Background Type 1 diabetes (T1D) in childhood is associated with subtle neurocognitive alterations, particularly in working memory, processing speed, and executive functions. Chronic hyperglycemia, glycemic variability, and severe acute complications may impair brain development during critical neurodevelopmental windows. Advanced diabetes technologies, including continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems, improve glycemic control and time in range, potentially offering neuroprotective effects. However, direct evidence linking sustained technology use to cognitive outcomes in pediatric populations remains limited. Methods This observational cohort study enrolled 153 children and adolescents (ages 6–17 years) with childhood-onset T1D followed at a tertiary pediatric diabetes center. Participants completed standardized neurocognitive assessments: Wechsler Intelligence Scale for Children-IV (WISC-IV), Behavior Rating Inventory of Executive Function-2 (BRIEF-2), and Child Behavior Checklist 6–18 (CBCL). Clinical data included age at onset, disease duration, phase-specific HbA1c trajectories, CGM and AID use (expressed as percentage of disease duration), acute complications, and comorbidities. Correlations between glycemic control, technology adoption, and neurocognitive outcomes were analyzed. Results The cohort demonstrated high-average full-scale IQ (108.4 ± 13.4) with relative working memory weakness (96.5 ± 14.3). Sustained CGM use (≥90% disease duration) and higher AID adoption (≥50%) were significantly associated with better Verbal Comprehension Index scores (p=0.02 and p=0.05, respectively). Good glycemic control (HbA1c ≤7%) during the first 2–5 years of disease correlated with superior verbal reasoning, executive function, and behavioral outcomes. Lower socioeconomic status associated with increased internalizing symptoms. Conclusions Early and sustained use of CGM and AID systems, coupled with optimal glycemic control during critical disease phases, is associated with preserved verbal cognitive abilities in youth with T1D. These findings support universal early access to advanced diabetes technologies as potentially neuroprotective interventions in pediatric T1D management.
Correlation between cognitive functions and glycemic control in patients with childhood-onset type 1 diabetes: exploring the role of CGM and AID systems
BASSI, MARTA
2026-05-27
Abstract
Background Type 1 diabetes (T1D) in childhood is associated with subtle neurocognitive alterations, particularly in working memory, processing speed, and executive functions. Chronic hyperglycemia, glycemic variability, and severe acute complications may impair brain development during critical neurodevelopmental windows. Advanced diabetes technologies, including continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems, improve glycemic control and time in range, potentially offering neuroprotective effects. However, direct evidence linking sustained technology use to cognitive outcomes in pediatric populations remains limited. Methods This observational cohort study enrolled 153 children and adolescents (ages 6–17 years) with childhood-onset T1D followed at a tertiary pediatric diabetes center. Participants completed standardized neurocognitive assessments: Wechsler Intelligence Scale for Children-IV (WISC-IV), Behavior Rating Inventory of Executive Function-2 (BRIEF-2), and Child Behavior Checklist 6–18 (CBCL). Clinical data included age at onset, disease duration, phase-specific HbA1c trajectories, CGM and AID use (expressed as percentage of disease duration), acute complications, and comorbidities. Correlations between glycemic control, technology adoption, and neurocognitive outcomes were analyzed. Results The cohort demonstrated high-average full-scale IQ (108.4 ± 13.4) with relative working memory weakness (96.5 ± 14.3). Sustained CGM use (≥90% disease duration) and higher AID adoption (≥50%) were significantly associated with better Verbal Comprehension Index scores (p=0.02 and p=0.05, respectively). Good glycemic control (HbA1c ≤7%) during the first 2–5 years of disease correlated with superior verbal reasoning, executive function, and behavioral outcomes. Lower socioeconomic status associated with increased internalizing symptoms. Conclusions Early and sustained use of CGM and AID systems, coupled with optimal glycemic control during critical disease phases, is associated with preserved verbal cognitive abilities in youth with T1D. These findings support universal early access to advanced diabetes technologies as potentially neuroprotective interventions in pediatric T1D management.
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