ACCORDING to recent findings, individuals who develop Type 1 diabetes ( T1D) face a heightened risk of mental health disorders. Previous research has demonstrated that regular and frequent insulin injections, glucose monitoring, and restrictions on diet are associated with psychological and behavioural reactions. Moreover, children diagnosed with T1D display higher levels of mental health problems. The presence of adult psychiatric morbidity may be the result of social and psychological factors from childhood. However, there is a potential biological link between childhood-onset T1D and psychiatric morbidity, as unstable glycemic control during neurodevelopment could impact health development. Researchers, led by Tomá Formánek, a PhD student at the University of Cambridge’s Department of Psychiatry, aimed to discern whether the mental health risks associated with T1D are due to the psychological burden of managing the condition or if common biological mechanisms play a role.
The study utilised data from a Czech national registry, encompassing 4,556 youth diagnosed with T1D before age 14 between 1994 and 2007. These individuals were matched with 45,560 counterparts without T1D based on sex, age, and other factors. Over a follow-up period of 10 to 24 years, the researchers employed stratified Cox proportional hazards models to assess the risk for six psychiatric diagnostic groups and 21 specific psychiatric disorders.
The results showed that, compared with their non-diabetic peers, children and adolescents with T1D had significantly higher risks for several mental health conditions. Specifically, they were more likely to develop substance use disorders (hazard ratio [HR] = 1.39), anxiety disorders (HR = 1.61), mood disorders (HR = 2.32), behavioural syndromes associated with physiological disturbances (HR = 4.18), and personality and behavioural disorders (HR = 1.39). Interestingly, the study also found that youth with T1D had a lower risk of developing schizophrenia (HR = 0.55). Further analysis revealed elevated risks for specific disorders such as alcohol use disorders (HR = 1.54), drug use disorders (HR = 1.21), and depression (HR = 2.61) among the diabetic cohort. The researchers also employed Mendelian Randomisation to explore potential genetic links between T1D and these psychiatric conditions but found no substantial evidence for common biological mechanisms.
The study authors concluded that children diagnosed with T1D face increased risks for a range of mental health conditions later in life, including anxiety disorders, depression, and substance use disorders. This finding adds to the growing body of evidence that links diabetes with mental health challenges across various age groups. The authors emphasised that the risk of mental health problems is unlikely to stem from common biological mechanisms and stressed the importance of early preventative measures.
Laith Gergi, EMJ
Reference
Formánek T et al. Childhood-onset type 1 diabetes and subsequent adult psychiatric disorders: a nationwide cohort and genome-wide Mendelian randomization study. Nat Mental Health. 2024;17:1-9.
