mother’s knowledge and socioeconomic status. Glob J Health Sci. 2013;5:214–26. DOI: https://doi.org/10.5539/gjhs.v5n6p214
Copyright (c) 2024 Marselya Ulfa, dr., Aditiawati Aditiawati, dr, Yulisnawati Hasanah, dr., Achirul Bakrie, dr., RM Indra, Shafri Dhaini, Mrs.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Accepted 2024-02-23
Published 2024-02-23
