Demographic and socioeconomic patterns in the risk of alcohol‐related hospital admission in children and young adults with childhood onset type‐1 diabetes from a record‐linked longitudinal population cohort study in Wales

Abstract

Background: Little is known about alcohol-related harm in children and young adults with type 1 diabetes (T1D). Education on managing alcohol intake is provided to teenagers with T1D in paediatric clinics in Wales, but its effectiveness is unknown. We compared the patterns in risk of alcohol-related hospital admissions (ARHA) between individuals with and without childhood-onset T1D. Methods: We extracted data for 1 791 577 individuals born during 1979 to 2014 with a general practitioner registration in Wales, and record-linked the demographic data to ARHA between 1998 and June 2016 within the Secure Anonymised Information Linkage Databank (SAIL). Linkage to a national T1D register (Brecon Cohort) identified 3575 children diagnosed aged <15 years since 1995. We estimated hazard ratios (HRs) with 95% confidence intervals (95% CIs) for the risk of ARHA using recurrent-event models, including interaction terms. Results: Individuals with T1D had a higher riskof ARHA (HR: 1.78; 95% CI: 1.60-1.98), adjusted for age group, sex, and deprivation. The risk in people with diabetes was highest aged 14 to 17 years, around three times higher than the peak in non-T1D aged 18 to 22. Females with diabetes had a lower risk generally. The association between deprivation and ARHA was weaker in the T1D group. Conclusion: Young people with T1D had increased risks of ARHA, particularly at school age, and smaller socioeconomic inequalities in ARHA. A review of interventions to reduce alcohol-related harm in T1D is needed, perhaps including modification of current education and guidance for teenagers on managing alcohol consumption and reviewing criteria for hospital admission.

Lack of consideration of socioeconomic factors in transition programme of adolescents with type 1 diabetes: A systematic review

“…In parallel with the psychiatric conditions, drug consumption habits merit examination. Adolescents with T1D have a higher risk of alcohol‐related hospital admission compared to adolescents without diabetes 49,50 …”

“…Adolescents with T1D have a higher risk of alcohol-related hospital admission compared to adolescents without diabetes. 49,50 Parental education level appears in just one study. However, parents' skills (knowledge about pump functions), health literacy level (reading comprehension), or diabetes-related numeracy have been associated with glycaemic control or adherence to insulin regimen in children and adolescents.…”

ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes

“…It is important to carry diabetes identification and always have quick‐acting carbohydrate treatment options available. Drinking alcohol can be a risk factor in young people not following their usual diabetes self‐care routine, such as checking glucose levels, eating regular meals, adjusting their insulin with physical activity and, as a result, their glucose levels can become unpredictable 80 Excessive amounts of alcohol can cause vomiting and dehydration which can lead to diabetic ketoacidosis (DKA) and hospitalization 80,81 Special care should be taken to prevent nocturnal hypoglycemia by having a carbohydrate snack at bedtime and monitoring glucose levels more often than usual during the night and the following day, at least until lunchtime 72 .…”

Recent Rates of Substance Use Among Adolescents and Young Adults with Type 1 Diabetes in the USA

“…A hypoglycemic event that is not recognized and treated quickly can result in loss of consciousness and/or seizure, which also requires a higher level of care and increases morbidity and mortality. Alcohol-related hospitalizations for people with T1D are most likely to occur for persons aged 14–17 years old [ 9 ], than in other age groups. As for drug use, cannabis consumption more than doubles the risk of diabetic ketoacidosis for adults with T1D [ 10 , 11 ], and limited data in youth with T1D suggests a similar trend [ 12 ].…”