Summary: Children diagnosed with type 1 diabetes show slower growth in total cortical and subcortical gray and white matter compared with children without diabetes.
Study overview and key finding
Source: NEMOURS
A multisite study led in part by Dr. Nelly Mauras at Nemours Children’s Health System in Jacksonville, Florida, reports that children with early-onset type 1 diabetes (T1D) experience slower brain growth in regions linked to cognitive function than peers without diabetes. The research—presented at the American Diabetes Association’s 79th Scientific Sessions—used repeated structural magnetic resonance imaging (MRI) to compare brain development in children with T1D to age-matched controls.
Why this matters
Despite advances in insulin therapy and diabetes technologies that improve daily care, children with T1D remain vulnerable to significant swings in blood glucose. These fluctuations can affect the developing brain. Understanding how long-term glycemic exposure relates to brain growth is a crucial step in developing strategies to reduce the risk of diabetes-related cognitive dysfunction later in life, according to Dr. Mauras, co-principal investigator and chief of endocrinology, diabetes & metabolism at Nemours Children’s Health System.
Study design and participants
The study was conducted through the Diabetes Research in Children Network (DirecNet) and enrolled 138 children with T1D. The median age at enrollment was seven years, and the average duration of diabetes at the start of the study was 2.4 years. Researchers performed structural MRIs at three time points: an initial baseline visit, a follow-up at 18 months, and a third scan approximately 2.9 years after the second visit. These scans measured volumes of gray and white matter across the whole brain and in specific regions of interest. A control group of 66 age-matched children without diabetes was included for comparison.
Findings
Across all time points, children with T1D showed slower growth in total cortical and subcortical gray and white matter when compared with the control group. The differences were especially evident in a network of metabolically active brain regions often referred to as the “default mode network,” which has been associated with cognitive processes and implicated in other brain disorders. Importantly, areas that showed reduced growth in the T1D group correlated with greater lifetime hyperglycemic exposure, as estimated by cumulative hemoglobin A1c (HbA1c) values from diagnosis onward.
Implications and next steps
The study’s results raise important questions about whether tighter, sustained blood glucose control—achieved through advanced diabetes management technologies—could mitigate effects on brain growth and reduce long-term risk for cognitive difficulties. Ongoing research will investigate whether maintaining blood sugar within a normal range over time can alter these brain development outcomes.
Collaboration and funding
The DirecNet collaboration includes Nemours Children’s Health System (Jacksonville), Stanford University, the University of Iowa, Washington University in St. Louis, and Yale University. Funding for the study was provided by the National Institutes of Health’s Special Type 1 Diabetes Funds and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Media contacts:
Stephanie Wight – NEMOURS
Image source:
The image used is in the public domain.
Original research presentation: Dr. Mauras and co-principal investigator Allan Reiss, MD, of Stanford University, presented these findings during a press briefing at the American Diabetes Association’s 79th Scientific Sessions.