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Diabetes Research in Children Network (DirecNet)

Welcome to DirecNet!

Child and researcher

This research study examines differences in brain structure and brain function in young children with type 1 diabetes as compared with non-diabetic controls over time, and correlate these changes with changes in blood sugar concentrations in the children with diabetes.  Since type 1 diabetes is among the most common chronic disease in childhood, a strategy to better understand and possibly treat early brain abnormalities is an area of significant public health interest in pediatrics.

Most of our knowledge regarding the effects of type 1 diabetes on the human brain is derived from imaging studies in adults, and the research performed with older children and adolescents suggest that the effects of type 1 diabetes may vary by age. In particular, early childhood is a period of rapid and dynamic brain development, and studies suggest that sustained hyper- and hypoglycemia, and increased glycemic excursions can lead to altered brain structure and neurocognitive function.

The study research team is the Diabetes Research in Children Network (DirecNet), a NIH-funded consortium of 5 academic centers, a neuroimaging core and a coordinating center. All children will have unsedated structural MRI, DTI and fMRI scans twice 2 years apart, along with age-appropriate neurocognitive testing. The children with type 1 diabetes will also have continuous glucose monitoring quarterly.

Our specific aims are to determine:

1) If variations in total and regional gray and white matter volumes and white matter microstructure change over time, and whether these changes are associated with measures of glycemic control. 

2) If children with type 1 diabetes show differences in activation of frontal-parietal brain networks associated with working memory and response inhibition relative to neurotypical controls, and if there are differences in functional connectivity of resting state networks (these studies use functional MRI imaging). 

3) If there are longitudinal differences in measures of IQ, and executive, visual-spatial and memory functions in children with type 1 diabetes relative to controls, and whether these changes are associated with measures of glycemic control.