ADHD and cardiometabolic risk profile in adults with type 2 diabetes: a longitudinal register-based study

To investigate the association between attention-deficit/hyperactivity disorder (ADHD) and cardiometabolic risk profile at the time of type 2 diabetes (T2D) diagnosis and examine longitudinal changes in cardiometabolic measures following T2D diagnosis.

A nationwide cohort study using linked Swedish health registers.

Adults aged 18-65 years with a first recorded diagnosis of T2D between 1996 and 2020. ADHD, treated as a lifetime condition, was identified through diagnostic and prescription records.

The cardiometabolic risk profile, comprising nine clinical parameters and two behavioural factors, was assessed at T2D diagnosis and was tracked for up to 5 years post-diagnosis. Linear regression (β_ADHD) and Poisson regression models with robust variance (risk ratios (RRs)) compared cardiometabolic risk factors at diagnosis between individuals with and without ADHD. Generalised estimating equations (β_ADHD*t) assessed longitudinal changes in clinical parameters following the diagnosis.

Among 80 607 individuals with T2D, 1204 (1.5%) had an ADHD diagnosis. At T2D diagnosis, individuals with ADHD were younger and had statistically significantly higher body mass index (BMI) (β_ADHD: 1.93 (95% CI 1.54 to 2.32)), triglycerides (β_ADHD: 0.31 (95% CI 0.17 to 0.45)) and smoking prevalence (RR: 1.58 (95% CI 1.44 to 1.74)) compared with those without ADHD. Other cardiometabolic risk factors did not differ significantly. Over the subsequent 5 years, trajectories in cardiometabolic risk factors were broadly similar, except for a greater reduction in BMI in individuals with ADHD (β_ADHD*t: -0.26 (95% CI -0.34 to -0.17)), independent of baseline BMI and glucose-lowering medications. After inverse probability of treatment weighting, the BMI reduction was substantially reduced and not significant (β_ADHD*t: -0.05 (95% CI -0.17 to 0.07)).

Among adults with newly diagnosed T2D, those with co-occurring ADHD had broadly similar cardiometabolic profiles to those without ADHD but presented at a younger age with a modestly higher BMI, triglycerides and smoking prevalence. Individuals with ADHD also showed a slightly greater reduction in BMI over time following T2D diagnosis. Despite modest overall cardiometabolic differences, incorporating ADHD status into preventive diabetes care may help identify a younger, more vulnerable subgroup who could benefit from targeted risk factor management.