Nearly one out of every five pediatric patients with type 2 diabetes also has a neurodevelopmental disorder, psychiatric illness or behavioral disorder. Psychotropic medications are often prescribed, many of which are associated with weight gain, hyperglycemia or glucose intolerance.
Lead investigator Dr. Lorraine E. Levitt Katz, stated that, "We started seeing pediatric patients who had gained a tremendous amount of weight while they were on some of the newer atypical antipsychotic agents." "We thought initially this would all be medication related, but it appears to be more multifactorial than that."
Dr. Katz and her associates reviewed the charts of their patients who had type 2 diabetes to determine how many were being treated for a neuropsychiatric disease at the time of their diabetes diagnosis.
Among the 237 patients, 46 (19.4%) had been diagnosed with a neuropsychiatric disease. Twenty-nine were prescribed at least one psychotropic medication, most frequently mood stabilizers and atypical antipsychotics.
Body mass index was not significantly different among those with neuropsychiatric illnesses (mean 33.7 versus 34.3). Gender distribution, race and age at onset were also similar in those with and those without a neuropsychiatric disease.
The authors theorize that "diabetes could appear in these patients due to a common neuroendocrine basis between the two diseases, a sudden increase in weight, overeating related to poor impulse control, and altered brain physiology due to neuropsychiatric disease."
They recommend that obese children with neuropsychiatric conditions be tested for diabetes, and that those with diabetes or insulin resistance be screened for psychiatric disorders.
"Before putting children on medications that may cause weight gain and an increase in insulin resistance, a risk-benefit analysis needs to be done," Dr. Katz said.
She noted that children with psychiatric diagnoses may be more sedentary and less prone to regular physical activity.
"I think there needs to be an individualized lifestyle related program," she added, "because for these kids there are more challenges associated with their additional diagnoses."
Pediatr Diabetes 2005;6:84-89.
DID YOU KNOW:
PRE-PREGNANCY EXERCISE LOWERS GESTATIONAL DIABETES RISK:
Gestational diabetes mellitus (GDM), a common pregnancy complication, is associated with substantial short- and long-term adverse health outcomes for both mothers and offspring. How to reduce GDM risk? Get moving ahead of time, according to the Nurses’ Health Study (#1912). Compared with women who were sedentary both at an early age (18-22 years) and before the index pregnancy, those who frequently engaged in vigorous activity (such as faster walking pace and greater stair climbing) in both periods had a 26% lower risk for GDM.
ADA 65th Scientific Sessions Poster 1912