Knowing Is Half the Battle!

Neurological consequences of diabetic ketoacidosis at initial presentation of type 1 diabetes in a prospective cohort study of children. By Cameron and colleagues. Diabetes Care 2014;37:1554–1562

What is the problem and what is known about it so far?

Researchers wanted to investigate the effect of childhood diabetic ketoacidosis (DKA) on brain function. DKA is an emergency condition in which blood glucose levels are extremely high. Signs of DKA are nausea, vomiting, stomach pain, fruity odor on the breath, and rapid breathing. DKA is very serious. If left untreated, it can lead to coma and death. 

Why did the researchers do this particular study?

Type 1 diabetes in children is on the rise. The most severe complication of type 1 diabetes in children is DKA. The researchers wanted to know if DKA causes injury to the brain that can affect a child’s mental processes.

Who was studied?

The study included 95 children and adolescents aged 6–18 years with a new diagnosis of type 1 diabetes. 

How was the study done?

Each participant was given a brain scan (MRI). The researchers looked at the brain scan images for evidence of injury. Participants were also given mental tests that measured mental state, memory, and attention.

What did the researchers find?

The brain scans of participants who had experienced DKA showed signs of injury to the brain, but those signs were gone within 5 days of having DKA. At 6 months after DKA, those participants had poorer memory skills and were not able to concentrate as well as those who had not experienced DKA.

What were the limitations of the study?

The researchers could not account for the possible effects of DKA episodes that could have taken place before the study began. Also, the mental tests were given at 6 months after DKA, so we do not know whether the effects on mental ability extend beyond that time period.

What are the implications of the study?

The study demonstrates the importance of avoiding DKA in children and alerts parents to the effects DKA can have on a child’s mental capabilities. The researchers suggest avoiding educational activities in children and adolescents at least 1–2 weeks after an episode of DKA.

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