Longitudinal Evaluation of Neurocognitive Complications in Pediatric Type 1 Diabetes Across Multi-Ethnic Groups—Exploring Risk and Protective Factors

PROJECT SUMMARY Our multidisciplinary team endeavors to address critical knowledge gaps regarding the impact of type 1 diabetes (T1D) on neurocognitive outcomes among a diverse population of children. Throughout the study, our team will observe factors that contribute to neurocognitive outcomes, such as nutritional and lifestyle behaviors, environmental exposures, and social determinants of health (SDOH). We will also explore the potential protective effects of diabetes management technologies, such as continuous glucose monitoring (CGM) and automated insulin delivery systems, to promote better neurocognitive outcomes for these children. The cooperative agreement’s overarching goals are to establish a clinical consortium comprised of a pre-pubertal diverse cohort of children with newly diagnosed T1D to evaluate the impact of T1D on neurocognitive function and to identify potential clinical and environmental risk and protective factors associated with neurocognitive function in T1D. The project’s board led by Drs. Page, Raymond, and Xiang, demonstrate their commitment to scientific development and the execution of a nationwide consortium by proposing to serve as one of the 10 Clinical Centers operating within the proposed NIDDK consortium to recruit and track a nationally diverse cohort (estimate = 1000 children) representing the pediatric population of patients with T1D. Therefore, our project’s board and multidisciplinary team will leverage our recruitment sites at both Children’s Hospital Los Angeles and Kaiser Permanente Southern California to enroll 100 participants (5-11y); 50 with newly diagnosed T1D and 50 age, gender, and race/ethnicity matched controls for this longitudinal study. The team will monitor: glycemic control (CGM metrics and hemoglobin A1c); lifestyle (diet, sleep, and physical activity); environmental exposures and SDOH; brain development; and neurocognitive and neuropsychological outcomes. Our team will partner with the Steering Committee to establish our long-term objectives to harmonize methods and develop an optimal protocol for collecting and storing plasma, urine, and stool samples to create a biobank for future biomarker investigations that predict neurocognitive outcomes in children with T1D. The team’s three specific aims are to first identify the effects of glycemic control on neurocognitive outcomes in children ages 5-11 with a new T1D diagnosis, second to determine the impact and neurocognitive outcomes in children with T1D concerning children’s diet, sleep, physical activity, obesity, environmental exposures, and SDOH, and third to perform an integrated analysis to identify subgroups of children with T1D at an increased risk for adverse neurocognitive outcomes, including the influence of sex, race/ethnicity, lifestyle, and SDOH.