1
|
Robinson DJ, Hanson K, Jain AB, Kichler JC, Mehta G, Melamed OC, Vallis M, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Houlden R, Kim J, Lewis J, MacDonald B, MacKay D, Mansell K, Rabi D, Sherifali D, Senior P. Diabetes and Mental Health. Can J Diabetes 2023; 47:308-344. [PMID: 37321702 DOI: 10.1016/j.jcjd.2023.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
|
2
|
Pasley K, Krivchenia K, Dell ML, McCoy KS, Paul GR. Clinical management of pediatric patients with cystic fibrosis and autism spectrum disorder. Pediatr Pulmonol 2023; 58:1160-1168. [PMID: 36610056 DOI: 10.1002/ppul.26311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/19/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cystic Fibrosis (CF) and autism spectrum disorder (ASD) are life-long conditions with intense treatment burdens for patients and families. Patients with a concurrent diagnosis (CF-ASD) experience unique obstacles to CF care. This study describes the experiences of our multidisciplinary CF team in caring for patients with CF-ASD and provides insight into provider and parental perspectives on clinical management. METHODS This is a three-part qualitative study involving (1) retrospective chart review of patients with CF-ASD, (2) surveys with multidisciplinary care team members, and (3) semistructured interviews with caregivers of patients with CF-ASD. Challenges in clinical management of this specific cohort were compiled using data from chart review and care team surveys. Strategies to address these concerns were identified and rated by individual families based on relevance and practicality. RESULTS Within our CF center, 12 patients have an official diagnosis of ASD. Median age of patients with CF-ASD was 8.5 years (range 3-20 years), 67% were male, and 83% were on highly effective modulator therapy. Clinical barriers included sensory processing issues, environmental overstimulation, intolerance to procedures and to disrupted routines. Potentially impactful strategies include patient-specific coping plans, guided behavioral interventions, parental advocacy, and improved communication between the family and multidisciplinary team. CONCLUSION Children with CF-ASD face extraordinary challenges beyond the experience of neurotypical children with CF. Increased awareness of this complex dual diagnosis will help providers be sensitive to the unique needs of these patients, help build consistent and trustworthy relationships with their families and deliver effective clinical care despite limitations.
Collapse
Affiliation(s)
- Kimberly Pasley
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Katelyn Krivchenia
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Mary Lynn Dell
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Karen S McCoy
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Grace R Paul
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| |
Collapse
|
3
|
Benton M, Cleal B, Prina M, Baykoca J, Willaing I, Price H, Ismail K. Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis. Gen Hosp Psychiatry 2023; 80:1-16. [PMID: 36493531 DOI: 10.1016/j.genhosppsych.2022.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Type 1 diabetes is associated with increased prevalence of individual categories of mental disorders. We aimed to systematically synthesise the prevalence of all the different categories of mental disorders to estimate the overall burden of psychiatric morbidity in the type 1 diabetes population. METHOD The electronic database of OVID was searched, and retrieved papers were screened for eligibility by two independent reviewers. Data were extracted using a standardised data extraction form and the quality of included papers was assessed. Where possible, comparisons with control groups without type 1 diabetes were made. Prevalence data were synthesised into Diagnostic and Statistical Manual of Mental Disorders version 5 categories, a narrative data-synthesis, and a subsequent meta-analysis where possible was conducted for mental disorder categories. RESULTS Thirty-eight articles were included. Depressive, anxiety, and feeding and eating disorders were the most examined mental disorders. Studies utilising diagnostic interviews reported higher prevalence of mental disorders than in studies utilising clinical registers, with an up to 24-fold difference respectively. In studies with a control group, the prevalence for nearly every mental disorder were increased for the type 1 diabetes samples. CONCLUSIONS There appears to be a high prevalence of mental disorders and associated need among people with type 1 diabetes, although the quality of research needs to improve. SYSTEMATIC REVIEW REGISTRATION This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020221530).
Collapse
Affiliation(s)
- Madeleine Benton
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom
| | - Bryan Cleal
- Steno Diabetes Center, Borgmester Ib Juuls Vej 83, 2730 Herlev, Copenhagen, Denmark
| | - Mathew Prina
- Social Epidemiology Research Group, King's College London, 18 De Crespigny Park, London SE5 8AF, United Kingdom
| | - Jeni Baykoca
- Southern Health NHS Foundation Trust, Southampton, Tremona Rd, Southampton SO16 6YD, United Kingdom
| | - Ingrid Willaing
- Steno Diabetes Center, Borgmester Ib Juuls Vej 83, 2730 Herlev, Copenhagen, Denmark
| | - Hermione Price
- Southern Health NHS Foundation Trust, Southampton, Tremona Rd, Southampton SO16 6YD, United Kingdom
| | - Khalida Ismail
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom.
| |
Collapse
|
4
|
Xie XN, Lei X, Xiao CY, Li YM, Lei XY. Association between type 1 diabetes and neurodevelopmental disorders in children and adolescents: A systematic review and meta-analysis. Front Psychiatry 2022; 13:982696. [PMID: 36483136 PMCID: PMC9722754 DOI: 10.3389/fpsyt.2022.982696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022] Open
Abstract
Type 1 diabetes and neurodevelopmental disorders are common chronic conditions in childhood and adolescence, and having one may lead to an increased chance of developing the other. Type 1 diabetes mellitus is mainly manifested by elevated blood glucose, while neurodevelopmental diseases are composed of a variety of diseases, which are relatively complex. The purpose of this meta-analysis was to find out the prevalence of type 1 diabetes-related neurodevelopmental disorders in children and adolescents and to explore the potential association between neurodevelopmental disorders and type 1 diabetes. PubMed, Embase and Web of science databases were searched from the inception to May 22, 2022 to identify relevant studies, Finally, 24 original studies were included in the meta-analysis. Prevalence estimates for neurodevelopmental disorders in the type 1 diabetes adolescent and their 95% confidence intervals were pooled using random effects models. The pooled estimates for autism spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD) in the type 1 diabetes population were 1.2 and 5.3%, respectively, both of which are higher than the 2019 global prevalence of ASD and ADHD in the general population. The results of the subgroup analysis showed that the prevalence of ASD and ADHD in the T1DM population tended to increase with age. In conclusion, there may be a potential link between the occurrence of type 1 diabetes mellitus and the development of neurodevelopmental disorders in children and adolescents, but more relevant studies are needed to understand the link between the underlying pathogenesis of type 1 diabetes and neurodevelopmental disorders. Systematic review registration [https://www.crd.york.ac.uk/PROSPERO/], identifier [CDR42022333443].
Collapse
Affiliation(s)
- Xue-Ni Xie
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
- School of Public Health, Kunming Medical University, Kunming, China
| | - Xue Lei
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Chun-Ye Xiao
- School of Nursing, Jinan University, Guangzhou, China
| | - Ya-Min Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xian-Yang Lei
- Office of the President, Central South University, Changsha, China
| |
Collapse
|
5
|
Association between autism spectrum disorder and diabetes: systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 136:104592. [PMID: 35217107 DOI: 10.1016/j.neubiorev.2022.104592] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 01/11/2023]
Abstract
There is mixed evidence on the link between autism spectrum disorder (ASD) and diabetes. We conducted the first systematic review/meta-analysis on their association. Based on a pre-registered protocol (PROSPERO: CRD42021261114), we searched Pubmed, Ovid, and Web of Science databases up to 6 December 2021, with no language/type of document restrictions. We assessed study quality using the Newcastle-Ottawa Scale (NOS). We included 24 studies (total: 3427,773 individuals; 237,529 with ASD and 92,832 with diabetes) in the systematic review and 20 in the meta-analysis (mean stars number on the NOS: 5.89/10). There was a significant association, albeit characterized by significant heterogeneity, when pooling unadjusted OR (1.535, 95% CI = 1.109-2.126), which remained significant when restricting the analysis to children and type 2 diabetes, but became non-significant when considering adjusted ORs (OR: 1.528, 95% CI = 0.954-2.448). No significant prospective association was found (n = 2) on diabetes predicting ASD (HR: 1.232, 0.826-11.837). Therefore, the association between ASD and diabetes is likely confounded by demographic and clinical factors that should be systematically investigated in future studies.
Collapse
|
6
|
Chen MH, Tsai SJ, Bai YM, Huang KL, Su TP, Chen TJ, Hsu JW. Type 1 Diabetes Mellitus and Risks of Major Psychiatric Disorders: A Nationwide Population-Based Cohort Study. DIABETES & METABOLISM 2022; 48:101319. [PMID: 35026379 DOI: 10.1016/j.diabet.2022.101319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The temporal association between type 1 diabetes mellitus (T1DM) and major psychiatric disorders, including schizophrenia, major affective disorder, autism spectrum disorder (ASD), and attention-deficit hyperactivity disorder (ADHD), remains elusive. METHODS The specialized databases of catastrophic diseases and mental disorders and the longitudinal health insurance database of Taiwan National Health Insurance Research Database were used in current study. A total of 6,226 patients with T1DM and 62,260 age- and sex-matched controls were recruited between 2001 and 2010 and were followed until the end of 2011 for the identification of diagnoses of schizophrenia (International Classification of Clinical Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] code: 295), bipolar disorder (ICD-9-CM codes: 296 except 296.2x, 296.3x, 296.9x, and 296.82), major depressive disorder (ICD-9-CM codes: 296.2x and 296.3x), ASD (ICD-9-CM code: 299), and ADHD (ICD-9-CM code: 314). RESULTS Cox regression analysis revealed increased hazard ratios of schizophrenia (12.28), bipolar disorder (13.80), major depressive disorder (10.41), ASD (14.52), and ADHD (8.19) in patients with T1DM compared with controls. DISCUSSION Our findings indicate the importance of clinicians closely monitoring the mental health condition of children, adolescents, and adults with T1DM. Additional studies should be conducted to elucidate the definite pathomechanisms of comorbidities between T1DM and major psychiatric disorders.
Collapse
Affiliation(s)
- Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
7
|
Zhang Z, Hou M, Ou H, Wang D, Li Z, Zhang H, Lu J. Expression and structural analysis of human neuroligin 2 and neuroligin 3 implicated in autism spectrum disorders. Front Endocrinol (Lausanne) 2022; 13:1067529. [PMID: 36479216 PMCID: PMC9719943 DOI: 10.3389/fendo.2022.1067529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022] Open
Abstract
The development of autism spectrum disorders (ASDs) involves both environmental factors such as maternal diabetes and genetic factors such as neuroligins (NLGNs). NLGN2 and NLGN3 are two members of NLGNs with distinct distributions and functions in synapse development and plasticity. The relationship between maternal diabetes and NLGNs, and the distinct working mechanisms of different NLGNs currently remain unclear. Here, we first analyzed the expression levels of NLGN2 and NLGN3 in a streptozotocin-induced ASD mouse model and different brain regions to reveal their differences and similarities. Then, cryogenic electron microscopy (cryo-EM) structures of human NLGN2 and NLGN3 were determined. The overall structures are similar to their homologs in previous reports. However, structural comparisons revealed the relative rotations of two protomers in the homodimers of NLGN2 and NLGN3. Taken together with the previously reported NLGN2-MDGA1 complex, we speculate that the distinct assembly adopted by NLGN2 and NLGN3 may affect their interactions with MDGAs. Our results provide structural insights into the potential distinct mechanisms of NLGN2 and NLGN3 implicated in the development of ASD.
Collapse
Affiliation(s)
- Zhenzhen Zhang
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Mengzhuo Hou
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Huaxing Ou
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Daping Wang
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, China
- Department of Orthopedics, Shenzhen Intelligent Orthopaedics and Biomedical Innovation Platform, Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zhifang Li
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, China
- *Correspondence: Jianping Lu, ; Huawei Zhang, ; Zhifang Li,
| | - Huawei Zhang
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, China
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Southern University of Science and Technology, Shenzhen, China
- *Correspondence: Jianping Lu, ; Huawei Zhang, ; Zhifang Li,
| | - Jianping Lu
- Department of Child and Adolescent Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
- *Correspondence: Jianping Lu, ; Huawei Zhang, ; Zhifang Li,
| |
Collapse
|
8
|
Blanchette JE, Aaron SP, Allen NA, Litchman ML. Equity in the Provision of Diabetes Self-Management Education and Support. Diabetes Spectr 2022; 35:284-294. [PMID: 36082013 PMCID: PMC9396716 DOI: 10.2337/dsi22-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Diabetes self-management education and support (DSMES) interventions must be accessible to all people with diabetes. To address equity in the delivery of DSMES, interventions should consider the unique needs of various populations. This article outlines the needs of a wide range of populations, including people with diabetes who are racially or ethnically diverse; have limited English proficiency or literacy; are deaf or hard of hearing; are blind or have low vision; are neurodiverse; live with learning disabilities or intellectual or developmental disabilities; have dementia or cognitive impairment; or are of sexual and/or gender minority. The authors discuss how best to tailor DSMES to meet the needs of these diverse groups.
Collapse
Affiliation(s)
- Julia E. Blanchette
- Center for Diabetes and Obesity, University Hospitals Cleveland Medical Center, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Corresponding author: Julia E. Blanchette,
| | | | - Nancy A. Allen
- University of Utah College of Nursing, Salt Lake City, UT
| | - Michelle L. Litchman
- University of Utah College of Nursing, Salt Lake City, UT
- Utah Diabetes and Endocrinology Center, Salt Lake City, UT
| |
Collapse
|
9
|
Heidari A, Rostam-Abadi Y, Rezaei N. The immune system and autism spectrum disorder: association and therapeutic challenges. Acta Neurobiol Exp (Wars) 2021; 81:249-263. [PMID: 34672295 DOI: 10.21307/ane-2021-023] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder, affecting communication and behavior. Historically, ASD had been described as a purely psychiatric disorder with genetic factors playing the most critical role. Recently, a growing body of literature has been emphasizing the importance of environmental and immunological factors in its pathogenesis, with the autoimmune process attracting the most attention. This study provides a review of the autoimmune involvement in the pathogenesis of ASD. The\r\nmicrobiome, the representative of the innate immune system in the central nervous system (CNS), plays a critical role in triggering inflammation. Besides, a bidirectional communicational pathway between the CNS and the intestine called the gut‑brain‑axis is linked to the development of ASD. Moreover, the higher plasma level of pro‑inflammatory cytokines in ASD patients and the higher prevalence of autoimmune disorders in the first‑degree family members of affected persons are other clues of the immune system involvement in\r\nthe pathogenesis of ASD. Furthermore, some anti‑inflammatory drugs, including resveratrol and palmitoylethanolamide have shown promising effects by relieving the manifestations of ASD. Although considerable advances have been made in elucidating the role of autoimmunity in the ASD pathogenesis, further studies with stronger methodologies are needed to apply the knowledge to the definitive treatment of ASD.
Collapse
Affiliation(s)
- Arash Heidari
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Yasna Rostam-Abadi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran;
| |
Collapse
|
10
|
Liu S, Kuja-Halkola R, Larsson H, Lichtenstein P, Ludvigsson JF, Svensson AM, Gudbjörnsdottir S, Tideman M, Serlachius E, Butwicka A. Neurodevelopmental Disorders, Glycemic Control, and Diabetic Complications in Type 1 Diabetes: a Nationwide Cohort Study. J Clin Endocrinol Metab 2021; 106:e4459-e4470. [PMID: 34171098 PMCID: PMC8530713 DOI: 10.1210/clinem/dgab467] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Indexed: 01/16/2023]
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.
Collapse
Affiliation(s)
- Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden
- School of Medical Sciences, Örebro University, 70182 Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden
- Department of Pediatrics, Örebro University Hospital, 70185 Örebro, Sweden
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, NG7 2UH Nottingham, UK
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Ann-Marie Svensson
- Swedish National Diabetes Register, Centre of Registers, 413 45 Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Soffia Gudbjörnsdottir
- Swedish National Diabetes Register, Centre of Registers, 413 45 Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Magnus Tideman
- School of Health and Social Science, Halmstad University, 301 18 Halmstad, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Service, Region Stockholm, 171 77 Stockholm, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Service, Region Stockholm, 104 31 Stockholm, Sweden
- Department of Child Psychiatry, Medical University of Warsaw, 02-091 Warsaw, Poland
| |
Collapse
|
11
|
Tromans S, Yao G, Alexander R, Mukaetova-Ladinska E, Kiani R, Al-Uzri M, Chester V, Carr R, Morgan Z, Vounzoulaki E, Brugha T. The Prevalence of Diabetes in Autistic Persons: A Systematic Review. Clin Pract Epidemiol Ment Health 2020; 16:212-225. [PMID: 33719361 PMCID: PMC7931154 DOI: 10.2174/1745017902016010212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/01/2020] [Accepted: 11/23/2020] [Indexed: 02/08/2023]
Abstract
Background: It has been proposed that autistic individuals are at an increased risk of type 1 and type 2 diabetes. Improved understanding of diabetes prevalence in autistic persons will help inform resource allocation for diabetes-related public health measures for this patient group. Objective: To conduct a systematic review of published literature pertaining to type 1 and type 2 diabetes prevalence in autistic individuals, including comparison with their non-autistic peers. Methods: Eligibility criteria included studies investigating the prevalence of diabetes in autistic individuals, as well as having been published in the English language. A systematic search of online databases (MEDLINE, PsycINFO, CINAHL, EMBASE and PubMed) was conducted on 4th April 2020. Additional approaches included the ancestry method, grey literature searches and expert consultation. Studies were qualitatively analysed with reporting quality appraised. Results: 19 eligible studies were identified, 7 of which provided type-specific diabetes prevalence data. Of 15 studies that included a non-autistic control group, 9 reported a higher diabetes prevalence among autistic persons, with a statistically significant difference in 4 studies. Studies demonstrating a higher diabetes prevalence in autistic groups had higher average study population sizes and reporting quality ratings. Conclusion: It is uncertain whether diabetes is significantly more prevalent in autistic persons relative to their non-autistic peers, though larger studies suggest a trend in this direction. Nevertheless, diabetes is a significant public health issue for the autistic community, which may require a tailored approach for identification and management. Prospero database registration number: CRD42019122176.
Collapse
Affiliation(s)
- Samuel Tromans
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.,Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Guiqing Yao
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Regi Alexander
- Department of Psychiatry, University of Hertfordshire, Hatfield, United Kingdom.,Hertfordshire Partnership University NHS Foundation Trust, Hatfield, United Kingdom
| | - Elizabeta Mukaetova-Ladinska
- Leicestershire Partnership NHS Trust, Leicester, United Kingdom.,Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Reza Kiani
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.,Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Mohammed Al-Uzri
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.,Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Verity Chester
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Richard Carr
- Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Zoe Morgan
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Elpida Vounzoulaki
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Traolach Brugha
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.,Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| |
Collapse
|
12
|
Oser TK, Oser SM, Parascando JA, Grisolano LA, Krishna KB, Hale DE, Litchman M, Majidi S, Haidet P. Challenges and Successes in Raising a Child With Type 1 Diabetes and Autism Spectrum Disorder: Mixed Methods Study. J Med Internet Res 2020; 22:e17184. [PMID: 32217508 PMCID: PMC7301267 DOI: 10.2196/17184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/22/2020] [Accepted: 03/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Self-management of type 1 diabetes (T1D) requires numerous decisions and actions by people with T1D and their caregivers and poses many daily challenges. For those with T1D and a developmental disorder such as autism spectrum disorder (ASD), more complex challenges arise, though these remain largely unstudied. OBJECTIVE This study aimed to better understand the barriers and facilitators of raising a child with T1D and ASD. Secondary analysis of web-based content (phase 1) and telephone interviews (phase 2) were conducted to further expand the existing knowledge on the challenges and successes faced by these families. METHODS Phase 1 involved a qualitative analysis of publicly available online forums and blog posts by caregivers of children with both T1D and ASD. Themes from phase 1 were used to create an interview guide for further in-depth exploration via interviews. In phase 2, caregivers of children with both T1D and ASD were recruited from Penn State Health endocrinology clinics and through the web from social media posts to T1D-focused groups and sites. Interested respondents were directed to a secure web-based eligibility assessment. Information related to T1D and ASD diagnosis, contact information, and demographics were collected. On the basis of survey responses, participants were selected for a follow-up telephone interview and were asked to complete the adaptive behavior assessment system, third edition parent form to assess autism severity and upload a copy of their child's most recent hemoglobin A1c (HbA1c) result. Interviews were transcribed, imported into NVivo qualitative data management software, and analyzed to determine common themes related to barriers and facilitators of raising a child with both ASD and T1D. RESULTS For phase 1, 398 forum posts and blog posts between 2009 and 2016 were analyzed. Common themes related to a lack of understanding by the separate ASD and T1D caregiver communities, advice on coping techniques, rules and routines, and descriptions of the health care experience. For phase 2, 12 eligible respondents were interviewed. For interviewees, the average age of the child at diagnosis with T1D and ASD was 7.92 years and 5.55 years, respectively. Average self-reported and documented HbA1c levels for children with T1D and ASD were 8.6% (70 mmol/mol) and 8.7% (72 mmol/mol), respectively. Common themes from the interviews related to increased emotional burden, frustration surrounding the amount of information they are expected to learn, and challenges in the school setting. CONCLUSIONS Caregivers of children with both T1D and ASD face unique challenges, distinct from those faced by caregivers of individuals who have either disorder alone. Understanding these challenges may help health care providers in caring for this unique population. Referral to the diabetes online community may be a potential resource to supplement the care received by the medical community.
Collapse
Affiliation(s)
- Tamara K Oser
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Sean M Oser
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jessica A Parascando
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Lee Ann Grisolano
- Department of Psychiatry, Penn State College of Medicine, Herhsey, PA, United States
| | - Kanthi Bangalore Krishna
- Division of Pediatric Endocrinology, Department of Pediatrics, Penn State of College of Medicine, Hershey, PA, United States
| | - Daniel E Hale
- Division of Pediatric Endocrinology, Department of Pediatrics, Penn State of College of Medicine, Hershey, PA, United States
| | - Michelle Litchman
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Shideh Majidi
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, CO, United States
| | - Paul Haidet
- Departments of Medicine, Public Health Sciences, and Humanities, Penn State College of Medicine, Hershey, PA, United States
| |
Collapse
|
13
|
Affiliation(s)
- B Balkau
- CESP Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Paris Sud, Villejuif, France
- European Regional Editor, Diabetic Medicine
| | - R I G Holt
- Human Development and Health, Faculty of Medicine, Medicine, University of Southampton, Southampton, UK
- Editor in Chief, Diabetic Medicine
| |
Collapse
|