Autism spectrum disorder in children with type 1 diabetes
Abstract
Aim: Links between autism spectrum disorder (ASD) and autoimmune diseases, including Type 1 diabetes have been proposed. This study assessed the frequency of ASD in children with Type 1 diabetes in the T1D Exchange (T1 DX) registry and the impact of ASD on characteristics of children with Type 1 diabetes. Methods: Analysis included 10 032 participants aged < 18 years (median Type 1 diabetes duration 6.5 years, 48% female, 77% non‐Hispanic White). Diagnosis of ASD was defined as autism, Asperger's or pervasive developmental disorder. Results: A diagnosis of ASD was recorded for 159 (1.58%) participants. Those with ASD were predominantly male (88% vs. 51% of those without ASD, P < 0.001) and slightly older (median 14 vs. 13 years, P = 0.022). Occurrence of diabetic ketoacidosis at Type 1 diabetes diagnosis was similar (35% vs. 41%, P = 0.161). Pump use was lower in those with ASD (51% vs. 63%, P = 0.005) but continuous glucose monitor use was similar (24% vs. 27%, P = 0.351). Median HbA 1c was slightly lower in those with ASD [68 vs. 69 mmol/mol (8.4% vs. 8.5%), P = 0.006]. This difference was more pronounced after adjusting for confounders. Conclusions: The frequency of ASD in the T1 DX registry was similar to that in the general population. These data show that despite deficits in communication, occurrence of diabetic ketoacidosis was similar in youth with and without ASD. Pump use was less frequent in those with ASD, possibly due to sensory issues, although CGM use did not differ. The lower HbA 1c may be due to a more regimented routine with ASD. Because comorbidities such as ASD complicate care of patients with Type 1 diabetes, further research is needed to support these children.
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Elimination disorders were reported in 2 diagnostic interview studies with prevalence of 0.48% and 2.49%.
“N = 2 studies reported on eliminations disorders and used diagnostic interviews with reported prevalence of 0.48% [34] and 2.49% [31].”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
Disruptive, impulse control and conduct disorder were reported in 8 studies; 7 diagnostic interview studies reported prevalence from 2.9% to 16.48% and 1 patient register study reported 0.27%.
“N = 8 [20,22,31,34,42,45,52,59] studies reported on disruptive, impulse control and conduct disorder.Specifically, studies examined oppositional defiant disorder n = 5, conduct disorder n = 5 and antisocial personality disorder n = 1.N = 7 studies utilised diagnostic interviews and reported a prevalence range of 2.9% to 16.48% and n = 1 studies used a patient register and reported a prevalence of”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
Substance-related and addictive disorders were reported in 9 studies; 7 diagnostic interview studies reported prevalence from 0.00% to 34.67% and 2 register/medical record studies reported 0.92% and 2.16%.
“N = 9 [20,21,23,31,34,38,42,52,58] studies reported on the prevalence of substance-related and addictive disorders.Where specified, n = 5 reported alcohol-related, n = 1 was cannabis-related, n = 1 was tobacco-related, n = 1 was medication-related, and n = 1 not specified.N = 7 studies used diagnostic interviews and reported prevalence ranging from 0.00% to 34.67% and n = 2 studies used patient”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of schizophrenia spectrum and other psychotic disorders based on interviews was 0.25% (95% CI 0.00-0.81) across 3 studies with a total sample size of 584.
“| | 3 | Interviews | 584 | 0.25 | 0.00-0.81 | 14.15% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of schizophrenia spectrum and other psychotic disorders based on registers was 0.04% (95% CI 0.01-0.07) across 2 studies with a total sample size of 18,424.
“| Type 1 diabetes [20,21,31,34,58] | 2 | Registers | 18,424 | 0.04 | 0.01-0.07 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of depressive disorders based on interviews was 14.35% (95% CI 10.65-18.05) across 18 studies with a total sample size of 1250.
“| [20-23,29-31,34-39,41,42,44,45,48,52,53,55,58,59] | 18 | Interviews | 1250 | 14.35 | 10.65-18.05 | 91.18% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of feeding and eating disorders based on registers was 0.60% (95% CI 0.50-0.73) across 2 studies with a total sample size of 18,424.
“| Type 1 diabetes [20-26,31,33,34,43,45,50-52,54] | 2 | Registers | 18,424 | 0.60 | 0.50-0.73 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of obsessive-compulsive disorder based on interviews was 0.83% (95% CI 0.14-1.52) across 7 studies with a total sample size of 1218.
“| | 7 | Interviews | 1218 | 0.83 | 0.14-1.52 | 42.50% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of trauma-and stressor-related disorders based on registers was 0.57% (95% CI 0.46-0.69) across 1 study with a total sample size of 17,122.
“| Type 1 diabetes [20,31,34,48,52,58] | 1 | Registers | 17,122 | 0.57 | 0.46-0.69 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of anxiety disorders based on interviews was 12.56% (95% CI 8.87-16.24) across 15 studies with a total sample size of 2156.
“| [20-23,30,31,34,35,38,42,44,45,48,52,53,58,59] | 15 | Interviews | 2156 | 12.56 | 8.87 16.24 | 88.97% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of trauma-and stressor-related disorders based on interviews was 1.17% (95% CI 0.02-2.33) across 5 studies with a total sample size of 796.
“| | 5 | Interviews | 796 | 1.17 | 0.02-2.33 | 57.07% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of anxiety disorders based on registers was 0.79% (95% CI 0.66-0.92) across 2 studies with a total sample size of 18,424.
“| Type 1 diabetes | 2 | Registers | 18,424 | 0.79 | 0.66 0.92 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of substance-related and addictive disorders based on interviews was 3.87% (95% CI 1.9-6.66) across 7 studies with a total sample size of 1173.
“| | 7 | Interviews | 1173 | 3.87 | 1.9-6.66 | 88.03% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of substance-related and addictive disorders based on registers was 1.98% (95% CI 1.77-2.18) across 2 studies with a total sample size of 18,424.
“| Type 1 diabetes [20,21,23,31,34,38,42,52,58] | 2 | Registers | 18,424 | 1.98 | 1.77-2.18 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of disruptive, impulse-control and conduct disorders based on registers was 0.27% (95% CI 0.20-0.36) across 1 study with a total sample size of 17,122.
“| Type 1 diabetes [20,22,31,34,42,45,52,59] | 1 | Registers | 17,122 | 0.27 | 0.20-0.36 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of disruptive, impulse-control and conduct disorders based on interviews was 6.43% (95% CI 3.32-9.55) across 7 studies with a total sample size of 786.
“| | 7 | Interviews | 786 | 6.43 | 3.32-9.55 | 70.46% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of feeding and eating disorders based on interviews was 6.60% (95% CI 4.11-9.09) across 14 studies with a total sample size of 2004.
“| | 14 | Interviews | 2004 | 6.60 | 4.11-9.09 | 86.75% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
In people with type 1 diabetes, the pooled prevalence of elimination disorder based on interviews was 0.86% (95% CI 0.01-1.71) across 2 studies with a total sample size of 448.
“| | 2 | Interviews | 448 | 0.86 | 0.01 1.71 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
The heterogeneity (I2) for the pooled prevalence of obsessive-compulsive disorder in people with type 1 diabetes based on interviews was 42.50%.
“| | 7 | Interviews | 1218 | 0.83 | 0.14-1.52 | 42.50% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
The heterogeneity (I2) for the pooled prevalence of substance-related and addictive disorders in people with type 1 diabetes based on interviews was 88.03%.
“| | 7 | Interviews | 1173 | 3.87 | 1.9-6.66 | 88.03% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
The heterogeneity (I2) for the pooled prevalence of anxiety disorders in people with type 1 diabetes based on interviews was 88.97%.
“| [20-23,30,31,34,35,38,42,44,45,48,52,53,58,59] | 15 | Interviews | 2156 | 12.56 | 8.87 16.24 | 88.97% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
The heterogeneity (I2) for the pooled prevalence of schizophrenia spectrum and other psychotic disorders in people with type 1 diabetes based on interviews was 14.15%.
“| | 3 | Interviews | 584 | 0.25 | 0.00-0.81 | 14.15% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
The heterogeneity (I2) for the pooled prevalence of depressive disorders in people with type 1 diabetes based on interviews was 91.18%.
“| [20-23,29-31,34-39,41,42,44,45,48,52,53,55,58,59] | 18 | Interviews | 1250 | 14.35 | 10.65-18.05 | 91.18% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
The heterogeneity (I2) for the pooled prevalence of disruptive, impulse-control and conduct disorders in people with type 1 diabetes based on interviews was 70.46%.
“| | 7 | Interviews | 786 | 6.43 | 3.32-9.55 | 70.46% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
The heterogeneity (I2) for the pooled prevalence of feeding and eating disorders in people with type 1 diabetes based on interviews was 86.75%.
“| | 14 | Interviews | 2004 | 6.60 | 4.11-9.09 | 86.75% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
The heterogeneity (I2) for the pooled prevalence of trauma-and stressor-related disorders in people with type 1 diabetes based on interviews was 57.07%.
“| | 5 | Interviews | 796 | 1.17 | 0.02-2.33 | 57.07% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [31]
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- Authors
- Bethin, K. E., Kanapka, L. G., Laffel, L. M., Majidi, S., Chaytor, N. S., MacLeish, S., Adams, R., Foster, N. C., & the T1D Exchange Clinic Network
- Affiliations
- University at Buffalo, State University of New York (US)
- Jaeb Center for Health Research (US)
- Joslin Diabetes Center (US)
- Barbara Davis Center for Diabetes Aurora CO
- Washington State University Spokane (US)
- Rainbow Babies & Children's Hospital (US)
- University Hospitals Cleveland Medical Center (US)
- Corresponding author
- Kanapka, L. G.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2019-07-25
- Volume
- 36
- Issue
- 10
- Pages
- 1282-1286
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- PMC
- PMC7063445
- OpenAlex
- W2954123782
- Cited by
- 25
- References
- 24
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 1 · 2023: 3 · 2022: 7 · 2021: 2 · 2020: 2 · 2019: 1
- FWCI
- 1.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Leona M. and Harry B. Helmsley Charitable Trust
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- autism spectrum disorder, type 1 diabetes, children, prevalence, diabetic ketoacidosis, insulin pump therapy, continuous glucose monitoring, glycemic control, HbA1c, autoimmune disease comorbidity
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Child, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Insulin Infusion Systems, Male, Registries, Blood Glucose Self-Monitoring, Comorbidity, Diabetic Ketoacidosis
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