Cerebral perfusion in pediatric type 1 diabetes: relation to vascular complications, psychological and neurophysiological functions

Regional cerebral hypoperfusion has been reported in patients with type 1 diabetes mellitus. Diabetic children also manifest a higher rate of mild cognitive dysfunction and electro-encephalographic abnormalities and these are best predicted by the occurrence of hypoglycemic events relatively early in life. More recent studies point toward the deleterious effect of chronic hyperglycemia on cognitive functioning and brain structure as measured with MRI. To study the relation between Regional cerebral perfusion in children and adolescents with type 1 diabetes measured by Single photon emission tomography (SPECT) and the vascular complications, psychological and neurophysiologic functions. One hundred children and adolescents with type 1 DM (64 females; mean age 15.3 ± 3.1 years) and 40 age- and sex-matched healthy control subjects were prospectively enrolled. Exclusion criteria comprised recent episodes of severe hypoglycemia or diabetic ketoacidosis (DKA) within the last 6 weeks. Regional cerebral blood flow was measured using SPECT. Patients underwent electro-encephalogram (EEG) and long latency evoked potential assessment, as well as Psychiatric assessment. Our study showed significant mean frontal and mean basal ganglia hypo perfusion in children having diabetes of more than 10 years duration compared to controls ( P < 0.05). Mean frontal and basal ganglia perfusion were significantly related to different grades of hypoglycemia and longer diabetes duration but were not affected by history of diabetic ketoacidosis. Regional cerebral blood flow was not correlated to P300 latency or amplitude, EEG or psychiatric morbidity. Cerebral perfusion is affected by the duration of diabetes, and attacks of hypoglycemia, though not correlated to EEG findings or psychiatric morbidities. Frontal and basal ganglia are most areas affected.