MON-217 - Coss-Sectional and Longitudinal Assessment of Cognitive Function Following New-Onset Type One Diabetes in Children

Introduction: Children have higher glucose demands to support brain development, which may increase their vulnerability to neurocognitive complications in type 1 diabetes (T1D). Prior studies reported worse cognitive function that may impact academic performance and treatment adherence.

Purpose: Glycemic control may influence cognitive function early after T1D onset, but this remains incompletely understood. We aimed to assess cross-sectional and longitudinal differences in cognition between youth with new-onset T1D and healthy sibling controls (HC), and the association between glycemic control and cognition in youth with new onset T1D.

Methods: NIH Toolbox tasks [List Sort, Picture Sequence, Vocabulary, Oral Reading, Flanker] assessed cognitive function in an observational study of youth with new-onset T1D and HC at 4 and 22 months after T1D onset (age: 5.5–18.5 years). In cross-sectional analyses, ANCOVA evaluated group differences and effects of diabetes ketoacidosis (DKA) at onset, and hierarchical linear regression examined the association between HbA1c at 4 months after onset and concurrent cognitive function (Model 1: age, socioeconomic score [SES], HbA1c at onset, gender and DKA status , Model 2: HbA1c at time of assessment). Longitudinally, repeated-measures ANCOVA assessed group differences (T1D vs HC) over time, and hierarchical regression examined the association between cumulative glycemic exposure (HbA1c area under curve >6% from 4–22 months) and cognitive function at 22 months ( Model 1: age, SES, HbA1c at T1D onset, gender and baseline cognitive scores, Model 2: HbA1c AUC >6%).

Results: Cross-sectionally , there were no differences in cognitive scores between T1D (n=70, mean age=11.2) and HC (n=60, mean age=11.6). Within T1D group, cognitive scores didn’t differ by DKA status at onset but adding HbA1c to the model was associated with a small decrease in concurrent picture sequencing score [β = - 0.21, R² change = 0.04, F(1, 56) = 3.71, p = 0.059] and a small but significant decrease in concurrent vocabulary score [β = -0.15 , R² change = 0.02, F(1, 56) = 5.04, p = 0.029]. Longitudinally, there was no significant interaction between time and group (T1D: n=33 vs HC: n=38) or a main effect of group. HbA1c AUC > 6% wasn’t associated with cognitive function at 22 months.

Conclusion: We found no significant differences between T1D and HC groups cross-sectionally or longitudinally, suggesting similar cognitive trajectories over time. In T1D group, higher HbA1c soon after onset was associated with worse concurrent expressive language (Vocabulary). Cumulative glycemic exposure wasn’t associated with cognitive outcomes at 22 months, consistent with prior studies reporting non-significant associations across some cognitive domains. However, our study may be underpowered because of the limited sample size. Larger studies with longer follow-up are needed for further evaluation.

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