Finding the Perfect Balance: Both High and Low Blood Sugar Affect Brain Growth in Children with Type 1 Diabetes

Children with Type 1 diabetes need special care and now more has been discovered that could help.

Recently, researchers at Stanford found that children with the highest and most variable blood sugar levels had the slowest brain growth. The findings were just published in the journal Diabetes.

It is true that glucose (the primary form of sugar in our blood and the brain’s primary fuel) in Type 1 diabetes needs a boost, as the body lacks the ability to produce a key hormone needed to regulate blood sugar levels. That’s why treatment for affected children has often focused on ensuring their glucose levels don’t get too low, since very low glucose can quickly put someone into a coma.

Now it’s becoming apparent that chronically high sugar is also not good for the brain. There’s a need for a perfect balance, say researchers, so a child’s brain development progresses properly.

The study, a joint effort among Stanford and four other universities, tracked brain structure and cognitive function in 144 young children with Type 1 diabetes as well as a comparison group of 72 children without diabetes. MRI scans taken over a period of 18 months showed that the brains of both groups of kids were growing, but gray- and white-matter growth was slower in several areas of the brain in the diabetic children.

“These studies provide strong evidence that the developing brain is a vulnerable target for diabetes complications,” noted researchers.

Affected brain areas included visual-spatial processing; auditory, language and object processing; executive function; spatial and working memory; and integration of information from the sensory system.

“The magnitude of the group differences in brain growth over time was surprising,” said Allan Reiss, MD, senior author for the study. “I actually thought these differences would be more subtle — they were not.”

While Reiss noted the remarkable resilience of a child’s brain, he cautioned that years of exposure to high and fluctuating glucose levels, the ability to compensate could falter.

What does it all mean?

Pediatric endocrinologist Bruce Buckingham, MD, the principal investigator for the Stanford arm of the trial, said he trusts that clinicians will recognize that hyperglycemia as well as hypoglycemia are harmful to developing brains.

“It is not easy to manage diabetes in these young children,” Buckingham said. “We need to do the best we can, balancing the risks of both hypo- and hyperglycemia on brain development. We cannot ignore either extreme. We need to work with some of the newer technology such as continuous glucose sensors to try and minimize both the lows and highs.”

Journal citation: Longitudinal Assessment of Neuroanatomical and Cognitive Differences in Young Children with Type 1 Diabetes: Association with Hyperglycemia Diabetes published ahead of print December 8, 2014, doi:10.2337/db14-1445