posted on 2021-04-26, 21:07authored byAllison L. B. Shapiro, Dana Dabelea, Jeanette M. Stafford, Ralph D’Agostino Jr, Catherine Pihoker, Angela D. Liese, Amy S. Shah, Anna Bellatorre, Jean M. Lawrence, Leora Henkin, Sharon Saydah, Greta Wilkening, SEARCH for Diabetes in Youth Study Group
Objective: Poor cognition has been observed
in children and adolescents with youth-onset type 1 (T1D) and type 2 diabetes
(T2D) compared to non-diabetic controls. Differences in cognition between youth-onset
T1D and T2D, however, are not known. Thus, using data from SEARCH for Diabetes
in Youth, a multicenter, observational cohort study, we tested the association
between diabetes type and cognitive function in adolescents and young adults
with T1D (n=1,095) and T2D (n=285). Research
Design and Methods: Cognition was assessed via the National Institutes of
Health Toolbox Cognition Battery and age-corrected composite Fluid Cognition
scores used as the primary outcome. Confounder-adjusted linear regression models
were run. Model 1 included diabetes type and clinical site. Model 2 additionally
included sex, race/ethnicity, waist-height ratio, diabetes duration, depressive
symptoms, glycemic control, any hypoglycemic episode in the past year, parental
education, and household income. Model 3 additionally included Picture Vocabulary
score, a measure of receptive language and crystallized cognition. Results:
Having T2D was significantly associated with lower fluid cognitive scores before
adjustment for confounders (Model 1; p <0.001). This association was
attenuated to non-significance with the addition of a priori confounders
(Model 2; p= 0.06) and Picture Vocabulary scores (Model 3; p = 0.49). Receptive
language, waist-height ratio, and depressive symptoms remained significant in
the final model (p<0.01 for all, respectively). Conclusions: These
data suggest that while youth with T2D have worse fluid cognition than youth
with T1D, these differences are accounted for by differences in crystallized
cognition (receptive language), central adiposity, and mental health. These potentially
modifiable factors are also independently associated with fluid cognitive
health, regardless of diabetes type. Future studies of cognitive health in
people with youth-onset diabetes should focus on investigating these
significant factors.
Funding
The SEARCH for Diabetes in Youth Cohort Study (1UC4DK108173) is funded by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases and supported by the Centers for Disease Control and Prevention. The Population Based Registry of Diabetes in Youth Study (1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139) is funded by the Centers for Disease Control and Prevention and supported by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Sites (SEARCH 1 through 4): Kaiser Permanente Southern California (U18DP006133, U48/CCU919219, U01 DP000246, and U18DP002714), University of Colorado Denver (U18DP006139, U48/CCU819241-3, U01 DP000247, and U18DP000247-06A1), Cincinnati's Children's Hospital Medical Center (U18DP006134, U48/CCU519239, U01 DP000248, and 1U18DP002709), University of North Carolina at Chapel Hill (U18DP006138, U48/CCU419249, U01 DP000254, and U18DP002708), Seattle Children's Hospital (U18DP006136, U58/CCU019235-4, U01 DP000244, and U18DP002710-01), Wake Forest University School of Medicine (U18DP006131, U48/CCU919219, U01 DP000250, and 200-2010-35171)