Childhood Type I Diabetes: Brain White Matter Changes

Naama Barnea-Goraly M.D. Center for Interdisciplinary Brain Sciences Research Stanford Interview with:
Naama Barnea-Goraly M.D.
Center for Interdisciplinary Brain Sciences Research
Stanford University What are the main findings of the study?

Answer: Our main findings showed that compared with age and sex matched controls, children with type 1 diabetes have significant differences in white matter structure in widespread brain regions. Within the type 1 diabetes group, earlier onset of diabetes and longer duration were associated with greater alterations in white matter structure. In addition, measures of hyperglycemia and glucose variability, but not hypoglycemia were associated with white matter structure; however, hypoglycemia exposure and the number of severe hypoglycemia events in our sample were too small to identify statistically meaningful differences. Finally, we observed a significant association between white matter structure and cognitive ability in children with type 1 diabetes, but not in controls. Were any of the findings unexpected?

Answer: The findings were what we had hypothesized based on previous observations in smaller samples. However, unlike previous studies, our study used continuous glucose monitors which allowed us to measure the blood sugars continuously every five minutes for up to 6 days and provided a more accurate measures of dysglycemia. Our results showed that beyond the previously observed effects of hyperglycemia on white matter structure, glucose fluctuations (as measured by standard deviation of glucose and Mean Amplitude of Glycemic Excursions, MAGE) also were associated with white matter structure in children with type 1 diabetes. What should clinicians and patients take away from your report?

Answer: Fear of hypoglycemia in young children with type 1 diabetes often results in caregivers maintaining relatively higher blood glucose levels to avoid lows altogether. However, our study suggests that this approach, which often results in hyperglycemia, may not be optimal and may be detrimental to white matter structure development in young children. What recommendations do you have for future research as a result of this study?

hyperglycemia It is still unknown whether better glucose control would eliminate structural brain differences between children with T1D and controls. Longitudinal studies of how brain changes with age would be important to show how brain structure and cognition change in children with type 1 diabetes as they go through puberty and beyond.


Naama Barnea-Goraly, Mira Raman, Paul Mazaika, Matthew Marzelli, Tamara Hershey, Stuart A. Weinzimer, Tandy Aye, Bruce Buckingham, Nelly Mauras, Neil H. White, Larry A. Fox, Michael Tansey, Roy W. Beck, Katrina J. Ruedy, Craig Kollman, Peiyao Cheng, Allan L. Reiss, and for the Diabetes Research in Children Network (DirecNet)*

Alterations in White Matter Structure in Young Children With Type 1 Diabetes
Diabetes Care published ahead of print December 6, 2013, doi:10.2337/dc13-1388