In the JournalsPerspective

Insulin pump therapy may improve glycemic management in children with type 1 diabetes, autism

Children with type 1 diabetes and comorbid autism have a glycemic profile that is similar to children with type 1 diabetes but without autism, despite fewer patients with autism using insulin pump therapy, according to findings published in Pediatric Diabetes.

Shideh Majidi

“Individualized care is still important in diabetes management, as it is in all cases, but simply having autism does not necessarily need to be seen by providers as a barrier to implementation of technology and aiming for glycemic targets,” Shideh Majidi, MD, assistant professor in pediatric endocrinology at the Barbara Davis Center for Childhood Diabetes at the University of Colorado Anschutz Medical Campus, told Endocrine Today. “Youth with [autism spectrum disorder] can successfully integrate technology into their diabetes care, and this study finds that technology use could result in better glycemic management compared to multiple daily insulin injections.”

In a retrospective chart review, Majidi and colleagues analyzed data from 30 children with comorbid diagnoses of autism and type 1 diabetes (28 boys; mean autism duration, 4.4 years), each matched by age, sex and race with three children with type 1 diabetes but without autism (n = 90), seen at the Barbara Davis Center in Colorado between June 2014 and June 2015 (mean age, 13 years; mean diabetes duration, 4.9 years). Researchers evaluated autism duration, diabetes duration, insulin regimen type, total daily insulin dose, use of continuous glucose monitoring and total number of diabetic ketoacidosis events reported. Glycemic control was assessed by HbA1c.

Researchers found that the prevalence of comorbid autism in the type 1 diabetes population at the Barbara Davis Center was 11.6 per 1,000, or 1.16%, which is comparable to the overall Colorado population (1.09%). There were no between-group differences in the average number of blood glucose checks per day; however, children with comorbid autism had a lower HbA1c when compared with the overall clinic population (8.16% vs. 8.86%; P = .0064). For children whose parents reported mild autism symptoms (n = 7), mean HbA1c was 8% and 28.6% used insulin pump therapy, according to researchers, whereas those whose parents reported moderate symptoms (n = 6) had a mean HbA1c of 8.7% and 33.3% used insulin pump therapy. Children with comorbid autism also had a lower mean daily insulin dose vs. controls with type 1 diabetes (mean, 40.8 U vs. 53 U; P = .005).

“This study found no increased prevalence of autism spectrum disorder in type 1 diabetes  compared to the general population,” Majidi said. “The study’s findings also suggest that individuals with autism are capable of having the same glycemic control as those without autism.”

There were no between-group differences with respect to CGM use; however, patients with comorbid autism were less likely to use insulin pump therapy vs. controls (37% vs. 61%; P = .03). After insulin pump therapy initiation, the researchers noted that HbA1c slope changes increased more over time for controls vs. patients with comorbid autism (P = .01).

The researchers noted that the data suggest that children with type 1 diabetes and autism may benefit more from uptake of insulin pump therapy vs. controls, particularly during adolescence, when HbA1c tends to rise.

“Due to more routine daily activities and rigid thinking, [insulin pump therapy] could benefit patients with [autism spectrum disorder] through providing more customizable insulin profiles,” the researchers wrote. “It may be hard to predict how much a child with [autism spectrum disorder] may eat, due to decreased communication skills, so the [insulin pump therapy] regimen would allow caregivers to give additional insulin without another shot.”

The researchers wrote that longitudinal studies could confirm the benefit of insulin pump therapy in patients with type 1 diabetes and autism when compared with the overall type 1 diabetes population. – by Regina Schaffer

For more information:

Shideh Majidi, MD, can be reached at the Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, Aurora, CO 80045; email: shideh.majidi@ucdenver.edu.

Disclosures: The authors report no relevant financial disclosures.

Children with type 1 diabetes and comorbid autism have a glycemic profile that is similar to children with type 1 diabetes but without autism, despite fewer patients with autism using insulin pump therapy, according to findings published in Pediatric Diabetes.

Shideh Majidi

“Individualized care is still important in diabetes management, as it is in all cases, but simply having autism does not necessarily need to be seen by providers as a barrier to implementation of technology and aiming for glycemic targets,” Shideh Majidi, MD, assistant professor in pediatric endocrinology at the Barbara Davis Center for Childhood Diabetes at the University of Colorado Anschutz Medical Campus, told Endocrine Today. “Youth with [autism spectrum disorder] can successfully integrate technology into their diabetes care, and this study finds that technology use could result in better glycemic management compared to multiple daily insulin injections.”

In a retrospective chart review, Majidi and colleagues analyzed data from 30 children with comorbid diagnoses of autism and type 1 diabetes (28 boys; mean autism duration, 4.4 years), each matched by age, sex and race with three children with type 1 diabetes but without autism (n = 90), seen at the Barbara Davis Center in Colorado between June 2014 and June 2015 (mean age, 13 years; mean diabetes duration, 4.9 years). Researchers evaluated autism duration, diabetes duration, insulin regimen type, total daily insulin dose, use of continuous glucose monitoring and total number of diabetic ketoacidosis events reported. Glycemic control was assessed by HbA1c.

Researchers found that the prevalence of comorbid autism in the type 1 diabetes population at the Barbara Davis Center was 11.6 per 1,000, or 1.16%, which is comparable to the overall Colorado population (1.09%). There were no between-group differences in the average number of blood glucose checks per day; however, children with comorbid autism had a lower HbA1c when compared with the overall clinic population (8.16% vs. 8.86%; P = .0064). For children whose parents reported mild autism symptoms (n = 7), mean HbA1c was 8% and 28.6% used insulin pump therapy, according to researchers, whereas those whose parents reported moderate symptoms (n = 6) had a mean HbA1c of 8.7% and 33.3% used insulin pump therapy. Children with comorbid autism also had a lower mean daily insulin dose vs. controls with type 1 diabetes (mean, 40.8 U vs. 53 U; P = .005).

“This study found no increased prevalence of autism spectrum disorder in type 1 diabetes  compared to the general population,” Majidi said. “The study’s findings also suggest that individuals with autism are capable of having the same glycemic control as those without autism.”

There were no between-group differences with respect to CGM use; however, patients with comorbid autism were less likely to use insulin pump therapy vs. controls (37% vs. 61%; P = .03). After insulin pump therapy initiation, the researchers noted that HbA1c slope changes increased more over time for controls vs. patients with comorbid autism (P = .01).

The researchers noted that the data suggest that children with type 1 diabetes and autism may benefit more from uptake of insulin pump therapy vs. controls, particularly during adolescence, when HbA1c tends to rise.

“Due to more routine daily activities and rigid thinking, [insulin pump therapy] could benefit patients with [autism spectrum disorder] through providing more customizable insulin profiles,” the researchers wrote. “It may be hard to predict how much a child with [autism spectrum disorder] may eat, due to decreased communication skills, so the [insulin pump therapy] regimen would allow caregivers to give additional insulin without another shot.”

The researchers wrote that longitudinal studies could confirm the benefit of insulin pump therapy in patients with type 1 diabetes and autism when compared with the overall type 1 diabetes population. – by Regina Schaffer

For more information:

Shideh Majidi, MD, can be reached at the Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, Aurora, CO 80045; email: shideh.majidi@ucdenver.edu.

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Sumana Narasimhan

    Sumana Narasimhan

    This is a good study from a good team. It is difficult to find good studies that include children with special needs. Often, they are left out due to exclusion criteria. At the same time, even though they make up a smaller segment of the population, that doesn’t mean they shouldn’t be studied.

    These findings are not surprising. Rather, they are a validation of what we have seen —children with diabetes and autism can do well, with or without pump therapy. Newer insulin pumps also offer minimal fingersticks for calibration, which can help children with diabetes and sensory issues. One should not assume these children will have worse glycemic control. However, with these children, there is often a caregiver playing an important role, or the child may live in a long-term care facility. Even if a child is high-functioning, they typically have an aide and support services at school to help with diabetes management. The study raises a very important question: What happens when these children turn 18, or lose services? That is something that requires further study.

    • Sumana Narasimhan, MD, FAAP
    • Pediatric endocrinologist
      Cleveland Clinic

    Disclosures: Narasimhan reports no relevant financial disclosures.