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Diabetes Care Not Linked to Learning Problems

Insulin therapy doesn't hurt kids' schoolwork, scientists say

MONDAY, Jan. 7, 2002 (HealthDayNews) -- Children with Type I diabetes don't seem to suffer any learning problems from the treatment for their blood sugar disease, a new study says.

Although earlier research has suggested that Type I diabetics may have subtle neurological defects associated with the therapy that controls their blood glucose levels, the new work says these don't add up to trouble with math or reading in school. The findings, from researchers at the University of Iowa, appear in the January issue of the journal Pediatrics.

Matt Petersen, director of diabetes information at the American Diabetes Association, calls the report "very reassuring."

"There's been long-standing concern that kids with Type I diabetes have some cognitive impairments and some learning problems. This is a pretty careful study that pretty carefully shows that, with this particular group, there aren't any," Petersen says.

Type I diabetes, which affects approximately 1 million Americans, occurs when the body fails to produce enough of the sugar-processing hormone insulin. Although the condition is called juvenile diabetes, it can appear after childhood.

Type I diabetics require daily injections of insulin to keep their blood glucose in check; too much of the hormone can drive them into a state of dangerously low blood sugar levels, or hypoglycemia. Repeated bouts of hypoglycemia can cause slight brain damage -- just as prolonged periods of the opposite state, hyperglycemia, have been linked to cognitive problems.

"The brain is very dependent on sugar, so severely low blood sugars are known to cause brain injury," says Dr. Richard Furlanetto, scientific director of the Juvenile Diabetes Research Foundation in New York City.

In the latest study, Ann Marie McCarthy and her colleagues at the University of Iowa compared the academic performances of 244 young diabetics and 319 of their classmates and siblings. The average age of the students was almost 15, and their average grade was the eighth.

Despite the previous connection between diabetes treatment and cognitive deficits, McCarthy's group could find no fingerprint for these problems in school performance.

In fact, the diabetics slightly outscored their siblings on tests of math and overall academic ability, and nudged their classmates on reading exams. However, these differences weren't considered statistically significant.

Diabetics who managed their blood sugar well had a slight edge over those who didn't do as well. However, McCarthy's group suggests that trend might mean brighter children are simply more attuned to their blood sugar levels.

Children with Type I diabetes differed from their siblings in a few important areas. They missed more school each year -- seven days versus five days -- and had more behavior problems. They also tended to be moodier, more tired and less compliant than their peers were.

"This could certainly have an impact on their interpersonal relationships and, over time, on their ability to manage their diabetes independently," says Christopher Ryan, a psychiatrist at the University of Pittsburgh who has studied the effects of diabetes on the brain.

On balance, however, Ryan says the Iowa research should be "welcome news to parents of children with diabetes."

Furlanetto agrees, but notes the findings have an important caveat.

The patients in the study weren't taking intensive insulin therapy -- three or four shots a day -- to control their blood sugar, so they were less likely to suffer hypoglycemia, he says.

Most Type I diabetics are now on some form of intensive treatment, he adds, so a group of them needs to be examined to see if the results hold.

What To Do: To find out more about Type I diabetes, try the Juvenile Diabetes Research Foundation or the American Diabetes Association.

SOURCES: Interviews with Matt Petersen, director, diabetes information, American Diabetes Association, Alexandria, Va.; Richard Furlanetto, M.D., Ph.D., scientific director, Juvenile Diabetes Research Foundation, New York City; Christopher M. Ryan, Ph.D., professor, psychiatry, University of Pittsburgh; Jan. 7, 2002, Pediatrics
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