This article discusses the findings of a prospective study that assessed whether a single episode of DKA is associated with cognitive declines in children with new onset or previously diagnosed T1DM. DKA was defined as having [1] a blood glucose concentration >300 mg/dL and [2] venous pH <7.25 or serum bicarbonate concentration <15 mmol/L. Participants included 758 children between the ages of 6-18 who presented with DKA in a randomized multi-site clinical trial evaluating IV fluid protocols for DKA treatment and children with T1DM and no history of DKA that were comparable in age, sex, and socioeconomic status.
Ultimately after neurocognitive assessment completed 2-6 months after hospital discharge, the study found that DKA was associated with lower scores in overall IQ, memory for item-color associations, and forward digit span recall. Backward digit span recall and memory for item-space relations did not differ between moderate/severe DKA, mild DKA, and non-DKA groups. Children with newly diagnosed T1DM were found to have had significant differences as a function of DKA status for item-color association memory but not for IQ and forward digit span. A lower pH in DKA patients was also correlated with lower IQ. For children with previously diagnosed T1DM, DKA status was not related to any of the cognitive outcomes but greater number of previous DKA episodes and higher HbA1c were independently and negatively related to IQ. Elevated HbA1c was also associated with lower item-color memory. Though, overall DKA exposure was associated with lower item-color memory only among those who were diagnosed prior to age 4, demonstrating increased vulnerability following early diagnosis. Therefore, because patients with repeated DKA exposure and poorly controlled T1DM are at substantial risk of cognitive deficits, it is important to prevent DKA in children with known T1DM and promptly diagnose patients with new onset of T1DM before the development of DKA.
