scholarly journals Poor glycaemic control is associated with increased risk of neurodevelopmental disorders in childhood-onset type 1 diabetes: a population-based cohort study

Diabetologia ◽  
2021 ◽  
Author(s):  
Shengxin Liu ◽  
Ralf Kuja-Halkola ◽  
Henrik Larsson ◽  
Paul Lichtenstein ◽  
Jonas F. Ludvigsson ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
General Population ◽  
Neurodevelopmental Disorders ◽  
Neurodevelopmental Disorder ◽  
Childhood Onset ◽  
Poor Glycaemic Control ◽  
Onset Type ◽  
Increased Risk

Abstract Aims/hypothesis The aim of this study was 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. We hypothesised that individuals with poor glycaemic control may be at a higher risk of neurodevelopmental disorders compared with the general population, as well as compared with individuals with type 1 diabetes with adequate glycaemic control. Methods This Swedish population-based cohort study was conducted using data from health registers from 1973 to 2013. We identified 8430 patients with childhood-onset type 1 diabetes (diagnosed before age 18 years) with a median age of diabetes onset of 9.6 (IQR 5.9–12.9) and 84,300 reference individuals from the general population, matched for sex, birth year and birth county. Cox models were used 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. Results During a median follow-up period of 5.6 years, 398 (4.7%) individuals 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 (95% CI 1.18, 1.46) after additionally adjusting for other psychiatric morbidity prior to inclusion, parental psychiatric morbidity and parental highest education level. The risk of any neurodevelopmental disorder increased with HbA1c levels and the highest risk was observed in patients with mean HbA1c >8.6% (>70 mmol/mol) (HRadjusted 1.90 [95% CI 1.51, 2.37]) compared with reference individuals without type 1 diabetes. In addition, when compared with patients with diabetes with HbA1c <7.5% (<58 mmol/mol), patients with HbA1c >8.6% (>70 mmol/mol) had the highest risk of any neurodevelopmental disorder (HRadjusted 3.71 [95% CI 2.75, 5.02]) and of specific neurodevelopmental disorders including ADHD (HRadjusted 4.16 [95% CI 2.92, 5.94]), ASD (HRadjusted 2.84 [95% CI 1.52, 5.28]) and intellectual disability (HRadjusted 3.93 [95% CI 1.38, 11.22]). Conclusions/interpretation 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. Graphical abstract

scholarly journals Neurodevelopmental disorders, glycaemic control and diabetic complications in type 1 diabetes: a nationwide cohort study

2021 ◽  
Author(s):  
Shengxin Liu ◽  
Ralf Kuja-Halkola ◽  
Henrik Larsson ◽  
Paul Lichtenstein ◽  
Jonas F  Ludvigsson ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Cohort Study ◽  
Intellectual Disability ◽  
Glycaemic Control ◽  
Diabetic Complications ◽  
Neurodevelopmental Disorders ◽  
Neurodevelopmental Disorder ◽  
Childhood Onset ◽  
Poor Glycaemic Control

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 of diabetes management. It remains unknown whether comorbid neurodevelopmental disorders are associated with long-term glycaemic 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 1973-2013, diagnosed with type 1 diabetes 1990-2013 (median onset age: 9.6 years). Out of 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 glycaemic control (assessed by mean of glycated haemoglobin [HbA1c]) and Cox regression to estimate hazard ratios (HRs) of nephropathy and retinopathy. Results The median of follow-up was 7.5 (IQR 3.9, 11.2) years. 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 glycaemic control (mean HbA1c &gt;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]). Conclusions Comorbid neurodevelopmental disorders, primarily ADHD and intellectual disability, were associated with poor glycaemic control and a higher risk of diabetic complications in childhood-onset type 1 diabetes.

scholarly journals OP40 Ethnic differences in early glycaemic control (hba1c) in childhood onset type 1 diabetes

2017 ◽  
Author(s):  
AR Khanolkar ◽  
R Amin ◽  
D Taylor-Robinson ◽  
R Viner ◽  
J Warner ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Ethnic Differences ◽  
Childhood Onset ◽  
Onset Type

scholarly journals Protocol for systematic review of evidence on the determinants and influence of early glycaemic control in childhood-onset type 1 diabetes

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Veena Mazarello Paes ◽  
Dimitrios Charalampopoulos ◽  
Amal R. Khanolkar ◽  
David Taylor-Robinson ◽  
Russell Viner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Childhood Onset ◽  
Onset Type

scholarly journals Mortality in childhood-onset type 1 diabetes: Nationwide population based data from Norway

2013 ◽  
Vol 23 (1) ◽  
Author(s):  
Torild Skrivarhaug
Keyword(s):  
Type 1 Diabetes ◽  
Premature Mortality ◽  
Diabetic Coma ◽  
Diabetic Patients ◽  
Childhood Onset ◽  
Onset Type ◽  
Treatment Type ◽  
Increased Risk

Type 1 diabetes with onset in childhood (0-14.9 years) represents one of the most frequent chronic diseases in children and young adults. Norway has one of the highest incidences of childhood onset type 1 diabetes in the world. Before introduction of insulin therapy in 1922, few children survived more than one to two years after clinical onset. When insulin came available, a major shift occurred in the distribution of causes of death in type 1 diabetic patients away from diabetic coma, which dominated the pre-insulin era, to renal and cardiac diseases. The disease is related to a significant burden to society and patients because most cases require lifelong treatment with insulin as well as day-to-day monitoring. Type 1 diabetes also confers increased risk of severe late complications such as renal failure, blindness, amputations, heart disease and stroke. Despite advances in diabetes treatment, type 1 diabetes is still associated with considerable premature mortality resulting from acute and chronic complications of diabetes and an increase in mortality at every age. Although the main cause of death in type 1 diabetes is long-term complications, an excess death rate has also been reported in subjects with short duration without signs of long-term complications.

Neonatal hyperbilirubinaemia is associated with a subsequent increased risk of childhood-onset type 1 diabetes

2019 ◽  
Vol 40 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Pei-Fen Liao ◽  
Jeng-Dau Tsai ◽  
Hsuan-Ju Chen ◽  
Hui-Hsien Pan ◽  
Tung-Wei Hung ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Childhood Onset ◽  
Onset Type ◽  
Increased Risk

Transition and beyond in childhood onset type 1 diabetes

2014 ◽  
Author(s):  
Suma Uday ◽  
James Yong ◽  
Fiona Campbell ◽  
Ramzi Ajjan
Keyword(s):  
Type 1 Diabetes ◽  
Childhood Onset ◽  
Onset Type
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