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Diabetes Care. 2018 Sep 29. pii: dc180609. doi: 10.2337/dc18-0609. [Epub ahead of print]

Poor Metabolic Control in Children and Adolescents With Type 1 Diabetes and Psychiatric Comorbidity.

Author information

1
Department of Pediatrics and Adolescent Medicine, Herlev Hospital, Herlev, Denmark.
2
Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
3
National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
4
Center of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
5
Department of Pediatrics and Adolescent Medicine, Nordsjællands Hospital, Hillerød, Denmark.
6
Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
7
Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
8
Department of Pediatrics and Adolescent Medicine, Herlev Hospital, Herlev, Denmark jannet.svensson@regionh.dk.

Abstract

OBJECTIVE:

Type 1 diabetes is associated with an increased risk of psychiatric morbidities. We investigated predictors and diabetes outcomes in a pediatric population with and without psychiatric comorbidities.

RESEARCH DESIGN AND METHODS:

Data from the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) and National Patient Register were collected (1996-2015) for this population-based study. We used Kaplan-Meier plots to investigate whether age at type 1 diabetes onset and average glycated hemoglobin (HbA1c) levels during the first 2 years after onset of type 1 diabetes (excluding HbA1c at debut) were associated with the risk of being diagnosed with a psychiatric disorder. Mixed-effects linear and logistic regression models were used to analyze HbA1c, BMI, severe hypoglycemia (SH), or ketoacidosis as outcomes, with psychiatric comorbidities as explanatory factor.

RESULTS:

Among 4,725 children and adolescents with type 1 diabetes identified in both registers, 1,035 were diagnosed with at least one psychiatric disorder. High average HbA1c levels during the first 2 years predicted higher risk of psychiatric diagnoses. Patients with psychiatric comorbidity had higher HbA1c levels (0.22% [95% CI 0.15; 0.29]; 2.40 mmol/mol [1.62; 3.18]; P < 0.001) and an increased risk of hospitalization with diabetic ketoacidosis (1.80 [1.18; 2.76]; P = 0.006). We found no associations with BMI or SH.

CONCLUSIONS:

High average HbA1c levels during the first 2 years after onset of type 1 diabetes might indicate later psychiatric comorbidities. Psychiatric comorbidity in children and adolescents with type 1 diabetes increases the risk of poor metabolic outcomes. Early focus on the disease burden might improve outcomes.

PMID:
30270201
DOI:
10.2337/dc18-0609

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