Cognitive function in children aged 7 to 16 years with type 1 diabetes at Kenyatta National Hospital
Background Type 1 Diabetes Mellitus (T1DM) is one of the most common chronic diseases of childhood. The burden of diabetes in children in Kenya is unknown, but the Ministry of Health estimates that three million people have the condition. Diabetes is known to cause cognitive dysfunction secondary to both its acute and chronic complications. Early recognition of this is important to help these children maintain normal intellectual function and achieve their full potential. Objectives To compare the cognitive function in children with Type 1 diabetes with that of non-diabetic children at Kenyatta National Hospital; and within the population of diabetic children, determine the relationship between cognitive function and both the duration of diabetes and level of glycaemic control. Study design This was a hospital based cross-sectional comparative study with two arms recruiting diabetic and non-diabetic children, respectively. Methods Sixty-six children with T1DM aged 7 to 16 years were enrolled from the paediatric Endocrinology clinic. Sixty-seven children aged 7 to 16 years recruited from the paediatric out-patient clinic formed the comparative group. The Modified Mini-Mental State Exam (MMSE) was administered to all children meeting inclusion criteria and scores were categorized into either normal or impaired cognitive function using age-specific cut-offs. Results Median (lower - upper IQR) age of children with diabetes was 13 (10-15) years and the median age in non-diabetics was 12 (10-13) years. There was no significant difference in cognitive function assessed using MMSE scores between diabetic and non-diabetic children. Overall, 17 out of the 66 diabetics (25.8%) had low MMSE score compared to 14 (20.9%) non-diabetics (OR = 1.31, 95% CI 0.54-3.21). The cognitive function did not differ significantly for the subdomains of the MMSE with mean scores for diabetics and non-diabetics of: 11.2 versus 11.3 (orientation); 6.0 versus 5.9 (attention and concentration); 3.0 versus 3.0 (registration); 2.3 versus 2.4 (recall) and 10.3 versus 10.4 (language). However, there was some evidence of higher scores for recall in non-diabetic children aged 12-14 years compared to diabetic children in the same age group (p = 0.078). Conclusion There was no significant difference in cognitive function in diabetic children compared to non-diabetic children as assessed using the Modified Mini Mental Status Examination. Recommendations Baseline and serial assessment may be more useful than a single assessment of the MMSE. A different tool may detect subtle differences in cognition.