Prevalence of Structural Central Nervous System Abnormalities in Early-Onset Type 1 Diabetes Mellitus.
Ho, Margaret S. BA (Hons) a,c; Weller, Narelle J. BappSc a,c; Ives, F. Jay MBChB, FRANZCR e; Carne, Christine L. BSc, PGDip (Paediatrics), GradCert (Diab Educ) c; Murray, Katherine BSc, PGDip HSc, GradDip (Diet) c; vanden Driesen, Rohan I. FRANZCR f; Nguyen, Thai P. MBBS, FRANZCR d; Robins, Peter D. MBBS e,g; Bulsara, Max MSc a,b; Davis, Elizabeth A. FRACP a,c; Jones, Timothy W. MD, FRACP a,c
[Article]
Journal of Pediatrics.
153(3):385-390, September 2008.
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Objective: To characterize the effects of severe hypoglycemia on the developing brain in children with early-onset type 1 diabetes mellitus (T1DM).
Study design: Children diagnosed with T1DM before age 6 years were studied. Those with prospectively monitored severe hypoglycemia (coma/seizure; n = 32) were compared with age-matched peers (n = 30) with no history of such events using magnetic resonance imaging. Glycemic control (evaluated based on glycated hemoglobin [HbAlc] level), episodes of diabetic ketoacidosis (DKA), and clinical variables were monitored continuously since diagnosis in all subjects.
Results: Mean HbAlc from diagnosis and the duration of T1DM were similar in those with and without a history of severe hypoglycemia (9.0% /- 0.9% vs 8.8% /- 0.9%; 7.2 /- 2.7 years vs 6.7 /- 2.3 years). A high prevalence of central nervous system (CNS) structural abnormalities was detected (29%), and mesial temporal sclerosis (MTS) was detected in 16% of the total sample (n = 62). The presence of MTS was not associated with a history of severe hypoglycemia or DKA. Analysis of brain matter volumes suggested relatively less gray matter density in those subjects with a history of severe hypoglycemia.
Conclusions: Early age of onset of T1DM per se is associated with a high incidence of CNS abnormalities, particularly MTS, suggesting hippocampal damage. Early-onset severe hypoglycemia may have an effect on gray matter volume.
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