To investigate this hypothesis, a retrospective chart review of nearly 1,000 children with type 1 diabetes were followed to identify children with autism. The prevalence of diabetes in children and youth <18 years of age is 1 in 400–500. The prevalence of diabetes for those aged <19 years from 1995–2000 in Ontario was 1.87 per 1,000. In 2003, the prevalence of autism spectrum disorder was reported in one study as 3.4 per 1,000 children and in another as 6.7 per 1,000 children (4 per 1,000 children with autism) aged 3–10 years in the U.S. Like type 1 diabetes, both immune-mediated and genetic factors have been implicated in the development of autism.
Based on recent clinical experiences and on the putative autoimmune etiology of these two conditions, we hypothesized that there would be an increased prevalence of autism spectrum disorder in a population of children with type 1 diabetes.
Children with both type 1 diabetes and autism spectrum disorder were identified (n = 9) by a retrospective chart review of all children with diabetes (n = 984 in 2002) attending the Diabetes Clinic at The Hospital for Sick Children.
Our data suggest that the prevalence of autism spectrum disorder in children with type 1 diabetes attending the Diabetes Clinic at The Hospital for Sick Children, Toronto, may be greater than that in the general population (0.9% [95% CI 0.3–1.5] vs. 0.34–0.67).. Certain factors may account for this finding, including a common autoimmune pathogenesis. In 1971, Money et al. reported a possible association between autism and a family history of autoimmune disease in a case report. In addition, Denney et al. described a lower percentage of helper-inducer cells and a decreased helper–to–suppressor cell ratio in children with autism, as well as a lower percentage of lymphocytes expressing bound interleukin-2 receptors, following mitogenic stimulation compared with control subjects. Comi et al. reported an increased incidence of autoimmune diseases in mothers of patients with autism compared with control mothers
A possible referral bias, the small sample size, and the absence of specific autism surveillance measures used for all children attending the Diabetes Clinic limit the generalizability of these findings.
Our report of an increased prevalence of autism spectrum disorder in a population of children with type 1 diabetes emphasizes the need to recognize a potential association between these two diseases allowing for better overall patient identification and referral for appropriate care.
Diabetes Care 28:925-926, 2005
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