Risk factors for cognitive impairments in children and adolescents with type 1 diabetes mellitus: pathophysiological aspects (literature review)

Type 1 diabetes mellitus (T1DM) in children and adolescents is associated not only with metabolic disturbances but also with the development of cognitive impairments, which may initially present subclinically. These impairments reflect central nervous system involvement driven by a variety of pathophysiological mechanisms. Recent studies have demonstrated that the cognitive status of children with T1DM is influenced by both acute and chronic factors, including episodes of hypoand hyperglycemia, diabetic ketoacidosis, disease duration, and poor glycemic control. Aim. Summarize current literature on the mechanisms underlying cognitive impairment in T1DM, as well as the possibilities for early diagnosis and prevention. The roles of neuroinflammation, oxidative stress, altered glucose transporter function, impaired neurogenesis, microvascular complications, gut dysbiosis, and psychiatric comorbidities in the pathogenesis of cerebral dysfunction are discussed. Particular attention is given to the methodological challenges of assessing cognitive status in the pediatric population, the potential use of laboratory and neuroimaging markers, and their clinical applicability. The review also highlights the impact of cognitive impairment on learning, social adaptation, and quality of life in patients. The data presented emphasize the need for the development of personalized strategies for prevention and intervention. Cognitive disturbances in T1DM are increasingly recognized as a major factor influencing long-term prognosis and the adaptive capacity of young patients.