Mental Health and Behavioral Screening in Pediatric Type 1 Diabetes

Duffus, Sara H.; Cooper, Katherine Louise; Agans, Robert; Jain, Nina

doi:10.2337/ds18-0053

Cited by 9 publications

(6 citation statements)

References 19 publications

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“…The COVID-19 pandemic has exacerbated mental health comorbidities throughout society, not least in patients with diabetes and other endocrine disorders (37,38). Children are a particularly vulnerable group, as their nervous systems, endocrine systems, and hypothalamic-pituitary-adrenal axes are not well developed.…”

Section: Discussionmentioning

confidence: 99%

The Challenges of Managing Pediatric Diabetes and Other Endocrine Disorders During the COVID-19 Pandemic: Results From an International Cross-Sectional Electronic Survey

et al. 2021

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BackgroundFrequency, dimensions, management, and outcomes of the COVID-19 pandemic in children with endocrine disorders and diabetes were assessed.MethodsA cross-sectional electronic survey was distributed to the global network of endocrine societies. Respondents’ professional and practice profiles, clinic sizes, their country of practice, and the impact of COVID-19 on endocrine diseases were investigated.ResultsRespondents from 131 pediatric endocrine centers in 51 countries across all continents completed the survey. Routine check-ups and education were altered in most pediatric endocrine clinics. Over 20% of clinics experienced a shortage of critical medications or essential supplies. ICU treatment was required for patients with diabetes and COVID-19 in 21.2% of centers. In diabetes, 44% of respondents reported increased diabetic ketoacidosis episodes in newly diagnosed cases and 30% in established cases. Biopsychosocial and behavioral changes were explicitly reported to be occurring among pediatric patients with endocrine disorders.ConclusionsThis large global survey conducted during the COVID-19 pandemic highlights that diabetes is more challenging to manage than any other pediatric endocrine disorder, with an increased risk of morbidity. Psychological distress due to COVID-19 needs to be recognized and addressed. The importance of close contact with healthcare professionals should be emphasized, and medical supplies should be readily available to all patients.

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Section: Discussionmentioning

confidence: 99%

The Challenges of Managing Pediatric Diabetes and Other Endocrine Disorders During the COVID-19 Pandemic: Results From an International Cross-Sectional Electronic Survey

et al. 2021

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“…Mental health issues have been exacerbated during the pandemic throughout society and in patients with endocrine conditions [114]. Due to children's not completed development of the central nervous system, including the hypothalamus-pituitary-adrenal axis, children exhibit increased susceptibility.…”

Section: Endocrine Conditions and Mental Health During The Covid-19 P...mentioning

confidence: 99%

The Interplay Between COVID-19 and Pediatric Endocrine Disorders. What have we Learned After More than Three Years of the Pandemic?

Kostopoulou

2023

Horm Metab Res

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As an increased body of COVID-19 related research is now available, it becomes apparent that the effects of COVID-19 extend beyond that of the respiratory system. Among others, the endocrine system is particularly vulnerable to perturbation from the COVID-19 infection. The present scoping review summarizes the bidirectional relationship between COVID-19 and endocrine system in children and adolescents, by describing both the possible susceptibility of children and adolescents without endocrinopathies to endocrine disorders following COVID-19 infection, but also the potential susceptibility to COVID-19 infection and severe infection, or the aggravation of endocrine dysfunction in patients with pre-existing endocrine diseases. Data suggest increased obesity and diabetes rates, as well as increased severity and frequency of diabetic ketoacidosis following COVID-19 infection. Conversely, patients with diabetes and obesity may experience a more severe course of COVID-19 infection. However, in the majority of cases, children and adolescents with well-managed and regulated endocrine disorders do not appear to be at increased risk of infection or severe infection from COVID-19. Thus, adhering to the appropriate “sick day management rules”, maintaining adequate supply of medications and supplies, keeping close contact with the therapeutic team and seeking medical help without delay when needed, are the main recommendations for a safe outcome. Additional lessons learnt during the pandemic include the risk for mental health diseases caused by children’s disrupted routine due to COVID-19 related protective measures and the importance of adopting alternative communication options, such as telehealth visits, in order to ensure uninterrupted endocrine care.

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“…In particular, comorbid psychological and neurodevelopmental disorders were shown to impair diabetes management. [5][6][7][8] A prime example is attention deficit hyperactivity disorder (ADHD), which affects 5%-10% of children 9 and is reported to be up to 35% more frequent (OR 1.35; 95% CI 1.08 to 1.73) in patients with T1D compared with healthy peers. 10 A Swedish active screening of children with T1D showed that among children with newly diagnosed ADHD, 77.8% had inadequate metabolic control (mean HbA1c >8.6%) compared with 42.9% in the group of children with treated ADHD.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…In particular, comorbid psychological and neurodevelopmental disorders were shown to impair diabetes management 5–8. A prime example is attention deficit hyperactivity disorder (ADHD), which affects 5%–10% of children9 and is reported to be up to 35% more frequent (OR 1.35; 95% CI 1.08 to 1.73) in patients with T1D compared with healthy peers 10.…”

Section: Introductionmentioning

confidence: 99%

Lisdexamphetamine versus methylphenidate for paediatric patients with attention-deficit hyperactivity disorder and type 1 diabetes (LAMAinDiab): protocol for a multicentre, randomised cross-over clinical trial in an outpatient telemedicine-supported setting

Michalak,

Chrzanowski,

Kuśmierczyk-Kozieł

et al. 2023

BMJ Open

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IntroductionAttention deficit hyperactivity disorder (ADHD) affects 5%–10% of paediatric population and is reportedly more common in children with type 1 diabetes (T1D), exacerbating its clinical course. Proper treatment of ADHD in such patients may thus provide neurological and metabolic benefits. To test this, we designed a non-commercial second phase clinical trial comparing the impact of different pharmacological interventions for ADHD in children with T1D.Methods and analysisThis is a multicentre, randomised, open-label, cross-over clinical trial in children and adolescents with ADHD and T1D. The trial will be conducted in four reference paediatric diabetes centres in Poland. Over 36 months, eligible patients with both T1D and ADHD (aged 8–16.5 years, T1D duration >1 year) will be offered participation. Patients’ guardians will undergo online once-weekly training sessions behaviour management for 10 weeks. Afterward, children will be randomised to methylphenidate (long-release capsule, doses 18-36-54 mg) versus lisdexamphetamine (LDX, 30-50-70 mg). Pharmacotherapy will continue for 6 months before switching to alternative medication. Throughout the trial, the participants will be evaluated every 3 months by their diabetologist and online psychological assessments. The primary endpoint (ADHD symptom severity, Conners 3.0 questionnaire) will be assessed by a blinded investigator. Secondary endpoints will include HbA1c, continuous glucose monitoring indices and quality-of-life (PedsQL).Ethics and disseminationThe trial is approved by Bioethical Committee at Medical University of Lodz and Polish regulatory agency (RNN/142/22/KE, UR/DBL/D/263/2022). The results will be communicated to the research and clinical community, and Polish agencies responsible for healthcare policy. Patient organisations focused on paediatric T1D will be notified by a consortium member. We hope to use the trial’s results to promote collaboration between mental health professionals and diabetes teams, evaluate the economic feasibility of using LDX in patients with both diseases and the long run improve ADHD treatment in children with T1D.Trial registration numbersEU Clinical Trials Register (EU-CTR, 2022-001906-24) andNCT05957055.

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Mental Health and Behavioral Screening in Pediatric Type 1 Diabetes

Cited by 9 publications

References 19 publications

The Challenges of Managing Pediatric Diabetes and Other Endocrine Disorders During the COVID-19 Pandemic: Results From an International Cross-Sectional Electronic Survey

The Challenges of Managing Pediatric Diabetes and Other Endocrine Disorders During the COVID-19 Pandemic: Results From an International Cross-Sectional Electronic Survey

The Interplay Between COVID-19 and Pediatric Endocrine Disorders. What have we Learned After More than Three Years of the Pandemic?

Lisdexamphetamine versus methylphenidate for paediatric patients with attention-deficit hyperactivity disorder and type 1 diabetes (LAMAinDiab): protocol for a multicentre, randomised cross-over clinical trial in an outpatient telemedicine-supported setting

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