Journal article
Diabetes mellitus and neurocognition: A report from the Childhood Cancer Survivor Study
Cancer, Vol.131(16), p.e70011
08/15/2025
DOI: 10.1002/cncr.70011
PMCID: PMC12333554
PMID: 40772450
Abstract
The objective of this research was to examine associations between diabetes mellitus (DM) and neurocognitive impairment in survivors of childhood cancer while exploring mechanistic associations with treatment exposures and moderating associations with cardiovascular disease (CVD) and risky lifestyle factors.
Survivors of the Childhood Cancer Survivor Study (N = 16,196; mean ± standard deviation age, 32.9 ± 7.9 years; 50.2% female; N = 615 with DM) self-reported neurocognitive functioning, risky drinking, physical inactivity, and tobacco use. Medical data were collected from chart review. Multivariable regression determined the association of DM with neurocognitive impairment while adjusting for relevant treatment exposures. Interactions between DM and treatment, risky lifestyle, and cardiovascular predictors on impairment were explored. Path analysis was used to examine the effects of treatment exposures through DM and CVD on impairment. Among survivors with DM, multivariable regressions examined predictors of neurocognitive change over time (mean, 11.21 years).
Survivors with DM had an increased risk of impairment relative to survivors without DM (task completion: odds ratio [OR], 1.5; 95% confidence limits [CI], 1.2-1.9; emotion regulation: OR, 1.4; 95% CI, 1.1-2.0; and organization: OR, 1.5; 95% CI, 1.1-2.0). The effects of cranial radiation on neurocognition were mediated by DM, including task completion (β = 0.02), emotion regulation (β = 0.02), memory (β = 0.01), and organization (β = 0.02; all p < .01). Among survivors with DM, CVD was associated with declines in task completion (estimate = 0.44; p < .01) and organization (estimate = 0.27; p = .03).
Survivors with DM are at increased risk of neurocognitive impairment. Although CVD did not exacerbate concurrent risk for impairment, it was associated with a decline in neurocognitive functioning over time in survivors with DM. Preventing/managing CVD in survivors with DM could mitigate additional neurocognitive decline.
Details
- Title: Subtitle
- Diabetes mellitus and neurocognition: A report from the Childhood Cancer Survivor Study
- Creators
- Rachel T Webster - St. Jude Children's Research HospitalSedigheh Mirzaei - St. Jude Children's Research HospitalShalini Bhatia - St. Jude Children's Research HospitalDeo Kumar Srivastava - St. Jude Children's Research HospitalSogol Mostoufi-Moab - Children's Hospital of PhiladelphiaStephanie B Dixon - St. Jude Children's Research HospitalEric J Chow - Fred Hutch Cancer CenterGregory T Armstrong - St. Jude Children's Research HospitalKevin R Krull - St. Jude Children's Research HospitalEllen van der Plas - Arkansas Children's Hospital
- Resource Type
- Journal article
- Publication Details
- Cancer, Vol.131(16), p.e70011
- DOI
- 10.1002/cncr.70011
- PMID
- 40772450
- PMCID
- PMC12333554
- NLM abbreviation
- Cancer
- ISSN
- 1097-0142
- eISSN
- 1097-0142
- Publisher
- WILEY
- Grant note
- P30 CA021765 / NCI NIH HHS U24 CA055727 / NCI NIH HHS American Lebanese Syrian Associated Charities
- Language
- English
- Date published
- 08/15/2025
- Academic Unit
- Psychiatry; Stead Family Department of Pediatrics
- Record Identifier
- 9984945087502771
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