ESPE2019 Poster Category 1 Diabetes and Insulin (14 abstracts)
Dual Diagnosis of Type 1 Diabetes and ADHD
Kineret Mazor-Aronovitch 1,2,3 , Orit Pinhas-Hamiel 1,2,3 , Dalit Modan-Moses 1,3 , Noah Levek 2,1 , Dikla Pivko-Levy 4 , Shahar Miller 5 , Chana Graph-Barel 2 , Rachel Frumkin Ben-David 2 , Michal Ben-Ami 1 , Eve Z Stern 1 , Noah Gruber 1,3 , Yael Levy-Shraga 1,3 & Zohar Landau 6,2,7
1Safra's Children Hospital, Sheba Medical Center, Pediatric Endocrinology & Diabetes Unit, Ramat Gan, Israel. 2Maccabi Health Care Services, National Juvenile Diabetes Clinic, Raanana, Israel. 3Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel. 4Wolfson Medical Center, Pediatric Diabetes & Endocrine Unit, Holon, Israel. 5Ben-Gurion University of the Negev, The Department of Software and Information System Engineering, Beer Sheva, Israel. 6Barzilai Medical Center, The Pediatric Department, Ashkelon, Israel. 7Ben-Gurion University of the Negev, The Goldman School of Medicine, Beer Sheva, Israel
Background: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. Type 1 diabetes (T1DM) is the most common metabolic disease in children. The treatment of T1DM requires high executive functions and requires very intensive treatment that could be an obstacle for patients with ADHD. Dual diagnosis of T1DM and ADHD might affect treatment, control and complications of T1DM. In order to prevent long-term complications we should target glycaemic control to HbA1c lower than 7% as well as low glucose variability. The aims of this study were to compare the following parameters between children with T1DM with or without ADHD: HbA1c, episodes of severe hypoglycaemia, diabetes ketoacidosis (DKA), quality of life (QOL), time in range and glucose variability parameters.
Methods: T1DM patients aged 6-18 years were recruited from 3 paediatric diabetes clinics. ADHD screening questionnaire was given to parents of T1DM patients without ADHD diagnosis. Patients with "suspected ADHD" were excluded from the study. All parents filled a Diabetes QOL questionnaire. Glycaemic data was downloaded from glucometers, pumps and CGMs. Other data, including HbA1c, hospitalisation, severe hypoglycaemia and DKA events were retrieved from the medical files.
Results: The study cohort comprised 111 patients with T1DM: 27 were diagnosed with ADHD (24%) and 84 without ADHD (Control group). Mean±SD age of the ADHD group and Control group was 14.6±2.8 and 12.6±3.3 years, respectively (P=0.006). Mean HbA1c was significantly higher in the ADHD group, 8.5±1.2 % vs. 7.8±1.0 % (P=0.003). There was no difference in QOL and in severe hypoglycaemia or DKA events between the groups. Sixty-two patients used CGM, 13 (21%) with ADHD. Time in range (TIR) (70–180 mg/dl) was significantly lower in the ADHD group, 49±17% vs. 59±15% (P=0.05). In a regression model for age the following parameters retrieved from CGMs were significantly higher in the ADHD group vs. the Control group: mean glucose (P=0.024), SD of glucose (P=0.028), TIR (P=0.015), percentage time above 180 mg/dl (P=0.025), percentage time above 240 mg/dl (P=0.015), and in glucose variability parameters: ADRR (P=0.016), HBGI (P=0.009), MAGE (P=0.042). There were no differences in percentage time below 70 mg/dl and below 55mg/dl.
Discussion: Coexistence of T1DM and ADHD during childhood leads to significantly higher HbA1c, TIR and glucose variability parameters compared to patients without ADHD. Healthcare providers should be aware of the difficulties of patients with T1DM and ADHD to get organised and to cope with the current intensive treatment of diabetes.
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