Disclosures: Liu reports no relevant financial disclosures. Please see the study for a list of all other authors’ relevant financial disclosures.
March 17, 2021
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High HbA1c in type 1 diabetes linked to increased risk for neurodevelopment disorders

Disclosures: Liu reports no relevant financial disclosures. Please see the study for a list of all other authors’ relevant financial disclosures.
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Children with type 1 diabetes have an increased risk for developing neurodevelopment disorders, with the risk greater for those with a high HbA1c, according to a study published in Diabetologia.

Shengxin Liu

“Diabetes teams should be aware of the relationship between poor glycemic control in type 1 diabetes and increased risk of neurodevelopmental disorders,” Shengxin Liu, MBBS, MSc, a PhD student in the department of medical epidemiology and biostatistics at Karolinska Institutet in Solna, Sweden, told Healio. “Assessment for comorbid neurodevelopmental disorders should be offered to children and adolescents with self-management difficulties, suboptimal glycemic control and unexplained academic problems. Psychosocial interventions should be provided to children with type 1 diabetes and comorbid neurodevelopmental disorders, preferably in an interdisciplinary setting involving diabetes team and professionals experienced in neurodevelopmental disorders.”

Type 1 diabetes increases the risk for any neurodevelopment disorder in children. Data were derived from Liu S, et al. Diabetologia. 2021;doi:10.1007/s00125-020-05372-5. 

Liu and colleagues conducted a population-based cohort study using data from health registers from 1973 to 2013.. People with childhood-onset type 1 diabetes born in Sweden from 1973 onward were identified from the SWEDIABKIDS database and Swedish Diabetes Register. Participants with an HbA1c measurement within 1 year of their diabetes diagnosis were included. Each child with diabetes was randomly matched by sex, birth year and birth county with 10 people without diabetes from Sweden’s Total Population Register. Neurodevelopment disorders were identified from the National Patient Register and the clinical databases for Child and Adolescent Mental Health Services, the Habilitation Register and the Halmstad University Register on Pupils with Intellectual Disability.

Researchers included 8,430 people with type 1 diabetes diagnosed before age 18 years and 84,300 matched reference individuals in the study. During a median follow-up of 5.6 years, 4.7% of the diabetes group and 3.6% of reference individuals received at least one neurodevelopment disorder diagnosis. After adjusting for covariates, childhood-onset type 1 diabetes was associated with a higher risk for any neurodevelopmental disorder (adjusted HR = 1.31; 95% CI, 1.18-1.46), ADHD (aHR = 1.29; 95% CI, 1.14-1.46) and autism spectrum disorders (aHR = 1.31; 95% CI, 1.04-1.65) compared with the reference group. Children with diabetes and a mean HbA1c of less than 7.5% did not show an increased risk for any neurodevelopmental disorder, whereas a higher risk was found for those with HbA1c between 7.5% and 8.6% (aHR = 1.22; 95% CI, 1.05-1.43) and HbA1c greater than 8.6% (aHR = 1.9; 95% CI, 1.51-2.37) compared with the general population.

When compared with people in the diabetes group with an HbA1c of less than 7.5%, individuals with an HbA1c of 7.5% to 8.6% (aHR = 1.64; 95% CI, 1.22-2.21) and an HbA1c greater than 8.6% (aHR = 3.71; 95% CI, 2.75-5.02) had an increased risk for any neurodevelopmental disorder. There was also an increased risk for ADHD in the subgroups with HbA1c of 7.5% to 8.6% (aHR = 1.73; 95% CI, 1.21-2.46) and HbA1c greater than 8.6% (aHR = 4.16; 95% CI, 2.92-5.94) compared with the lowest HbA1c group. The risk for autism spectrum disorders and intellectual disability was not increased with an HbA1c between 7.5% and 8.6%, but children with an HbA1c greater than 8.6% had an increased risk for autism spectrum disorders (aHR = 2.84; 95% CI, 1.52-5.28) and intellectual disability (aHR = 3.93; 95% CI, 1.38-11.22).

Liu said future longitudinal studies are needed to evaluate a wider range of diabetes-related factors and better analyze the association between neurodevelopmental disorders and type 1 diabetes.

“Research integrating pediatric psychological service and diabetes care are needed to assess the effectiveness of screening for neurodevelopmental disorders in type 1 diabetes and therapeutic strategies in children with both conditions,” Liu said.

For more information:

Shengxin Liu, MBBS, MSc, can be reached at shengxin.liu@ki.se