Sweet but Sour: Acute and Chronic Hyperglycemia are Associated with Impaired Attention in Children with Type 1 Diabetes Mellitus

Introduction: Chronically poor glycemic control in pediatric patients with type 1 diabetes mellitus (T1DM) is associated with long-term neurocognitive dysfunction. The exact nature of acute hyperglycemia on cognition has been insufficiently investigated. Assessment of neurocognitive capability can be performed with MOXO continuous performance test (CPT), that measures sustained attention and vigilance in the presence of measurable distractors.

Aims: To examine the association between blood glucose levels in pediatric patients with T1DM with attention functioning, to allow for better understanding of the neurologic implications of poor glycemic control.

Methods: Participants included 43 children with T1DM, aged 6-18 years, attending follow-up at the Pediatric Endocrinology Clinic, Assuta Hospital. After collecting blood glucose levels, children completed MOXO-CPT in a standardized environment. MOXO scores were analyzed in relation to preceding blood glucose levels and HbA1c. Results were compared to MOXO scores of healthy children obtained from previous studies.

Results: Compared to the healthy population, children with T1DM demonstrated poorer attention, with a greater number of omission errors (mean 16.97, p<0.001, 95% CI 10.35-23.59) and poorer processing speed (SD -3.47, p<0.001, 95% CI -4.03- -2.92). Among children with long-standing T1DM (duration >5 years), both pre-test blood glucose levels and HbA1c correlated with impaired attention (R=0.53, p<0.05; R=0.82, p

Conclusions: Both acute and chronic hyperglycemia are associated with diminished attention. Routine neurocognitive assessment should be considered in the long-term management of T1DM, particularly in children with disease duration of more than five years.