Impact of attention deficit hyperactivity disorder on metabolic control in adolescents with type1 diabetes

Maček, Jerneja; Battelino, Tadej; Černelič-Bizjak, Maša; Zupanc, Cita; Bograf, Ana Kovac; Vesnić, Sabina; Klemenčič, Simona; Volk, Eva; Bratina, Nataša

doi:10.1016/j.jpsychores.2019.109816

Cited by 12 publications

(10 citation statements)

References 34 publications

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“…Generally, poorer glycemic control was observed in patients with comorbid ADHD ( 6-9 ), but not in those with ASD ( 10 , 11 , 13 ), compared with patients with type 1 diabetes alone. However, earlier research suffers from different definitions of ADHD and ASD, mostly based on self- or parent-reported questionnaire data ( 7 , 8 ) or medical charts where diagnostic criteria have not been specified ( 6 , 9 , 13 ). Additionally, glycemic control in these studies was generally assessed by a point value of glycated hemoglobin (HbA 1c ).…”

mentioning

confidence: 99%

Neurodevelopmental Disorders, Glycemic Control, and Diabetic Complications in Type 1 Diabetes: a Nationwide Cohort Study

Liu

Kuja‐Halkola

Larsson

et al. 2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Neurodevelopmental disorders are more prevalent in childhood-onset type 1 diabetes than in the general population, and the symptoms may limit the individual’s ability of diabetes management. It remains unknown whether comorbid neurodevelopmental disorders are associated with long-term glycaemic control and risk of diabetic complications. Methods This population-based cohort study used longitudinally collected data from Swedish registers. We identified 11,326 individuals born 1973-2013, diagnosed with type 1 diabetes 1990-2013 (median onset age: 9.6 years). Out of them, 764 had a comorbid neurodevelopmental disorder, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, and intellectual disability. We used multinomial logistic regression to calculate odds ratios (ORs) of having poor glycaemic control (assessed by mean of glycated haemoglobin [HbA1c]) and Cox regression to estimate hazard ratios (HRs) of nephropathy and retinopathy. Results The median of follow-up was 7.5 (IQR 3.9, 11.2) years. Having any neurodevelopmental disorder (ORadjusted 1.51 [95%CI 1.13, 2.03]), or ADHD (ORadjusted 2.31 [95%CI 1.54, 3.45]) was associated with poor glycaemic control (mean HbA1c >8.5%). Increased risk of diabetic complications was observed in patients with comorbid neurodevelopmental disorders (HRadjusted 1.72 [95%CI 1.21, 2.44] for nephropathy, HRadjusted 1.18 [95%CI 1.00, 1.40] for retinopathy) and patients with ADHD (HRadjusted 1.90 [95%CI 1.20, 3.00] for nephropathy, HRadjusted 1.33 [95%CI 1.07, 1.66] for retinopathy). Patients with intellectual disability have a particularly higher risk of nephropathy (HRadjusted 2.64 [95%CI 1.30, 5.37]). Conclusions Comorbid neurodevelopmental disorders, primarily ADHD and intellectual disability, were associated with poor glycaemic control and a higher risk of diabetic complications in childhood-onset type 1 diabetes.

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mentioning

confidence: 99%

Neurodevelopmental Disorders, Glycemic Control, and Diabetic Complications in Type 1 Diabetes: a Nationwide Cohort Study

Liu

Kuja‐Halkola

Larsson

et al. 2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…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.…”

Section: Description Of Included Studies and Risk Of Biasmentioning

confidence: 99%

“…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.…”

Section: Description Of Included Studies and Risk Of Biasmentioning

confidence: 99%

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

Zhao²,

Liu³

et al. 2022

Front. Pediatr.

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BackgroundThis study aims to investigate the prevalence estimate of diabetes mellitus (DM) among people with attention deficit hyperactivity disorder (ADHD) as well as the prevalence of ADHD among those with DM. In addition, the impact of ADHD on glycemic control in patients with DM was also assessed using a systematic review and meta-analysis of currently available published data.Materials and methodsThe PubMed, Embase, Web of Science, and PsycInfo databases were searched for potential studies. Two reviewers independently selected studies according to the inclusion and exclusion criteria. All pooled analyses were conducted using the random-effects models on Review Manager 5.3.ResultsSeventeen observational studies were included. The pooled results showed an increase in the prevalence of DM among patients with ADHD versus those without ADHD [type 1 DM OR: 1.37 (95% CI: 1.17–1.61); type 2 DM OR: 2.05 (95% CI: 1.37–3.07)]. There was an overall 35% increase in the prevalence of ADHD among patients with type 1 DM [OR: 1.35 (95% CI: 1.08–1.73)]. Children with type 1 DM and ADHD had higher levels of hemoglobin A1c [standardized mean of differences: 0.67 (95% CI: 0.48–0.86)], and prevalence of hypoglycemic and ketoacidosis index compared with those without ADHD.ConclusionOur study revealed the bidirectional associations between ADHD and DM. Patients with ADHD and type 1 DM comorbidities were more likely to have poorer diabetes control. More studies are needed to confirm this association and elucidate the underlying mechanism.

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“…Nevertheless, studies have shown an association between concomitant ADHD and worse diabetes outcomes. 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.…”

Section: Family Structure Is Associated With Mental Health and Attent...mentioning

confidence: 99%

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

Bächle

Stahl‐Pehe

Castillo

et al. 2022

Exp Clin Endocrinol Diabetes

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Objective To analyze the cross-sectional associations of family structure with mental health and attention deficit (hyperactivity) disorders (AD(H)D) in 11- to 17-year-old adolescents with early-onset type 1 diabetes participating in one of three baseline surveys as part of an ongoing cohort study. Methods Parents (n=1,631) completed the Strengths and Difficulties Questionnaire to screen for their child’s mental health and answered questions about their child’s diagnosis of AD(H)D. Associations between mental health or AD(H)D and family structure were analyzed using multivariable logistic regression analyses adjusted for various personal and diabetes-related variables. Results Compared to adolescents living with both parents, adolescents living with one parent and his/her partner had 2.35 (95% confidence interval 1.32; 4.21) higher odds of abnormal screening result and 2.08 (1.09; 3.95) higher odds of a borderline screening result while adolescents living with a single parent had 1.84 (1.07; 3.17)/1.08 (0.53; 2.21) higher odds of abnormal/borderline screening results. The odds ratios for diagnosed attention deficit (hyperactivity) disorder were 2.17 (0.98; 4.84) for adolescents living with one parent and his/her partner and 1.27 (0.54; 3.01) for those living with a single parent vs. both parents. Conclusions Our results indicate higher odds of mental health problems and AD(H)D in adolescents with type 1 diabetes who do not live with both parents; this finding was most pronounced in individuals living with one parent and his/her partner vs. both parents. Longitudinal studies are needed to verify our results and elucidate the underlying mechanisms.

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Impact of attention deficit hyperactivity disorder on metabolic control in adolescents with type1 diabetes

Cited by 12 publications

References 34 publications

Neurodevelopmental Disorders, Glycemic Control, and Diabetic Complications in Type 1 Diabetes: a Nationwide Cohort Study

Neurodevelopmental Disorders, Glycemic Control, and Diabetic Complications in Type 1 Diabetes: a Nationwide Cohort Study

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

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

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