A study conducted by a team in the UK and the Czech Republic found that children diagnosed with diabetes Type 1 patients are at significantly higher risk of developing a range of mental health problems, including mood and anxiety disorders.
Diabetes diagnosis can cause mood and anxiety disorders
The findings highlight the urgent need for mental health monitoring and support for young people diagnosed with type 1 diabetes.
The work appeared on NatureMentalHealth.
According to the charity JDRF, there are 8.7 million people living with type 1 diabetes worldwide, including over 400,000 people in the UK. It is a chronic, life-threatening condition, usually diagnosed in childhood, which has a lifelong impact.
Currently, people with type 1 diabetes rely on a routine of finger-prick blood tests and insulin injections or infusions because their pancreas no longer produces insulin on its own, although recent developments in artificial pancreas technology are helping to transform this care.
Previous studies have shown potential links between childhood-onset type 1 diabetes and a range of mental health disorders in adulthood. However, it is unclear whether these links can best be explained by the impacts of living with the condition and its treatment, or whether underlying common biological mechanisms may be implicated; for example, the impact of unstable blood sugar levels on the developing adolescent brain.
To answer this question, a team of researchers relied on data from more than 4,500 children with type 1 diabetes registered in a national registry in the Czech Republic and on large-scale European DNA studies.
From the national registry data, researchers found that children diagnosed with type 1 diabetes were more than twice as likely to develop a mood disorder and more than 50 percent more likely to develop an anxiety disorder than children without the condition. They were also more than four times more likely to develop behavioral syndromes, including eating and sleep disorders.
In contrast, children with type 1 diabetes had a much lower risk of developing psychotic disorders, such as schizophrenia: nearly half the risk of their peers.
The findings are consistent with those of two other national registry studies conducted in Sweden and Denmark, suggesting they could be applied to other countries, including the UK.
The team used a statistical technique known as Mendelian randomization to investigate causal links between type 1 diabetes and these various psychiatric disorders, but found little evidence to support a common underlying biological mechanism.
Tomáš Formánek, a PhD student at the University of Cambridge and the National Institute of Mental Health in Klecany, Czech Republic, said: “Although we found a worryingly increased risk of mental health problems among people with type 1 diabetes, our study, and others before it, suggest that this is unlikely to be the result of common biological mechanisms. This highlights the importance of prevention and continued attention to the mental health needs of children and young people with type 1 diabetes.”
Researchers say mental health problems in later life may be a result of children with type 1 diabetes being forced to make significant changes in their lives, with constant attention to monitoring food intake and the need to check blood sugar levels and administer insulin injections. This often leaves these children feeling excluded from social events and picked on by peers, teachers and even family members.
Dr Benjamin Perry from the Department of Psychiatry at the University of Cambridge said: “We know that people diagnosed with type 1 diabetes can experience ‘diabetes stress’. This can include extreme frustration with blood sugar levels and feelings of isolation, and can lead to exhaustion, hopelessness and a feeling of lack of control. It is no wonder, then, that they are at risk of worsening mental health problems, which extend into their adult lives.”
Professor Peter Jones, also from the Department of Psychiatry at the University of Cambridge, added: “Our findings highlight the urgent need to support children diagnosed with type 1 diabetes, to look out for signs of mental health problems and to offer timely, expert help. In this way, it may be possible to help these children earlier, before these problems fully take hold.”
Type 1 diabetes is associated with a higher risk of mental health problems
Both children with type 1 diabetes and their immediate family members are at greater risk of mental health problems than those without the disease, according to a large study conducted by researchers at Karolinska Institutet and published in the journal Diabetes Care . The findings underscore the need for psychological counseling for both children and their families in diabetes care.
Research shows that children and adolescents with type 1 diabetes are at increased risk of developing mental health problems, such as depression, anxiety, and stress-related disorders, and that these comorbidities can hinder optimal care.
Current International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines recommend screening for mental health problems in children with type 1 diabetes, but do not adequately address the needs of family members, who are also at increased risk for mental health problems. Furthermore, the reasons behind the association between family mental health problems and type 1 diabetes are not fully understood.
“Many clinicians intuitively assume that diabetes in a child negatively affects the mental health of both the patient and their family members,” says Agnieszka Butwicka, associate professor at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet and the study’s last senior author. “But we think the answer is not that simple. Our study indicates that there may also be a genetic component behind this association.”
The study linked nearly 3.5 million people born in Sweden between 1973 and 2007 to their biological parents, full and half siblings, and cousins. More than 20,000 people were diagnosed with childhood-onset type 1 diabetes and found to have nearly double the risk of depression and about 1.6 times higher risk of anxiety and stress-related disorders than those who did not have the disease.
Their parents and siblings also had slightly higher risks for anxiety and stress-related disorders, although to a lesser extent, while their half-siblings and cousins had no or only marginally higher risks for some conditions.
“These findings have great clinical relevance because they mean that therapeutic intervention should also involve close family members, not just patients,” says Agnieszka Butwicka.
Because parent-offspring and full siblings share more genetic material (about 50%) than half-siblings (about 25%) and cousins (less than 12.5%), researchers say the findings support the idea that genes may be a contributing factor to mental health problems in type 1 diabetes.
Because this is only an observational study, it is not possible to conclusively determine what causes these associations.
“Further studies are needed to fully understand the genetic and environmental contributions underlying psychiatric disorders in type 1 diabetes,” says Shengxin Liu, a doctoral student at Karolinska Institutet and corresponding author of the study.
New insights into adult-onset type 1 diabetes
Type 1 diabetes, a chronic condition that affects millions of young people worldwide, is not exclusive to childhood. About half of cases are diagnosed in adulthood, and there is a need to understand the factors that contribute to the development of type 1 diabetes in adults.
A study from Karolinska Institutet now provides new insights into the development of the disease in adults. The findings are presented in The Lancet Diabetes & Endocrinology.
The research, conducted at the Institute of Environmental Medicine, was based on data from more than 2.8 million individuals and aimed to compare the heritability of type 1 diabetes in adults and children.
The findings indicate that having a first-degree relative with the condition significantly increases the risk of developing type 1 diabetes in adulthood, and the risk is greater if the relative developed diabetes early in life. Overall, the heritability is lower for type 1 diabetes in adults than in children.
Yuxia Wei, a doctoral student at the Institute of Environmental Medicine and first author, says, “Our study provides new insights into the causes of type 1 diabetes in adults. The lower heritability in adults suggests that environmental factors play a larger role in the development of the disease in adults than in children.”
Yuxia Wei, a doctoral student at the Institute of Environmental Medicine and first author, says, “Our study provides new insights into the causes of type 1 diabetes in adults. The lower heritability in adults suggests that environmental factors play a larger role in the development of the disease in adults than in children.”
The study highlights the need for more research to identify environmental factors that contribute to adult-onset type 1 diabetes. “Understanding these factors is critical to developing targeted interventions to prevent the development of the disease,” says Sofia Carlsson, a senior lecturer at the Institute of Environmental Medicine.
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