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Evaluation of Cognitive Deficits in Adults with Type 1 Diabetes Stratified by the Age of Diabetes Onset: A Cross-Sectional Study

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Abstract

Introduction

Type 1 diabetes (T1DM) is associated with cognitive deficits, and age at diagnosis is thought to play a substantial role. However, there are limited data for the cognitive performance in young adults, in relation to the age of diabetes onset. The lack of information is particularly striking in the context of developing regions.

Methods

This cross-sectional study was performed from August 2018 to July 2020. We included adult participants with T1DM, stratified by the age of diabetes onset (till 6 years of age, between 7 to 12 years of age, and 13 to < 18 years of age) and compared them with the control group (no diabetes or pre-diabetes). We filled a structured case record proforma for all participants and recorded relevant socio-demographic and medical details. Detailed neuropsychological assessment with 13 psychological tests representing four cognitive domains was carried—(1) attention, working memory and executive functions; (2) learning and memory; (3) visuoperceptual functions; and (4) information processing speed.

Results

We evaluated 100 individuals, 73 (men 48.0%) with T1DM and 27 (men 51.9%) without T1DM. After adjustment for age, gender and education, the mean differences in composite Z scores (for the four cognitive domains) between participants with T1DM and without T1DM were 0.08 for attention, working memory and executive functions (p = 0.614); 0.07 for learning and memory (p = 0.694); 0.05 for visuoperceptual (p = 0.784); and 0.22 for information processing speed (p = 0.305). No significant differences were found for the three subgroups of individuals with T1DM, when compared with the control group. Effect size (Cohen's d) for the individual tests (n = 13) ranged from − 0.36 to + 0.39, and none of the comparisons were statistically significant. Amongst the participants with T1DM, higher education had a significant positive association with three of the four cognitive domains evaluated.

Conclusions

To conclude, our findings suggest minimal differences in the cognitive functioning of patients with T1DM with different age of onset of diabetes compared to healthy controls, when evaluated in early adulthood. This is possibly the first study from South Asia with an in-depth and comprehensive assessment of cognitive functions in patients with T1DM, using a detailed neuropsychological battery.

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Acknowledgements

The author thank study participants for generously donating their time and information.

Author information

Authors and Affiliations

  1. Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India

    Vinay Dogra, Bhavika Mittal, Yashdeep Gupta & Nikhil Tandon

  2. Department of NMR & MRI Facility, All India Institute of Medical Sciences, New Delhi, 110029, India

    S. Senthil Kumaran

  3. Department of Clinical Neuropsychology, All India Institute of Medical Sciences, New Delhi, 110029, India

    Ashima Nehra

  4. Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India

    Rajesh Sagar

  5. Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India

    Anu Gupta

  6. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India

    Mani Kalaivani

Authors
  1. Vinay Dogra
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  2. Bhavika Mittal
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Corresponding authors

Correspondence to Yashdeep Gupta or Nikhil Tandon.

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Funding

This project was funded by Department of Science and Technology with grant No. SR/CSRI/162/2016 to Yashdeep Gupta as the Principal Investigator. No sponsorship of funding was received for the publication of this article.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Author Contributions

YG and AG conceptualised this research. The first draft was written by VD, AG and YG. VD, BK, SSK, AN and YG were involved in execution of this work. MK helped with statistical part. NT provided the overall supervision and helped in providing inputs in planning and patient recruitment. RS provided inputs in the planning stage. All authors helped in editing and provided the final approval of this manuscript for publication. YG is the guarantor of this work and has full access to the data.

Disclosures

Vinay Dogra, Bhavika Mittal, S. Senthil Kumaran, Ashima Nehra, Rajesh Sagar, Anu Gupta, Mani Kalaivani, Yashdeep Gupta, and Nikhil Tandon have nothing to disclose.

Compliance with Ethics Guidelines

The study was approved by the institutional ethics committee (Ref No. IEC-585/05.01.2017, RP-52/2017, dated 29th March, 2017) and informed consent was obtained from all participants. The study was conducted in accordance with the International Conference on Harmonisation Guidelines for Good Clinical Practice and the Declaration of Helsinki.

Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Supplementary Information

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Supplementary file1 (PDF 199 KB)

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Dogra, V., Mittal, B., Senthil Kumaran, S. et al. Evaluation of Cognitive Deficits in Adults with Type 1 Diabetes Stratified by the Age of Diabetes Onset: A Cross-Sectional Study. Adv Ther 39, 1711–1723 (2022). https://doi.org/10.1007/s12325-022-02063-y

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