Graduation Year

2015

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Epidemiology and Biostatistics

Major Professor

Kathleen O'Rourke, Ph.D.

Co-Major Professor

Roy Beck, MD, Ph.D.

Committee Member

Amy Alman, Ph.D.

Committee Member

Craig Kollman, Ph.D.

Committee Member

Getachew Dagne, Ph.D.

Committee Member

Henry Rodriguez, MD

Keywords

ADHD, glycemic control, type 1 diabetes

Abstract

Individual day-to-day management and effective control of type 1 diabetes (T1D) is ultimately driven by decisions made by the individual. Individuals with attention deficit hyperactivity disorder (ADHD) have a higher tendency to be inattentive, impulsive, and hyperactive. Attention deficits and impulsivity among adolescents and adults with T1D could result in poor diabetes management through infrequent self-monitoring of blood glucose and inadequate insulin dosing – key components of achieving optimal glycemic control.

This study included 7,380 adolescents and young adults, ages 13-25 years, participating in the T1D Exchange clinic registry (median age 17.4 years, duration 7.7 yrs, 50% female, 81% white). Participants were classified into 3 groups for the primary analyses using participant reported diagnosis and medication use: 1) No ADHD; 2) ADHD with current medication; 3) ADHD without current medication. Groups were compared in logistic and linear regression models for: self-monitoring of blood glucose (SMBG) /day, missed insulin dose ≥1 time/week, HbA1c, and at least 1 diabetic ketoacidosis (DKA) and severe hypoglycemic (SH) event in the past 3 months.

Overall, 774 (10%) participants reported a diagnosis of ADHD of whom 371 currently took medication. Mean SMBG/day was 4.7, 5.0, and 4.9 in the ADHD w/o meds, ADHD with meds, and no ADHD groups, respectively. ADHD patients w/o meds (36%, P=0.02) or with meds (39%, P=0.003) were more likely to report missing insulin doses compared with no ADHD pts (30%). Mean HbA1c was higher in ADHD w/o meds (9.0%, P<0.001) and ADHD with meds (8.9%, P=0.002) compared with no ADHD pts (8.6%). The odds of having at least one DKA event in the past 3 months was 1.8 and 1.5 times higher in the ADHD w/o meds (P<0.001) and ADHD with meds (P=0.01) group compared with no ADHD. The ADHD w/o meds group was significantly more likely to have had a SH event (OR 1.7 95% CI 1.2-2.3; P<0.001) compared with the no ADHD group but the occurrence of SH in the ADHD with meds group was similar to the no ADHD.

Results of this study supported the working hypothesis that ADHD without treatment with medication has a negative impact on aspects of diabetes management and glycemic control. Participants with ADHD with and without medication were more likely to miss insulin doses, less likely to use an insulin pump, more likely to have high HbA1c levels, and had a higher frequency of DKA and SH. These results have important public health implications for adolescents and young adults with T1D who are already at risk for poor glycemic control. Since ADHD has a meaningful impact on glycemic outcomes it is important for providers of adolescents and young adults with T1D to review history and signs of an ADHD diagnosis along with diagnosis of other psychosocial disorders with their patients and consider recommending psychosocial services.

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