Objective: Type 1 diabetes in childhood is associated with an increased risk of psychiatric morbidities. We investigated predictors and diabetes outcomes in a pediatric population with psychiatric comorbidities.
Research Design and Methods: Nationwide pediatric registerbased study. Data from the Danish national childhood diabetes register (DanDiabKids) and The National Patient Register were collected (19962015) for this population-based study. We used KaplanMeier plots to test whether age at type 1 diabetes onset and glycated hemoglobin (HbA1c) levels during the first 2 years following onset were associated with the risk of psychiatric disorders. Mixed-effects linear and logistic regression models were used with HbA1c, BMI, severe hypoglycemia, or ketoacidosis as outcomes and psychiatric comorbidities as explanatory factors.
Results: In total 4730 children and adolescents (52.1% boys) with type 1 diabetes were identified in both registers. The mean age at onset of diabetes was 8.98 years (3.81 S.D.), birth year ranged from 19792013, mean duration of diabetes at last visit was 5.95 years (3.65), 93.85% were of Danish ethnicity, and 5.37% were immigrants or offspring of immigrants. Among children and adolescents with type 1 diabetes, 1035 (21.9%) were also diagnosed with a psychiatric disorder within the observational period. High initial HbA1c levels predicted higher risk of psychiatric morbidity. Patients with psychiatric comorbidity had higher HbA1c levels (0.21% (0.14; 0.28) (2.32 mmol/mol (1.56; 3.08)) (P<0.001)) and an increased risk of hospitalization with diabetic ketoacidosis 1.76 (1.17; 2.65) (P=0.007). HbA1c levels were highest in patients with potentially reactive psychiatric disorders, e.g., anxiety, mood, behavioral, and eating disorders (0.28% (0.19; 0.36) (3.06 mmol/mol (2.12; 3.99)) (P<0.001)). Children with neurodevelopmental/constitutional psychiatric disorders were not found to have higher HbA1c levels. We found no associations with BMI or hypoglycemia.
Conclusions: We found that high HbA1c levels in the period immediately after type 1 diabetes onset was a possible indicator for subsequent psychiatric disorders, and that having a psychiatric disorder was associated with an increased risk of poor metabolic outcomes, especially in patients with potentially reactive disorders. An increased focus on the disease burden might improve outcomes as reactive psychiatric disorders might be prevented if symptoms are targeted early.
27 Sep 2018 - 29 Sep 2018