Original Article
Diabetic Ketoacidosis and Memory Dysfunction in Children with Type 1 Diabetes

https://doi.org/10.1016/j.jpeds.2009.07.054Get rights and content

Objective

We tested the hypothesis that diabetic ketoacidosis (DKA) results in memory deficits typical of hypoxic/ischemic injury because recent studies suggest that cerebral metabolic changes similar to those observed in hypoxic/ischemic cerebral injury are observed in children with DKA, even without symptoms suggesting cerebral injury.

Study design

Thirty-three children with type 1 diabetes mellitus (T1DM) and a history of DKA and 29 children with T1DM without a history of DKA were enrolled from an academic hospital pediatric endocrinology clinic. These groups were comparable on demographic and disease-related variables. These groups' ability to recall events in association with specific details, the memory function most directly affected by mild hypoxia/ischemia, was compared on 2 tasks (ie, event-color associations and event–spatial position associations).

Results

In multivariate analyses controlling for other critical variables, children with DKA history had significantly lower rates of accurate memory on both tasks (mean, 0.34 ± 0.13 on the color task and 0.57 ± 0.15 on the spatial task) than did children without DKA history (mean, 0.44 ± 0.11 and 0.65 ± 0.18, P < .01).

Conclusions

DKA disrupts memory function, underscoring the importance of DKA prevention when T1DM is known and prompt diagnosis of children with new onset of T1DM.

Section snippets

Methods

Patients with T1DM between the ages of 7 and 16 years were recruited from the pediatric endocrinology clinic at the University of California, Davis, Medical Center. The study was approved by the University of California Davis Internal Review Board, and written consent was obtained from the parents or guardians. Patients were eligible for participation if they did not have a history of attention and learning disorders (eg, disorders such as attention deficit hyperactivity disorder and dyslexia,

Results

Sixty-six children with T1DM enrolled in the study; 3 were excluded from the analyses because their pretest blood glucose concentrations were above the specified range (n = 2) or because the IQ score was more then 2 standard deviations below the mean. One additional patient was excluded because his parents elected to end participation before completion of the memory tasks. Descriptive data for the remaining 62 children who comprised the study sample are presented in the Table. None of the

Discussion

The ability to remember specific events along with information about the context in which these events occurred is a fundamental capacity, supporting mundane yet crucial abilities as well as more complex senses such as continuity of self. Our study demonstrated that this capacity is significantly reduced in children with T1DM who had DKA. The nearly identical mean HbA1c levels and frequency of high and low glucose episodes between children with and without a history of DKA suggest that these

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    Supported by a Young Investigator Research Award from the Children's Miracle Network. The authors declare no conflicts of interest.

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