Early and sustained diabetes technology exposure is associated with cognitive outcomes in youth with type 1 diabetes.

AIMS: To evaluate neurocognitive and behavioral outcomes in youth with pediatric-onset type 1 diabetes (T1D), focusing on the associations between continuous glucose monitoring (CGM) and automated insulin delivery (AID), and WISC-IV scores. The role of disease duration, age and mode at onset, glycemic control, socioeconomic status, and diabetes-related complications and comorbidities was also explored. METHODS: In this prospective observational cohort study, 153 children and adolescents (6-17 years) with T1D underwent standardized assessments of intelligence, executive function and behavior (WISC-IV, BRIEF-2, and CBCL). Clinical and socioeconomic data were collected. Associations between glycemic control, technology adoption, comorbidities, acute complications, and neurocognitive outcomes were analyzed. RESULTS: Participants showed high-average full-scale IQ with relative working-memory weakness. Sustained CGM use (≥90 % of disease duration) and higher AID use (≥50 %) were associated with higher Verbal Comprehension (p = 0.005 and p = 0.025) and General Ability Index (p = 0.015 and p = 0.043). HbA1c ≤ 7 % [53 mmol/mol] during the first 2-5 years after diagnosis was associated with better verbal reasoning, executive-function, and behavioral profiles. Lower socioeconomic status was associated with higher internalizing symptoms. CONCLUSIONS: Early and sustained CGM/AID were associated with more favorable verbal cognitive and general ability outcomes in youth with T1D, supporting a potential neuroprotective role of advanced diabetes technologies.