Impact of Glucose Variability on Dynamic Cognitive Function in Youth with T1D

The Opportunity

Type 1 diabetes (T1D) is one of the most common chronic diseases in childhood, with a rapidly rising incidence and prevalence. Studies have found that previous exposure to extreme glycemic events (e.g., severe hypoglycemia, ketoacidosis, etc.) and chronic hyperglycemia can be associated with impaired cognitive function; however, it is unknown how daily glycemic variability impacts cognitive functions. The problem to be solved in this project was determining the impact of glucose variability on dynamic cognitive function in youth with type 1 diabetes.

Our Approach

The team started by optimizing a smartphone application to test dynamic cognition in youth. A new smartphone app with excellent validity and reliability for assessing dynamic cognitive processes in adults was developed by a team member, Dr. Hassenstab. A pilot study in the lab was conducted to optimize the task’s instructions, stimuli, and timing parameters for children and adolescents. An analysis protocol was also optimized for integrating real-time glucose fluctuations and assessments of cognition in youth with T1D. Real-time glucose-level readings were collected using continuous glucose monitoring (CGM) technology and cognitive function via the new app from youth with T1D in their daily lives.

The Solution

Cognitive testing was translated to daily, real-world settings for youth with and without T1D, and an analysis protocol was developed to integrate cognitive performance and glucose variability in youth with T1D. It was then translated to higher-risk youth with T1D in the community who do not have access to specialty diabetes care and youth with type 2 diabetes. Optimized tools were used in a fully powered study to determine the impact of glycemic control on cognitive function in real-world settings in youth with T1D, and data-driven guidelines were provided for glucose levels and more effective academic accommodations.