ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This study explored the potential causal pathways underlying the association between childhood-onset T1D and subsequent psychiatric disorders, using data from a Czech national register of 4,500 children (age ≤14 years) with type 1 diabetes (T1D) and large-scale European genetic studies. Children diagnosed with T1D had an elevated risk of developing substance use, mood, anxiety and personality disorders, and behavioural syndromes. In contrast, they had a lower risk of developing psychotic disorders.

Previous studies reported links between childhood-onset T1D and mental health disorders in adulthood (1,2). However, it was unclear if these associations are due to common underlying biological mechanisms or reflect the impact of managing and living with T1D. This study explored this question using a two-step approach, including observational and genetic (Mendelian randomization) analyses. Firstly, data from the Czech national register were analysed. Individuals diagnosed with T1D in childhood had a lower risk of developing psychotic disorders but a higher risk of developing most other psychiatric disorders (mood and anxiety disorders, behavioural syndromes), compared with children without T1D.

However, the Mendelian randomization analysis, using data from large-scale genome-wide association studies (GWAS) of European participants, did not support the observational findings for most studied psychiatric disorders. Only the association between T1D and lower risk of psychotic disorders or schizophrenia was consistent between observational and Mendelian randomization analyses, although the latter weakened on adjustment for multiple testing.

Overall, the findings indicate the adverse impact of living with diabetes on mental health, instead of a common underlying mechanism between T1D and psychiatric disorders. Living with T1D requires many daily tasks, including insulin injections and dose adjustments, glucose monitoring, hypo- or hyperglycemia episodes, which can lead to distress and adverse long-term mental health. This highlights the importance of supporting people with diabetes, the need for vigilance to identify early signs of distress and mental health problems, and to offer expert help when needed.

Further research is needed to explore associations between T1D and earlier-onset neurodevelopmental disorders, such as autism spectrum disorder and attention deficit hyperactivity disorder, which also tend to occur more often in young people with T1D.

References: 1. Liu S, Leone M, Ludvigsson JF, Lichtenstein P, D’Onofrio B, Svensson AM, et al. Association and Familial Coaggregation of Childhood-Onset Type 1 Diabetes With Depression, Anxiety, and Stress-Related Disorders: A Population-Based Cohort Study. Diabetes Care. 2022;45(9):1987-93.2. Dybdal D, Tolstrup JS, Sildorf SM, Boisen KA, Svensson J, Skovgaard AM, Teilmann GK. Increasing risk of psychiatric morbidity after childhood onset type 1 diabetes: a population-based cohort study. Diabetologia. 2018;61(4):831-8.