Study: Better Blood Sugar Control in Teens Limits Diabetes-Related Brain Damage

Cognitive harm appears reversible, results of analysis by Nemours Children’s Health Jacksonville and Stanford University shows.

Better glucose control can improve brain structure and function in adolescents with type 1 diabetes (T1D), reducing the disease’s damaging cognitive effects, according to the results of a study published in Nature Communications.

Investigators from Nemours Children’s Health Jacksonville, and Stanford University of Medicine led the study.

“These results offer hope that harm to the developing brain from [T1D] might be reversible with rigorous glucose control,” Nelly Mauras, MD, pediatric endocrinologist at Nemours Children’s Health Jacksonville and professor of pediatrics at Mayo Clinic College of Medicine, said in a statement. “Use of an automated hybrid closed-loop system, an insulin delivery system linked to a continuous glucose monitor, was associated with better blood glucose concentrations, which translated in our study to quantifiable differences in brain structure and cognition.”

Investigators followed a cohort of children with and without diabetes from Diabetes Research in Children Network (DirecNet). DirecNet was funded by the National Institutes of Health and followed children for approximately 8 years. The DirecNet studies added to evidence that children and adolescents with diabetes undergo changes in the brain, including causing below-normal IQ, and linked to high blood sugar.

Investigators recruited 24 adolescents aged 14 to 17 years who were diagnosed with T1D before aged 8 years and were receiving insulin therapy. The individuals were randomized into 2 groups: 1 using a hybrid closed-loop insulin delivery system and the other receiving standard diabetes care.

Cognitive assessments and multi-modal brain imaging with all individuals were conducted before and after the 6-month study period.

Investigators found that individuals using the hybrid closed-loop glucose control system showed significantly greater improvement than the standard of care group in key brain metrics, which indicated normal brain development.

Additionally, those in the hybrid closed-loop group showed higher cognitive IQ outcomes and functional brain activity, which was more in line with adolescent brain development for those who did not have T1D.

A hybrid closed-loop insulin delivery system can increase the amount of time when blood sugar is in a healthy range, particularly helping to stabilize blood sugar during sleep. It uses a close glucose monitor (CGM), which measures blood sugar every 5 minutes through a sensor under the skin and connects wirelessly to an insulin pump that adjusts the amount of insulin based on the latest reading.

“We have known for some time that better control of blood glucose levels in [individuals] with [T1D] can prevent or reduce damage to a number of biological systems, for example, kidney, eyes, nerves, blood vessels. Our new research joins with other studies to highlight that better control of blood glucose levels in children with [T1D] can potentially reduce injury to the maturing brain and lead to measurable improvements in brain development and function as well,” Allan Reiss, MD, the Howard C. Robbins professor of psychiatry and behavioral Sciences and a professor of radiology at Stanford University, said in the statement.

Reference

Better blood sugar control in teens may limit diabetes-related brain damage. News release. EurekAlert. August 30, 2022. Accessed August 31, 2022. https://www.eurekalert.org/news-releases/963327