Dual diagnosis of type 1 diabetes mellitus and attention deficit hyperactivity disorder

Abstract

Background: Data regarding glycemic control in children and adolescents with a dual diagnosis of type 1 diabetes mellitus (T1DM) and attention-deficit/hyperactivity disorder (ADHD) are limited.Objective: To compare various aspects of diabetes control among youth with T1DM, between those with and without ADHD.Methods: In this cross-sectional study of youth with T1DM, 39 had ADHD (mean age 14.1 ± 2.8 years) and 82 did not (control group, mean age 12.6 ± 3.3 years).Health-related quality of life was assessed by a Diabetes Quality of Life (DQOL) questionnaire submitted to their parents. Glycemic data were downloaded from glucometers, pumps, and continuous glucose monitoring systems. HbA1c levels, hospitalizations, and severe hypoglycemic and diabetes ketoacidosis events were retrieved from the medical files.Results: Compared to the control group mean HbA1c level of the ADHD group was higher: 8.3 ± 1.1% versus 7.7 ± 1.0% (p = 0.005) and the percent of time that glucose level was in the target range (70-180 mg/dl) was lower: 48 ± 17% versus 59 ± 14% (p = 0.006). Mean glucose and glucose variability were higher in the ADHD group.Youth with ADHD who were not pharmacologically treated had worse HbA1c and more hospitalizations than those who were treated. DQOL did not differ between the control group, the treated ADHD group, and the untreated ADHD-Group.Conclusions: Dual diagnosis of T1DM and ADHD during childhood leads to worse diabetes control, which is more pronounced in the context of untreated ADHD.Healthcare providers should be aware of the difficulties facing youth with T1DM and ADHD in coping with the current intensive treatment of diabetes.

The relationship between diabetes mellitus and attention deficit hyperactivity disorder: A systematic review and meta-analysis

“…These studies were carried out in Germany, Australia, Sweden, Taiwan, Turkey, and Israel with various data sources. Among these studies, five studies used data linked to a health insurance database ( 4 , 17 , 18 , 20 , 30 ), seven studies collected data from hospital patients ( 9 , 10 , 19 , 25 , 26 , 28 , 29 ), and the remaining five studies collected data from national health research databases. The majority of studies examined children or adolescents, whereas only two were examined adults.…”

“…After additional evaluation, 15 studies were excluded because they did not report the ADHD or DM outcome, case series of neonates with diabetes, and reporting scores of ADHD scales in T1DM patients without a comparison group. A total of 17 articles were included in our data extraction (4,9,10,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Among the included studies, three studies (17,18,30) had overlapping populations reporting different types of diabetes in children or adults, so we included all of them.…”

“…The majority of studies examined children or adolescents, whereas only two were examined adults. Glycemic control was only reported in T1DM patients in nine studies (9,10,(24)(25)(26)(27)(28)(29)(30). All studies failed to report the proportion of responders.…”

Family Structure is Associated with Mental Health and Attention Deficit (Hyperactivity) Disorders in Adolescents with Type 1 Diabetes

“…ADHD symptoms, such as the lack of attention and motivation, impulsivity, poor self-control, and relatively poor decision-making skills, make it difficult for people with diabetes and concomitant ADHD to adhere to appropriate diabetes management, including frequent self-monitoring of blood glucose, compliance with a balanced diet and regular exercise, and the essential adjustment of insulin doses [5,8]. As a consequence, adolescents with diabetes and ADHD have been found to have worse metabolic control [8,9], more episodes of severe hypoglycemia and ketoacidosis [8,10] (statistically significant only for ketoacidosis), more hospitalizations [9], and higher rates of insulin pump discontinuation [11] than those with diabetes who do not have ADHD.…”

Association between type 1 diabetes and neurodevelopmental disorders in children and adolescents: A systematic review and meta-analysis

“…It is defined as a group of metabolic diseases characterized by hyperglycemia caused by defective insulin secretion, defective insulin action or both. There are two types of diabetes, type 1 diabetes mellitus (T1DM) and type 2 diabetes ( 19 ). The prevalence of diabetes is increasing year by year, with 451 million adults worldwide living with diabetes as of 2017, and the number is expected to rise to 693 million by 2045 ( 20 ).…”