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Neurodevelopmental Disorders, Glycemic Control, and Diabetic Complications in Type 1 Diabetes: a Nationwide Cohort

Shengxin Liu¹, Ralf Kuja-Halkola¹, Henrik Larsson^1,2

¹Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden.

The Journal of Clinical Endocrinology and Metabolism

|June 25, 2021

Insights

Children with type 1 diabetes and neurodevelopmental disorders, like ADHD and intellectual disability, face poorer glycemic control. This increases their risk of serious diabetic complications, impacting long-term health outcomes.

Area of Science:

Pediatrics
Endocrinology
Neuroscience

Background:

Neurodevelopmental disorders are more common in childhood-onset type 1 diabetes.
These conditions can hinder effective diabetes management.
Understanding this link is crucial for patient care.

Purpose of the Study:

To examine the association between comorbid neurodevelopmental disorders and long-term glycemic control in type 1 diabetes.
To assess the risk of diabetic complications in these individuals.
To identify specific neurodevelopmental disorders that pose the greatest risk.

Main Methods:

Population-based cohort study using Swedish register data.
Included 11,326 individuals diagnosed with type 1 diabetes (median onset age 9.6 years).
Analyzed data from 764 individuals with comorbid neurodevelopmental disorders (ADHD, ASD, intellectual disability) using logistic and Cox regression.

Main Results:

Comorbid neurodevelopmental disorders, particularly ADHD, were linked to poor glycemic control (HbA1c > 8.5%).
Increased risks of nephropathy and retinopathy were observed in patients with neurodevelopmental disorders.
Intellectual disability showed a significantly higher risk for nephropathy.

Conclusions:

Comorbid neurodevelopmental disorders, especially ADHD and intellectual disability, are associated with worse glycemic control in childhood-onset type 1 diabetes.
These conditions elevate the risk of developing diabetic complications like nephropathy and retinopathy.
Targeted interventions are needed for this vulnerable patient group.

Read full analysis

Abstract

Context:

Neurodevelopmental disorders are more prevalent in childhood-onset type 1 diabetes than in the general population, and the symptoms may limit the individual's ability for diabetes management.

Objective:

This study investigated whether comorbid neurodevelopmental disorders are associated with long-term glycemic control and risk of diabetic complications.

Methods:

This population-based cohort study used longitudinally collected data from Swedish registers. We identified 11 326 individuals born during 1973-2013, diagnosed with type 1 diabetes during 1990-2013 (median onset age: 9.6 years). Among them, 764 had a comorbid neurodevelopmental disorder, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, and intellectual disability. We used multinomial logistic regression to calculate odds ratios (ORs) of having poor glycemic control (assessed by glycated hemoglobin [HbA1c]) and Cox regression to estimate hazard ratios (HRs) of nephropathy and retinopathy.

Results:

The median follow-up was 7.5 years (interquartile range [IQR] 3.9, 11.2). Having any neurodevelopmental disorder (ORadjusted 1.51 [95% CI 1.13, 2.03]), or ADHD (ORadjusted 2.31 [95% CI 1.54, 3.45]) was associated with poor glycemic control (mean HbA1c > 8.5%). Increased risk of diabetic complications was observed in patients with comorbid neurodevelopmental disorders (HRadjusted 1.72 [95% CI 1.21, 2.44] for nephropathy, HRadjusted 1.18 [95% CI 1.00, 1.40] for retinopathy) and patients with ADHD (HRadjusted 1.90 [95% CI 1.20, 3.00] for nephropathy, HRadjusted 1.33 [95% CI 1.07, 1.66] for retinopathy). Patients with intellectual disability have a particularly higher risk of nephropathy (HRadjusted 2.64 [95% CI 1.30, 5.37]).

Conclusion:

Comorbid neurodevelopmental disorders, primarily ADHD and intellectual disability, were associated with poor glycemic control and a higher risk of diabetic complications in childhood-onset type 1 diabetes.

Keywords:

glycemic control nephropathy neurodevelopmental disorders retinopathy type 1 diabetes

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