Poor blood sugar control in kids with T1D tied to Neurodevelopmental Disorders

Several studies have suggested a link between childhood-onset of type 1 diabetes and increased risk of neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and intellectual disability. However, there is limited evidence regarding whether maintaining adequate glycaemic control similarly benefits paediatric patients through reduced psychological morbidity risk. While previous studies have described associations between glycemic control and cognitive health during midlife and later, only a few studies have examined whether suboptimal glycemic control in pediatric patients impacted the risk of neurodevelopmental disorders. Therefore, researchers of Sweden conducted a study, to investigate the effect of childhood-onset type 1 diabetes on the risk of subsequent neurodevelopmental disorders, and the role of glycaemic control in this association.

It was a retrospective, Swedish population-based cohort study using data from Swediabkids database and the Swedish Diabetes Register from 1973 to 2013. Researchers identified 8430 patients with childhood-onset type 1 diabetes and compared them with 84,300 reference individuals from the general population, matched for sex, birth year and birth county. They used Cox models to estimate the effect of HbA1c on the risk of subsequent neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and intellectual disability. The major outcome assessed was the development of a neurodevelopmental disorder. They also assessed the incidence of specific neurodevelopmental disorders such as ADHD, ASD, and intellectual disability.

Key findings of the study:

• During the follow-up period of 5.6 years, researchers noted 398 (4.7%) of those with type 1 diabetes received a diagnosis of any neurodevelopmental disorder compared with 3066 (3.6%) in the general population, corresponding to an adjusted HR (HRadjusted) of 1.31.

• In analyses adjusted for psychiatric morbidity prior to inclusion, parental psychiatric morbidity, and parental highest education level, results suggested those with type 1 diabetes were at a 31% greater risk of developing a neurodevelopmental disorder (HR, 1.31)

• They found that the risk of any neurodevelopmental disorder increased with HbA1c levels and the highest risk was observed in patients with mean HbA1c >8.6% (HRadjusted 1.90) compared with reference individuals without type 1 diabetes.

• Additionally, they found, when compared to diabetic patients with an HbA1c less than 7.5%, those with an HbA1c above 8.6% had the greater risk of developing any neurodevelopmental disorder (HR, 3.71) and specific disorders including ADHD (HR, 4.16), ASD (HR, 2.84), and intellectual disability (HR, 3.93).

The authors concluded, "Childhood-onset type 1 diabetes is associated with an increased risk of neurodevelopmental disorders, with the highest risk seen in individuals with poor glycaemic control. Routine neurodevelopmental follow-up visits should be considered in type 1 diabetes, especially in patients with poor glycaemic control".

For further information:

https://link.springer.com/article/10.1007%2Fs00125-020-05372-5#Abs1