Aim To examine the association of childhood‐onset type 1 diabetes (T1D) and attention‐deficit/hyperactivity disorder (ADHD) with educational outcomes from compulsory school to university. Methods Using multiple Swedish nationwide registers, we followed up on 1,474,941 individuals born in Sweden from 1981–1995 to December 31, 2013. Associations of T1D and ADHD with achieving educational milestones (from compulsory school to university) and school performances were estimated using logistic and linear regression models and sibling comparison models. Results Compared to their peers, children with both T1D and ADHD were less likely to achieve any of the educational attainments, including completing compulsory school (adjusted OR [aOR] [95% CI]: 0.43 [0.26, 0.72]), be eligible to and finishing upper secondary school (0.26 [0.19, 0.36], 0.24 [0.17, 0.35], respectively), and starting university (0.38 [0.17, 0.90]). The odds of achieving these educational milestones were substantially lower in children with ADHD alone (aORs: 0.14–0.44), but were slightly worse or no differences in children with T1D alone (aORs: 0.86–1.08). All associations above remained similar in the sibling comparison models. Conclusion Children and adolescents with both T1D and ADHD had long‐term educational underachievement, with ADHD being the major contributor. Our findings suggest the importance of assessing ADHD in children with T1D and targeted support for minimising the education gap between the affected children and their peers.

OBJECTIVE To assess the association and familial coaggregation between early-onset type 2 diabetes (diagnosed before age 45 years) and mood, anxiety, and stress-related disorders and estimate the contribution of genetic and environmental factors to their co-occurrence. RESEARCH DESIGN AND METHODS This population-based cohort study included individuals born in Sweden during 1968–1998, from whom pairs of full siblings, half-siblings, and cousins were identified. Information on diagnoses of early-onset type 2 diabetes and mood (including unipolar depression and bipolar disorder), anxiety, and stress-related disorders was obtained from the National Patient Register. Logistic and Cox regression models were used to assess the phenotypic association and familial coaggregation between type 2 diabetes and psychiatric disorders. Quantitative genetic modeling was conducted in full and maternal half-sibling pairs to estimate the relative contributions of genetic and environmental factors to the association. RESULTS Among a total of 3,061,192 individuals, 7,896 (0.3%) were diagnosed with early-onset type 2 diabetes. These individuals had higher risks of any diagnosis (odds ratio [OR] 3.62 [95% CI 3.44, 3.80]) and specific diagnosis of unipolar depression (3.97 [3.75, 4.22]), bipolar disorder (4.17 [3.68, 4.73]), anxiety (3.76 [3.54, 3.99]), and stress-related disorders (3.35 [3.11, 3.61]). Relatives of individuals with early-onset type 2 diabetes also had higher overall risks of the examined psychiatric disorders (ORs 1.03–1.57). These associations are largely explained by genetic factors (51–78%), with the rest explained by nonshared environmental factors. CONCLUSIONS Our findings highlight the burden of mood, anxiety, and stress-related disorders in early-onset type 2 diabetes and demonstrate that shared familial liability may contribute to their co-occurrence, suggesting that in future research investigators should aim to identify shared risk factors and ultimately refine preventive and intervention strategies.

OBJECTIVE To estimate the association and familial coaggregation of childhood-onset type 1 diabetes with depression, anxiety, and stress-related disorders. RESEARCH DESIGN AND METHODS This was a population-based cohort study with use of data from Swedish nationwide registers. A total of ∼3.5 million individuals born in Sweden 1973–2007 were linked to their biological parents, full siblings and half-siblings, and cousins. Cox models were used to estimate the association and familial coaggregation of type 1 diabetes with depression, anxiety, and stress-related disorders. RESULTS Individuals diagnosed with childhood-onset type 1 diabetes (n = 20,005) were found to be at greater risks of all outcomes: any psychiatric diagnosis (adjusted hazard ratio [aHR] 1.66 [95% CI 1.59–1.72]) or specific diagnoses of depression (1.85 [1.76–1.94]), anxiety (1.41[1.33–1.50]), and stress-related disorders (1.75 [1.62–1.89]), as well as use of antidepressants or anxiolytics (1.30 [1.26–1.34]), compared with individuals without type 1 diabetes. Overall, relatives of individuals with type 1 diabetes were at elevated risks of developing these outcomes, with the highest risks seen in parents (aHRs 1.18–1.25), followed by full siblings (aHRs 1.05–1.20), and the magnitudes of risk estimates appear proportional to familial relatedness. CONCLUSIONS These results support existing evidence that children and adolescents with type 1 diabetes are at greater risks of developing depression, anxiety, and stress-related disorders and indicate that shared familial factors might contribute to these elevated risks. Our findings highlight the need for psychological consulting for children and their families in diabetes care. Quantitative and molecular genetic studies are warranted to further understand the etiology of these psychiatric disorders in type 1 diabetes.

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Psychiatric disorders in children and adolescents with type 1 diabetes (T1D) have caught increasing attention. While psychotropic drugs offer great value in managing psychiatric symptoms, their adverse effects engender considerable controversy regarding their use in pediatric patients, let alone in those with T1D. Despite the topic’s high visibility, little evidence exists on the patterns of psychotropic drug use in pediatric T1D patients. We thus conducted this cohort study of 3,720,381 children and adolescents (13,191 [0.36%] had T1D) using several Swedish national registers. We examined the trends and patterns (prescription source and treatment duration) of psychotropic drug use and estimated the risk of initiating psychotropic drugs after T1D onset. We found that psychotropic drug use increased significantly in children and adolescents with T1D from 2006 to 2019 (Figure 1), with ADHD medications, SSRI, hypnotics and anxiolytics among the most used ones. The primary prescription source was psychiatric care, and treatment durations were mostly <12 months (except for ADHD medications). Children and adolescents with newly-onset T1D had a higher risk of initiating any psychotropic drug (hazard ratio 1.29, 95%CI 1.20-1.38) than their peers without T1D. Our findings highlight the need for risk/benefit studies of psychotropic drugs among young users with T1D to inform future research and guideline development. Disclosure S.Liu: None. T.Lagerberg: None. J.F.Ludvigsson: Research Support; Janssen Pharmaceuticals, Inc., MSD Life Science Foundation. M.Taylor: None. B.Donofrio: None. P.Lichtenstein: None. S.Gudbjörnsdottir: None. A.Butwicka: None. Funding Swedish Research Council (2017-00788)