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Link Between Type 1 Diabetes and Psychiatric Comorbidities in Children

Dec 15, 2018
 
Editor: Steve Freed, R.PH., CDE

Author: Angela Reyes, Pharm.D. Candidate, LECOM College of Pharmacy

Following diabetes diagnosis, children and adolescents have high risk of developing psychiatric condition.

Type 1 diabetes has many complications and comorbidities. Childhood and early adolescence is a time of vulnerability and it is also when most type 1 diabetes cases emerge. In general, at this age, incidence of major psychiatric disorders increases. A diabetes diagnosis can lead to anxiety, depression, eating disorders, and psychological distress.

Research has shown that a child diagnosed with type 1 diabetes will often be diagnosed with more than one psychiatric condition. A recent study investigated whether the age and level of control over diabetes diagnosis predicted any psychiatric comorbidities.

The following study used data listed in the Danish national registries. The registries contain all medical and psychiatric diagnoses from any inpatient admission in a Danish public hospital. This study collected information about psychiatric and type 1 diabetes diagnosis from 1996 to 2015. The data came from 4,725 children and adolescents under 15 years of age. Records show 1,035 subjects were diagnosed with at least one psychiatric condition.

Of those, 175 subjects had a psychiatric diagnosis before type 1 diabetes onset, 575 had a diagnosis during pediatric care, and 285 after referral to adult care. The most common psychiatric disorder recorded was anxiety, followed by behavioral and emotional disorders, mood disorders, psychoactive substance misuse disorder, and inattention and hyperactivity disorders. Forty-six percent of the subjects were diagnosed with two or more psychiatric disorders and 22.8% were diagnosed with three or more psychiatric disorders.

Results showed that shortly after type 1 diabetes diagnosis, a higher risk of psychiatric disorders was seen in the 10–15-year-old population. After 15–20 years with diabetes, however, the risk was 30% with all groups. Children with higher HbA1c levels had the highest risk of developing a disorder within the first 2 years after diagnosis, but this leveled out again after 15–20 years with type 1 diabetes. The mean HbA1c was a predictor of psychiatric disorder. The mean HbA1c level was higher in children with a psychiatric disorder compared with children with no psychiatric disorder. No link was found between BMI or DKA and psychiatric disorders.

This study reflects the findings of other research that associates type 1 diabetes with more psychiatric conditions. This study, however, was the first to show diabetes diagnosis linked to any comorbid psychiatric disorder. In the first couple years after type 1 diabetes diagnosis, HbA1c levels seem to predict development of psychiatric disorders. Also having a psychiatric disorder was linked to higher HbA1c levels. The high percentage (30%) of most groups, no matter the age being diagnosed with a psychiatric disorder within 15–20 years of type 1 diabetes diagnosis, is an important find. Special attention is needed for those ages 10–15 years since a diagnosis of type 1 diabetes meant an even more increased risk of developing a psychiatric condition within  the first 2 years.

The possible mechanism behind these findings could be that the stress of the diagnosis increases hormones that in turn increase glucose levels. This can alter the balance in the body and change insulin needs. The constant fluctuations only feed into a cycle of stress for the patient and compounds from there. Successful interventions, especially in the age range of 10–15, could significantly improve mental and physical outcomes in a youth newly diagnosed with diabetes. Future research is needed in this area to help optimize treatment in this population.

Practice Pearls:

  • After type 1 diabetes diagnosis, a higher risk of psychiatric disorders was seen in the 10–15-year-old population.
  • 30% of people with type 1 in this study have a psychiatric condition after 15–20 years of managing the disease.
  • The most common psychiatric disorder recorded was anxiety, followed by behavioral and emotional disorders, mood disorders, psychoactive substance misuse disorder, and inattention and hyperactivity disorders.

Reference:

Stine M. Sildorf, Nina Breinegaard, Emilie B. Lindkvist, Janne S. Tolstrup, Kirsten A. Boisen, Grete K. Teilmann, Anne Mette Skovgaard, Jannet Svensson. Poor Metabolic Control in Children and Adolescents With Type 1 Diabetes and Psychiatric Comorbidity. Diabetes Care (Nov 2018) 41 (11) 2289-2296; DOI: 10.2337/dc18-0609

Angela Reyes, Pharm.D. Candidate, LECOM College of Pharmacy