Distinct attentional profiles associated with diabetic ketoacidosis and hypoglycemia in pediatric type 1 diabetes: MOXO-CPT assessment

Type 1 diabetes (T1D) in children and adolescents has been associated with alterations in attentional and executive functioning. Acute metabolic complications, particularly diabetic ketoacidosis (DKA) and clinically significant hypoglycemia (CSH), may adversely affect neurocognitive development. This study evaluated the associations between acute metabolic events and attentional functioning in pediatric patients with T1D. The study included 117 children and adolescents with T1D (55 females, 62 males; mean age 12.86 ± 3.16 years). Participants were stratified according to the presence of DKA and CSH. Cognitive functioning was assessed using the MOXO Continuous Performance Test (MOXO-CPT), which evaluates sustained attention, timeliness, impulsivity, and hyperactivity. Associations between cognitive performance and clinical variables were analyzed using ANOVA, ANCOVA, and multivariable regression models. Patients with a history of CSH demonstrated significantly lower sustained attention ( p < 0.001) and timeliness scores ( p < 0.001) compared with controls. DKA was associated with poorer impulsivity scores ( p = 0.008). After adjustment for age, sex, HbA1c, diabetes duration, and treatment modality, the differences in sustained attention and timeliness, whereas the association with impulsivity was attenuated. Acute metabolic complications in pediatric T1D were associated with domain-specific alterations in attentional functioning. CSH was primarily related to impaired sustained attention and timeliness, whereas DKA was associated mainly with impulsivity. Early identification of attentional difficulties may support individualized diabetes care and improve long-term metabolic safety.