Comparison of Glycemic and Metabolic Control in Youth With Type 1 Diabetes With and Without Antipsychotic Medication: Analysis From the Nationwide German/Austrian Diabetes Survey (DPV)

Galler, Angela; Bollow, Esther; Meusers, Michael; Bartus, B; Näke, Andrea; Haberland, Holger; Schober, Edith; Holl, Reinhard W.

doi:10.2337/dc14-2538

Cited by 27 publications

(25 citation statements)

References 32 publications

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“…Our finding that having a psychiatric disorder is associated with compromised treatment outcomes is consistent with previous clinical (16)(17)(18)(19)(20) and populationbased studies (4)(5)(6) in pediatric populations; although previous studies have investigated individual disorders and none included the entire range of psychiatric disorders.…”

Section: Findings In Relation To Other Studiessupporting

confidence: 91%

“…We found that having a psychiatric diagnosis from the potentially reactive disorder group or a combination of both types of disorder was associated with higher HbA 1c levels. In comparison, the German/Austrian diabetes register study generally found greater differences in metabolic outcome (0.3-0.8% [3.5-9 mmol/mol]) when they investigated individual diagnoses (4)(5)(6).…”

Section: Findings In Relation To Other Studiesmentioning

confidence: 94%

“…This is a potential limitation regarding reactive disorders, but taking into account the risk of recurrence or persistency of these disorders in youngsters facing chronic stressful experiences (12), we believe that our approach is acceptable. We did not have information on the treatment of psychiatric disorders, diabetes-related family stress, quality of life, or socioeconomic factors, all of which might influence diabetes outcomes and the burden of the disease (4,5,32,39,40).…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…The German/Austrian diabetes register study group investigated HbA 1c levels and other diabetesrelated outcomes in patients with psychiatric comorbidities, including depression, eating disorders, and psychosis. They obtained mixed results regarding BMI but observed that overall diabetes outcomes were poorer and characterized by higher HbA 1c levels, more episodes of severe hypoglycemia (SH) and diabetic ketoacidosis (DKA), and longer, more frequent hospitalizations (4)(5)(6).…”

mentioning

confidence: 99%

“…Despite clinical and research evidence that a child with type 1 diabetes often receives more than one psychiatric diagnosis (1,3), most studies evaluate one disorder at a time (4)(5)(6)(16)(17)(18)(19)(20).…”

mentioning

confidence: 99%

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Poor Metabolic Control in Children and Adolescents With Type 1 Diabetes and Psychiatric Comorbidity

et al. 2018

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OBJECTIVEType 1 diabetes is associated with an increased risk of psychiatric morbidities. We investigated predictors and diabetes outcomes in a pediatric population with and without psychiatric comorbidities. RESEARCH DESIGN AND METHODSData from the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) and National Patient Register were collected (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) for this population-based study. We used Kaplan-Meier plots to investigate whether age at type 1 diabetes onset and average glycated hemoglobin (HbA 1c ) levels during the first 2 years after onset of type 1 diabetes (excluding HbA 1c at debut) were associated with the risk of being diagnosed with a psychiatric disorder. Mixed-effects linear and logistic regression models were used to analyze HbA 1c , BMI, severe hypoglycemia (SH), or ketoacidosis as outcomes, with psychiatric comorbidities as explanatory factor. RESULTSAmong 4,725 children and adolescents with type 1 diabetes identified in both registers, 1,035 were diagnosed with at least one psychiatric disorder. High average HbA 1c levels during the first 2 years predicted higher risk of psychiatric diagnoses. Patients with psychiatric comorbidity had higher HbA 1c levels (0.22% [95% CI 0.15; 0.29]; 2.40 mmol/mol [1.62; 3.18]; P < 0.001) and an increased risk of hospitalization with diabetic ketoacidosis (1.80 [1.18; 2.76]; P = 0.006). We found no associations with BMI or SH. CONCLUSIONSHigh average HbA 1c levels during the first 2 years after onset of type 1 diabetes might indicate later psychiatric comorbidities. Psychiatric comorbidity in children and adolescents with type 1 diabetes increases the risk of poor metabolic outcomes. Early focus on the disease burden might improve outcomes.Type 1 diabetes in childhood has been found to be associated with an increased risk of psychiatric comorbidities (1-3), which might intensify the burden of disease and accelerate metabolic deterioration (4-6), subsequently increasing the risk of mortality and long-term complications such as retinopathy, nephropathy, and neuropathy (7-9).

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Section: Findings In Relation To Other Studiessupporting

confidence: 91%

Section: Findings In Relation To Other Studiesmentioning

confidence: 94%

Section: Strengths and Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Poor Metabolic Control in Children and Adolescents With Type 1 Diabetes and Psychiatric Comorbidity

et al. 2018

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Association of Insulin Pump Therapy vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, and Glycemic Control Among Children, Adolescents, and Young Adults With Type 1 Diabetes

Karges

Schwandt

Heidtmann

et al. 2017

JAMA

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368

247

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Among young patients with type 1 diabetes, insulin pump therapy, compared with insulin injection therapy, was associated with lower risks of severe hypoglycemia and diabetic ketoacidosis and with better glycemic control during the most recent year of therapy. These findings provide evidence for improved clinical outcomes associated with insulin pump therapy compared with injection therapy in children, adolescents, and young adults with type 1 diabetes.

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Psychotropic Medication Use in Children and Adolescents With Type 1 Diabetes

Liu,

Lagerberg,

Ludvigsson

et al. 2023

JAMA Netw Open

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ImportanceChildren and adolescents with type 1 diabetes (T1D) face elevated risks of psychiatric disorders. Despite their nonnegligible adverse effects, psychotropic medications are a common cost-effective approach to alleviating psychiatric symptoms, but evidence regarding their dispensation to children and adolescents with T1D remains lacking.ObjectiveTo examine the trends and patterns of psychotropic medication dispensation among children and adolescents with T1D in Sweden between 2006 and 2019.Design, Setting, and ParticipantsThis cohort study used data from multiple Swedish registers. The main study cohort included children and adolescents residing in Sweden from 2006 to 2019 and was followed up until the earliest of December 31, 2019, 18th birthday, emigration, or death. Data analyses were conducted from November 1, 2022, to April 30, 2023.ExposuresType 1 diabetes.Main Outcomes and MeasuresThe primary outcomes were trends and patterns of psychotropic medication dispensation (including antipsychotics, antidepressants, anxiolytics, hypnotics, mood stabilizers, and medications for attention-deficit/hyperactivity disorder [ADHD]), psychotropic medication initiation, and history of neurodevelopmental and psychiatric diagnosis. Cumulative incidence curves and Cox proportional hazard models were used to estimate the aggregated incidence and hazard ratios of medication initiation after diabetes onset.ResultsOf 3 723 745 children and adolescents (1 896 199 boys [50.9%]), 13 200 (0.4%; 7242 boys [54.9%]) had T1D (median [IQR] age at diagnosis, 11.1 [7.6-14.7] years). Between 2006 and 2019, psychotropic medication dispensation increased from 0.85% (95% CI, 0.65%-1.10%) to 3.84% (3.11%-4.69%) among children and from 2.72% (95% CI, 2.15%-3.39%) to 13.54% (95% CI, 12.88%-14.23%) among adolescents with T1D, consistently higher than their peers without T1D. The most commonly dispensed medications included hypnotics, ADHD medications, anxiolytics, and selective serotonin reuptake inhibitors, and all exhibited increasing trends. For those with T1D, psychiatric care was the primary prescription source, and up to 50.1% of treatments lasted more than 12 months. In addition, children and adolescents with T1D showed higher cumulative incidence and hazard ratios of medication initiation after diabetes onset than their same-age and same-sex counterparts.Conclusions and RelevanceThis cohort study found an increasing trend in psychotropic medication dispensation among children and adolescents with T1D from 2006 to 2019, persistently higher than those without T1D. These findings call for further in-depth investigations into the benefits and risks of psychotropic medications within this population and highlight the importance of integrating pediatric diabetes care and mental health care for early detection of psychological needs and careful monitoring of medication use.

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Comparison of Glycemic and Metabolic Control in Youth With Type 1 Diabetes With and Without Antipsychotic Medication: Analysis From the Nationwide German/Austrian Diabetes Survey (DPV)

Cited by 27 publications

References 32 publications

Poor Metabolic Control in Children and Adolescents With Type 1 Diabetes and Psychiatric Comorbidity

Poor Metabolic Control in Children and Adolescents With Type 1 Diabetes and Psychiatric Comorbidity

Association of Insulin Pump Therapy vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, and Glycemic Control Among Children, Adolescents, and Young Adults With Type 1 Diabetes

Psychotropic Medication Use in Children and Adolescents With Type 1 Diabetes

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