Keeping blood sugars within a tight target range is not exactly easy for people with diabetes. Fears about different diabetes-related complications, like kidney damage, heart disease, and retinopathy, are frequent among PWD and their loves ones, and these complications are often discussed by medical teams.
But what about how diabetes affects the brain? A few studies from the 2004-2006 showed reduction in grey and white brain matter and that higher lifetime A1C, length of diabetes and severe hypoglycemia affect the reduction.1 (For info on grey and white matter, see here.) The brain continues developing and maturing until the average age of 25 years old2, with its most rapid development before the age of 5.3
Given the concerns that past studies raised, researchers at six academic centers across the U.S. conducted a study to focus on diabetes and brain development.1 There were 144 children with type 1 diabetes aged 4-9 years at the start of the study who did not have other cognitive or developmental issues.1 The participants of the study underwent cognitive testing, MRIs, physical exams, and their CGM and A1C data was provided to the researchers.1 The study went on for up to six years, with hopes of tracking changes over time and through varying developmental stages.1
The results showed hyperglycemia and age of diagnosis as the most significant risk factors for neurocognitive deficits.1 Dr. Bruce Buckingham, one of the investigators at Stanford University, stated that, “Despite the fear of hypoglycemia causing neurocognitive impairment, in this study there was no correlation with clinical and glycemic metrics of hypoglycemia and neurocognitive changes.”
Dr. Buckingham goes on to say, “Neurocognitive changes were observed with an overall 4% change in global IQ, but it is unknown if these changes are reversible. The average percent time in range was 45%, and the percent time >180 mg/dl was 50%. With the development of automated insulin delivery systems there are significant improvements in these metrics of hyperglycemia with the time in range increasing to over 70%, and the percent time >180 has been cut in half to about 25% of the time.”
The authors state that the data from this study supports the theory that the brain is possibly affected negatively by a diagnosis of diabetes in young children.1 They also state that further and more long-term studies should be completed to see if the changes can be avoided with tight glucose control, if the changes are reversible, and possibly to change the targets for young children with diabetes to be more aggressive.1
As with most studies on how diabetes can affect peoples’ bodies, the focus should be on what is (relatively) in our control. Sometimes it feels like we can’t control much, but the reality is that diabetes management has many options for personalization, so finding tools and tricks to make diabetes easier and less intrusive can be done. CWD encourages more people to access and utilize the latest technologies, which can help decrease burden and increase time in range. For more information on the closed-loop systems that are available, check out these from some of our partners:
CWD would like to extend a big thank you to Dr. Buckingham for your contribution to this article. Dr. Buckingham has done so much for us as people with diabetes and continues to work tirelessly to make the lives of PWD and their families better.
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES