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 The less common form of diabetes, known as type 1, develops in
childhood or young adulthood when the pancreas fails to produce the
hormone insulin, which is needed for the body to convert blood sugar
into energy.
Complications of type 1 diabetes - like dangerously high blood
sugar, or dangerously low levels of sugar in the brain - have both
been associated with cognitive problems. But not all studies have
tied type 1 diabetes to worse academic performance, researchers note
in JAMA.
For the current study, they examined average reading and math scores
for more than 631,000 public school children in grades 2 through 8
in Denmark over five years. They found no meaningful differences in
average test scores between the 2,031 kids with type 1 diabetes and
the rest of the students in the study.
"Being a parent myself to a child with type 1 diabetes, I know there
is a lot to worry about in diabetes," said lead study author Niels
Skipper of Aarhus University. "The take-home message here is that
school performance should not be one of them, and that children with
diabetes have the same opportunities for learning and education as
their peers," Skipper said by email.
Children in the study took standardized tests in reading and math
that were scored from 0 to 100.
Students with type 1 diabetes had been living with the condition for
an average of 4.5 years and roughly two-thirds of them used insulin
pumps.
Overall average test scores for kids with diabetes were 56.56,
compared with 56.11 for children without diabetes. On math tests,
average scores were 56.06 for students with diabetes and 55.68 for
those without the condition. Average reading scores were 56.81 with
diabetes and 56.32 without it. These differences were all too small
to rule out the possibility that they were due to chance.
Test scores were below average, however, for diabetic students who
had dangerously high blood sugar. In contrast, the students with
diabetes without severely elevated blood sugar had average scores
that were slightly above average.
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This suggests that poor blood sugar control, and not just the
diabetes diagnosis itself, are what may explain the potential for
cognitive problems to develop with the disease, said Dr. Andrew
Budson, chief of cognitive and behavioral neurology at the Veterans
Affairs Boston Healthcare System and a researcher at Boston
University School of Medicine.
Dangerously high blood sugar can increase the risk of strokes, and
these episodes may in turn cause cognitive problems in people with
diabetes, Budson, who wasn't involved in the study, said by email.
The inference "is that an increase in strokes is the only reason
that individuals with diabetes end up with problems with thinking
and memory in middle or late life," Budson said.
"Now individuals with diabetes of any age know exactly what they
need to do to keep their memory as strong as possible: they need to
keep their blood sugar under good control because that will reduce
their risk of strokes," Budson advised.
The study wasn't designed to determine whether or how diabetes might
directly cause cognitive problems, and it also wasn't designed to
assess risk factors for stroke, a rare event in children.
One limitation of the study is that students had not been living
with diabetes for that long when they took their standardized tests,
and it's possible that academic performance might get worse over
time, the study authors note.
It's also possible that results in Denmark, where there's high
awareness of how to manage diabetes and government-funded
healthcare, may not reflect what would happen elsewhere.
SOURCE: https://bit.ly/2UMG58p JAMA, online February 5, 2019.
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