Neurocognitive and Behavioral Outcomes in Patients With Insulin Resistance and Type 2 Diabetes: A Systematic Review of Recent Evidence

This systematic review explores the association between insulin resistance (IR) and type 2 diabetes (T2D) with neurocognitive and behavioral outcomes in adolescents. With the rising global burden of metabolic disorders in youth, understanding the cognitive implications is crucial. A comprehensive search was conducted across PubMed, Scopus, and Web of Science, yielding 665 records. Following stringent eligibility criteria and quality screening, nine studies published between January 2020 and June 2024 were included. These studies assessed executive function, memory, attention, emotional regulation, and neuroimaging outcomes in adolescents aged 10-19 years with IR or T2D. Most studies (seven of nine) demonstrated either a low risk of bias (RoB) or some concerns, with none rated as high risk. The findings consistently pointed to impairments in executive functioning, working memory, and psychosocial outcomes, with eight of nine studies (89%) reporting at least one cognitive or behavioral deficit. However, heterogeneity in outcome measures and study designs limited direct comparability. The review highlights emerging evidence of a diabetes-cognition link during adolescence, emphasizing the need for early interventions and standardized cognitive assessments. Gaps remain in long-term follow-up, representation from low- and middle-income countries (LMICs), and the exploration of modifiable lifestyle factors. This review adds to the growing call for targeted research and public health strategies to address the neurocognitive vulnerabilities associated with adolescent metabolic dysfunction.