A child’s Type 1 diabetes (T1D) diagnosis can be a time of stressful transition for families, as children and their caregivers get used to monitoring and controlling blood sugar levels on a regular basis. “Insulin pumps and other tools can help keep blood sugar levels within a safe range, while family dynamics and stress can also impact glycemic control,” says Erika Helgeson, a School of Public Health associate professor co-leading a new study with SPH Professor Lynn Eberly on improving cognitive outcomes for kids with T1D. “We’re interested in understanding how various risk and protective factors affect the brain development of children with Type 1 diabetes, and how to promote better cognitive function in children with T1D.”
According to the Centers for Disease Control and Prevention, over 300,000 children and 1.7 million adults have Type 1 diabetes (T1D), which may be associated with dysfunctions in attention, mental efficiency, visual motor skills, and learning.
This long-term study involving the Coordinating Centers for Biometric Research (CCBR), UMN’s Masonic Institute for the Developing Brain (MIDB), and the Advanced Research and Diagnostic Laboratory (ARDL), along with 11 clinical centers across the country, will be the most comprehensive examination of the mechanisms and markers of the cognitive impact of T1D on the developing brain.
CCBR has spent the past year working with partner institutions to develop a scientifically rigorous, uniform protocol for the study. Clinical researchers at participating clinical centers will give recently diagnosed children cognitive tasks and surveys and take blood samples and images of their brains. They’ll do the same for another group of kids without T1D, and send test results and samples back to the School of Public Health for analysis.
“Studies are pointing towards poorly controlled blood sugar as a contributor to cognitive issues in children with T1D, and we’re collaborating with study partners to discover strategies to decrease the risk of complications later in life,” Helgeson says. Collaborator Alicia Kunin-Batson in the Medical School will help lead the development of the cognitive assessment protocol with the clinical sites.
The researchers expect to start enrolling children in the five-year study in fall 2025, with preliminary results planned by 2029.
The synergy of researchers with diverse specialties across UMN has been integral to developing an effective research design for the study. Steve Nelson, an associate professor in the Medical School and MIDB Imaging Core director, contributed procedures for imaging patients’ developing brains to detect changes in structure and function due to T1D. Nelson says the scale of this collaborative effort will produce extensive data on developmental challenges children with T1D face.
“It takes so many levels of expertise to tackle type 1 diabetes in a really meaningful way,” Nelson says. “With this collaboration, we’ve found the right people. We’ve pulled in scientists who’ve studied diabetes for decades, and our partnerships make the work really impactful.”
The neurocognitive assessments and imaging protocols complement Medical School Professor Amy Karger’s methods for identifying signs of cognitive disorders in study participants’ blood samples. Karger explained that she and her team at ARDL are searching for biomarkers–measurable substances that indicate a disorder’s presence–in children that indicate negative changes to their brains from poorly controlled blood sugar.
“If we find ways to predict which kids are going to have worse neurocognitive outcomes with biomarkers, we may be able to preserve brain functioning rather than losing it due to an injury from T1D,” says Karger.
The team will also collect data on family stress, adverse childhood experiences, and other social and academic data to identify contributing factors to brain function.
The researchers are assembling stakeholder groups of parents, patients, healthcare workers, and members of advocacy groups from each site. Helgeson says these community partners will inform the researchers’ protocols and outreach efforts by sharing their lived experiences, and the results of the study will be shared back with the community.
“Of course, we’ll submit our work to academic journals so that pediatric endocrinologists can use the study results to inform their patients’ care,” Helgeson says. “But we’re also working closely with community members affected by Type 1 diabetes to make sure information reaches the people who really need it the most.”
