A new research study co-led by Jennifer Raymond, MD, MCR, Chief of the Center for Endocrinology, Diabetes and Metabolism at CHLA, is launching at 12 U.S. sites to explore how Type 1 diabetes affects the development of children’s brains during key growth periods. The five-year study is funded by a $2.7 million National Institutes of Health (NIH) grant.
Type 1 diabetes has previously been associated with cognitive issues in adults, especially with working memory. But the impacts on children have not been thoroughly investigated, and past research has involved small population sizes and primarily white, privately insured children. The new study aims to address this gap by recruiting over 1,000 children from a wide range of ethnic, racial, and socioeconomic backgrounds who have been recently diagnosed with Type 1 diabetes.
The researchers will track participants’ cognitive abilities over time using functional magnetic resonance imaging (MRI) and various neurocognitive assessments. The goal is to identify factors, such as glucose levels, diet, and behavioral health, that positively or negatively impact cognitive development. This will help inform potential adjustments to future diabetes care, minimizing neurocognitive burden.
Dr. Raymond is a co-principal investigator on the new study, along with USC’s Kathleen Alanna Page, MD, and Anny H. Xiang, PhD, from Kaiser Permanente Southern California. Dr. Raymond will collaborate on this study with other CHLA team members, including Lily C. Chao, MD, MS, Clinical Director of Diabetes, pediatric psychologist Cynthia E. Muñoz, PhD, MPH, MA, and neuropsychologist Sharon H. O’Neil, PhD, MHA, ABPP-CN, ABPdN.
Representation in research
For Dr. Raymond, ensuring that medical research is representative of all pediatric patients has always been a priority. “Our kids at CHLA, many of whom come from historically marginalized communities, were not routinely represented in past studies looking at neurocognitive outcomes for children with type 1 diabetes,” she explains. “My team and I are incredibly lucky to care for these patients at CHLA, and we need to better understand the barriers and factors that our patients and families face so we can best serve them.”
Dr. Raymond’s team has previously welcomed input from CHLA patient families to help guide and design research studies. “My lab is bilingual, multicultural, and committed to addressing disparities and inequities,” she explains. “Our previous projects have all started with engaging patients and families. Their feedback informs how we design our research approaches using knowledge of the systemic and individual obstacles our families face.”
“CHLA will be one of the two Southern California sites where we recruit young people for the study,” Dr. Raymond says. Her team will help to organize community groups and patient advisory boards to offer guidance throughout the study process.
Year one and beyond
Currently, the study is in its early stages. “Right now, we’re bringing together scientists from each site to review individual proposals and confirm what will be assessed in the study,” Dr. Raymond explains. From there, the group will break into committees to organize specific study aspects. “That will occur over the next year, and then we’ll start involving our stakeholders to assist with recruitment and implementation strategies before recruiting families and getting started,” Dr. Raymond adds.
Her team will work to recruit young people with Type 1 diabetes and a control group of children without diabetes. They’ll monitor both groups through functional MRI and neurocognitive tests for the duration of the study. “We want to track their neurocognitive development and also see if different factors like glucose levels, diet, environmental impacts, behavioral health, and community are associated with the results we gather,” Dr. Raymond says.
After this study is complete, she envisions further studies to analyze how each of these factors affects brain development, and then using that knowledge to inform diabetes management and treatment strategies. “For example, if variability in patients’ glucose levels has a significant neurocognitive effect, it could help us to refine our use of glucose monitoring and automated insulin delivery technology for young people living with diabetes,” she says.
Above all, Dr. Raymond wants to continue prioritizing the role of underrepresented patients and families in research. “The more effort we can put into ensuring our patients and families are included and are given a voice in research, the better.”
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