Poor Glycemic Control in Children with T1D Increases Risk of Developmental Disorders

Data from an analysis of 4 decades of healthcare data is shedding light on potential associations between poor glycemic control among children with type 1 diabetes and incidence of neurodevelopment disorders.

Using data from more than 8000 diabetic patients and 84,000 reference patients, investigators concluded poor glycemic control was associated with greater risks of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD), and intellectual disability.

“Our findings suggest that maintaining adequate glycemic control is important for controlling potential psychological burdens in childhood-onset type 1 diabetes, since patients with adequate glycemic control showed no statistically significant difference in risk of any neurodevelopmental disorders compared with the general population,” wrote investigators.

While previous studies have described associations between glycemic control and cognitive health during midlife and later, few studies have examined whether suboptimal glycemic control in pediatric patients impacted risk of neurodevelopmental disorders. With this in mind, a team led by investigators from the Karolinska Institute sought to evaluate potential associations between glycemic control in children with type 1 diabetes and neurodevelopmental disorders.

Using the Swediabkids database and the Swedish Diabetes Register, which contained data on births in Sweden dating back to 1973, investigators identified 8430 patients with childhood-onset type 1 diabetes and 84,300 reference individuals from the general population matched for sex, birth year, and birth county. Of note, the median age at diabetes diagnosis was 9.6 (IQR, 5.9-12.9) years.

The primary outcome of the analysis was development of a neurodevelopmental disorder. Secondary outcomes included incidence of specific neurodevelopmental disorders including ADHD, ASD, and intellectual disability. For the purpose of analysis, Cox models were used to assess the effect of HbA1c on risk of subsequent neurodevelopmental disorders.

During the follow-up period, which lasted a median of 5.6 years, 398 (47%) of those with type 1 diabetes received a diagnosis of any neurodevelopmental disorder. IN the reference cohort, 3.6% developed a neurodevelopmental disorder. 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; 95% CI, 1.18-1.46).

Further analysis indicated increased HbA1c levels were associated with increased risk of neurodevelopmental disorders, with the greatest risk seen among those with a mean HbA1c greater than 8.6% (HR, 1.90; 95% CI, 1.51-2.37) compared to reference individuals. Additionally, 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; 95% CI, 2.75-5.02) and specific disorders including ADHD (HR, 4.16; 95% CI, 2.92-5.94), ASD (HR, 2.84; 95% CI, 1.52-5.28), and intellectual disability (HR, 3.93; 95% CI, 1.38-11.22).

“Several implications for clinicians may be derived from the present study. First, our findings further support existing evidence that individuals with childhood-onset type 1 diabetes are at higher risk of neurodevelopmental disorders. Second, we demonstrated that glycemic control is an independent risk factor for clinically diagnosed neurodevelopmental disorders,” wrote investigators. “Thus, optimal diabetes management along with psychological care is crucial for children and adolescents with type 1 diabetes.”

This study, “Poor glycaemic control is associated with increased risk of neurodevelopmental disorders in childhood-onset type 1 diabetes: a population-based cohort study,” was published in Diabetologia.