Prevalence, characteristics, and diabetes management in children with comorbid autism spectrum disorder and type 1 diabetes

Abstract

Objective: To determine autism spectrum disorder (ASD) prevalence within our pediatric type 1 diabetes (T1D) clinic population and determine clinical characteristics and technology used by individuals with both ASD and T1D compared to matched controls with T1D alone and compared to our overall pediatric T1D clinic.Methods: Medical chart review showed 30 individuals with both ASD and type 1 diabetes (ASD + T1D). Controls (n = 90) were matched for age, sex, race/ethnicity, and T1D duration. ASD + T1D was compared to both matched controls and the pediatric T1D clinical population.Results: ASD prevalence in the pediatric T1D population was 1.16% (CI 0.96-1.26).Compared to the T1D clinic, ASD + T1D had more males (93% vs 52%; P < 0.0001), lower hemoglobin A1c (HbA1c) (8.2% vs 8.9%; 66 vs 74 mmol/mol; P = 0.006), and lower insulin pump (CSII) use (37% vs 56%; P < 0.0001). No differences were found between ASD + T1D and matched controls in HbA1c or blood glucose checks per day. The ASD + T1D group was less likely to use CSII than matched controls (37% vs 61%; P = 0.03). HbA1c did not change after CSII initiation in ASD + T1D, but increased for matched controls.Conclusions: Prevalence of ASD in the pediatric T1D population is comparable to the general population in Colorado. Individuals with ASD may experience barriers limiting CSII use, but achieve equivalent glycemic control compared to those without ASD.CSII may be more effective in maintaining lower HbA1c over time in those with ASD than in those without ASD. K E Y W O R D S autistic disorder, diabetes mellitus, disease management, pediatrics, type 1 Type 1 diabetes (T1D) is one of the most common chronic diseases of childhood, 1,2 requiring complex management and multiple daily interventions to administer insulin and monitor blood sugars. Psychological comorbidities, such as depression have been extensively studied in T1D. However, existing research on T1D and developmental disorders, specifically autism spectrum disorder (ASD), is extremely sparse. Impairments in social behavior and reciprocal social interactions are hallmark features of ASD. 3 Individuals with ASD show delayed language development, deficits in social-emotional reciprocity, eye

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.…”

“…Up to 1 in 59 children in the United States have been identified with ASD [ 7 ], and the reported prevalence of ASD is also increasing [ 3 , 7 ]. 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 ].…”

The immune system and autism spectrum disorder: association and therapeutic challenges

“…The prevalence of ASD among children with T1DM who attended a diabetic clinic in Toronto was greater than the general population (Freeman et al, 2005). In line with this study, it has been clarified that the prevalence of ASD in T1DM patients in Colorado and Ontario were 1.16% and 0.9%, respectively, both higher than the ASD prevalence in the normal population living in Colorado (0.7%) (Stanek et al, 2019). The same authors found a lower HbA1c level (P<0.0001) and insulin pump (P<0.0001) in ASD+T1DM patients compared to T1DM patients.…”

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

“…Up to 1 in 59 children in the United States have been identified with ASD [7], and the reported prevalence of ASD is also increasing [3,7]. There is little research regarding the prevalence of individuals with both ASD and T1D in the United States [3,[6][7][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].…”