부산대학교 도서관

There is continued debate over the relationship of severe hypoglycemia (SH) and/or hyperglycemia to the modest cognitive impairment commonly found in children and adolescents with T1DM. We examined a large, well-characterized sample of 5-16 year old T1DM (n=117) and non-diabetic sibling controls (n=58) to determine the relationship of previons SH and hyperglycemia to cognitive performance. Subjects were given cognitive tasks sampling relevant domains, including verbal and spatial intelligence (General Intelligence and Spatial Relations, WJ-III), verbal and spatial memory (Word Lists and Dot Recall, CMS, and Spatial Delayed Response Task), and processing speed (simple reaction time task, Go No Go). T1DM subjects were categorized as having experienced 0, 1-2, or 3 or more (3+) SH episodes and as having their first SH episode before or after 5 years of age. Exposure to hyperglycemia was estimated using median HbA1c weighted for the duration of T1DM (wt-A1c). Analyses showed that subjects with T1DM had significantly lower verbal intelligence (p=.02) than non-diabetic siblings. Within the T1DM group, verbal intelligence was significantly lower (p=.02) with increased wt-A1c, but not with repeated SH. In contrast, spatial intelligence and delayed recall (p's=.02 and .01, respectively) were significantly lower with repeated SH, but not hyperglycemia. This pattern was particularly strong (p=.01) when SH episodes occurred before age 5. In conclusion, a history of SH (particularly when experienced early) and hyperglycemia are differently related to cognitive outcome in T1DM. These results reinforce the importance of avoiding both SH and chronic hyperglycemia in T1DM, particularly during the developmental stages of early childhood. [ABSTRACT FROM AUTHOR]