Autism spectrum disorder in children with Type 1 diabetes

Abstract

Aim Links between autism spectrum disorder (ASD) and autoimmune diseases, including Type 1 diabetes have been proposed. This study assessed the frequency of ASD in children with Type 1 diabetes in the T1D Exchange (T1DX) registry and the impact of ASD on characteristics of children with Type 1 diabetes.Methods Analysis included 10 032 participants aged < 18 years (median Type 1 diabetes duration 6.5 years, 48% female, 77% non-Hispanic White). Diagnosis of ASD was defined as autism, Asperger's or pervasive developmental disorder.Results A diagnosis of ASD was recorded for 159 (1.58%) participants. Those with ASD were predominantly male (88% vs. 51% of those without ASD, P < 0.001) and slightly older (median 14 vs. 13 years, P = 0.022). Occurrence of diabetic ketoacidosis at Type 1 diabetes diagnosis was similar (35% vs. 41%, P = 0.161). Pump use was lower in those with ASD (51% vs. 63%, P = 0.005) but continuous glucose monitor use was similar (24% vs. 27%, P = 0.351). Median HbA 1c was slightly lower in those with ASD [68 vs. 69 mmol/mol (8.4% vs. 8.5%), P = 0.006]. This difference was more pronounced after adjusting for confounders. ConclusionsThe frequency of ASD in the T1DX registry was similar to that in the general population. These data show that despite deficits in communication, occurrence of diabetic ketoacidosis was similar in youth with and without ASD. Pump use was less frequent in those with ASD, possibly due to sensory issues, although CGM use did not differ. The lower HbA 1c may be due to a more regimented routine with ASD. Because comorbidities such as ASD complicate care of patients with Type 1 diabetes, further research is needed to support these children.

Challenges and Successes in Raising a Child With Type 1 Diabetes and Autism Spectrum Disorder: Mixed Methods Study

“…These findings complement the work of Stanek et al [ 9 ] and Bethin et al [ 10 ], who found that CGM use was the same among children with T1D and ASD as it was among those with T1D but without ASD, whereas insulin pump use was lower for those with both T1D and ASD. This qualitative work adds some explanatory context, as caregivers identified that sensory issues can preclude the successful use of insulin pumps and that successful solutions for some have included the use of tubeless pumps and desensitization techniques, such as the routine use of band-aids before attempting to use diabetes technology.…”

“…It is not surprising that this study did not achieve statistical significance, as it was not powered to do so and the sample size was chosen for the greater qualitative focus here. This also echoes comments by Bethin et al [ 10 ] and Stanek et al [ 9 ] that further work is needed to be able to better support these children and their families. From this study specifically, we propose that further research with larger sample sizes is needed to continue to explore the potential relationships between the degree of functioning related to ASD and glycemic control.…”

“…There is little research regarding the prevalence of individuals with both ASD and T1D in the United States [ 3 , 6 - 8 ], although a recent study found the prevalence of ASD in the pediatric T1D population in 1 clinic to be 1.16% (95% CI 0.96-1.26) [ 9 ]. An additional study reported that among 10,032 participants from the T1D Exchange Clinic Network, 159 (1.58%) had T1D and ASD [ 10 ]. These studies suggest that there is no increased prevalence of ASD in children with diabetes.…”

“…In addition, 31% of children with ASD also have an ID [ 3 ]. Although ASD alone may not lead to increased diabetic ketoacidosis, severe hypoglycemia, or worsening glycemic control [ 10 ], T1D patients with both ASD and comorbid ID are more likely to have very poor glycemic control, higher emergency room utilization, and lower rates of achieving national standards of diabetes management, including lower rates of lipid screening and retinopathy screening [ 11 - 13 ]. With this comes greater risk for negative outcomes, and indeed diabetes-related morbidity and mortality have been identified as a particular concern for people with ID [ 14 , 15 ].…”

Learning about diabetes through epidemiology

“…Bethin et al . used data from the T1D Exchange Clinic Network of 80 US paediatric and adult endocrinology practices to show that an autistic spectrum disorder was identified in 1.6% of 10 032 people with type 1 diabetes aged < 18 years, a rate similar to the background population . People with an autistic spectrum disorder had a slightly lower HbA 1c and there were fewer pump users among them (51% vs 63%).…”