Impact of Glucose Variability on Dynamic Cognitive Function in Youth with Type 1 Diabetes

血糖变异性对 1 型糖尿病青少年动态认知功能的影响

• 批准号: 10654542
• 负责人: Mary Katherine Osborn Ray
• 金额: $ 11.96万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10654542
• 关键词: Acute; Address; Affect; Biological; Blood Glucose; Brain; Childhood; Chronic; Cognition; Cognitive; Complications of Diabetes Mellitus; Continuous Glucose Monitor; Data; Data Collection; Development; Development Plans; Diabetes Mellitus; Diabetic Ketoacidosis; Disease; Event; Food; Future; Gestational Diabetes; Glucose; Goals; Health; Health Technology; Health behavior; Hyperglycemia; Hypoglycemia; Incidence; Individual; Insulin-Dependent Diabetes Mellitus; Laboratories; Learning; Life; Longevity; Measures; Methods; Non-Insulin-Dependent Diabetes Mellitus; Oxidative Stress; Participant; Patients; Pattern; Population; Prevalence; Quality of life; Recommendation; Research Personnel; Risk Factors; Short-Term Memory; Sleep Deprivation; Testing; Time; Time Series Analysis; Translating; Work; Youth; brain health; career development; cognitive function; cognitive performance; cognitive skill; cognitive testing; euglycemia; glycemic control; high standard; improved; innovation; mHealth; machine learning model; novel; peer; processing speed; rate of change; skills; smartphone application; type I and type II diabetes

PROJECT SUMMARY/ABSTRACT Type 1 diabetes (T1D) is one of the most common chronic childhood diseases and has a rapidly rising incidence and prevalence. Management of blood glucose is challenging and often leads to frequent and rapid swings between normal, high, and low glucose. This glucose variability has recently been identified as an independent risk factor for diabetic complications. One of the least studied and understood complications of T1D is altered cognition and its relationship to glucose variability. As the brain uses a substantial amount of the body’s glucose to support its functions, especially during dynamic periods of brain development, there are strong biological reasons for the potential vulnerability of youth with T1D. Several studies have shown lower cognitive scores in youth with T1D compared to their peers without T1D, and shown that poorer overall glycemic control as indicated by severe glycemic events (e.g., diabetic ketoacidosis) and chronic hyperglycemia, are associated with lower cognitive scores both acutely and long-term. However, these studies we conducted in a controlled, optimized laboratory settings at a single time point. Little is still known about how typical glucose fluctuations that occur daily in real-life settings affect cognitive function in the moment, particularly dynamic cognitive skills that are sensitive to environmental or physical conditions of the individual (e.g. sleep deprivation) and thus fluctuate throughout the day (e.g., working memory, processing speed). Determining the relationship between glycemic fluctuations and dynamic cognitive function is critically important in youth given that dynamic cognitive skills are fundamental for learning, integrating, and using novel information in their daily lives. Understanding how these skills are affected in daily life, how they relate to glycemic fluctuations, and any contributing factors, could motivate improvements in academic accommodations and T1D treatment recommendations. Importantly, this work could also be expanded to better understand the impact of glycemic variability on brain health throughout the lifespan in T1D and could be translated to other forms of diabetes (e.g., type 2 diabetes, gestational diabetes). The primary goal of this study is to determine if real-time, real-life glycemic variability predicts fluctuations in dynamic cognitive function in youth with T1D. A secondary goal is to determine whether dynamic cognitive function in youth with T1D differs from youth without T1D, independent of significant glycemic extremes. To address these questions, I will apply a unique and innovative combination of continuous health and cognitive data collection methods, multivariate time-series analyses, and machine learning models. This work, combined with a tailored career development plan, will form the basis of my future work as an independent investigator, which will expand to address how diabetes-related health behaviors (e.g., food choice) impact glucose fluctuations, and subsequent brain health (i.e., cognitive function), using novel mobile health (mHealth) technologies across different types of diabetes.

项目概要/摘要 1 型糖尿病 (T1D) 是最常见的慢性儿童疾病之一，并且发病率迅速上升 血糖的发生率和患病率的管理具有挑战性，并且常常导致频繁和快速的发生。 这种葡萄糖变异性最近被认为是一种在正常、高和低血糖之间波动的现象。 糖尿病并发症的独立危险因素之一。 T1D 是认知的改变及其与葡萄糖变异性的关系，因为大脑使用了大量的葡萄糖。 身体的葡萄糖来支持其功能，特别是在大脑发育的动态时期，有 多项研究表明，青少年罹患 T1D 的可能性较低，这是有很强的生物学原因的。 与未患 T1D 的同龄人相比，患有 T1D 的青少年的认知得分总体较差 严重血糖事件（例如糖尿病酮症酸中毒）和慢性血糖表明血糖控制 然而，这些研究表明，高血糖与短期和长期的认知评分较低有关。 我们在一个受控的、优化的实验室环境中在一个时间点进行的研究仍然知之甚少。 现实生活中每天发生的典型血糖波动会影响当下的认知功能， 特别是动态认知技能，对个人的环境或身体状况敏感 （例如睡眠不足），从而全天波动（例如工作记忆、处理速度）。 确定血糖波动与动态认知功能之间的关系至关重要 鉴于动态认知技能是学习、整合和发展的基础，因此对青少年来说很重要 了解这些技能在日常生活中如何受到影响。 它们与血糖波动有关，任何影响因素都可以促进学业进步 重要的是，这项工作还可以扩展到。 更好地了解血糖变异性对 T1D 患者整个生命周期中大脑健康的影响，并且可以 转化为其他形式的糖尿病（例如 2 型糖尿病、妊娠糖尿病）。 是为了确定实时、真实的血糖变异性是否可以预测动态认知功能的波动 患有 T1D 的青少年的第二个目标是确定患有 T1D 的青少年的动态认知功能是否存在差异。 没有 T1D 的青少年，独立于显着的血糖极端值，为了解决这些问题，我将申请。 持续健康和认知数据收集方法、多变量的独特创新组合 时间序列分析和机器学习模型，与量身定制的职业发展相结合。 计划，将构成我作为一名独立调查员的未来工作的基础，该工作将扩展到解决如何 与糖尿病相关的健康行为（例如食物选择）会影响血糖波动以及随后的大脑健康 （即认知功能），在不同类型的糖尿病中使用新型移动健康（mHealth）技术。