Adhd Symptoms are Common and Associated with Worse Glycemic Control in Adults with Type 1 Diabetes

Abstract

Objective: To assess the association between attention-deficit/hyperactivity disorder (ADHD), type 1 diabetes mellitus (T1D), and cardiovascular comorbidities in adults. Methods: The Adult Self-Report Scale V1.1 (ASRS) for ADHD symptoms was electronically sent to 2069 adults with T1D. Cardiometabolic conditions, laboratory measurements, and PHQ-2/PHQ-9 depression scores were obtained from the electronic medical record. Results: 292 (14.1%) individuals responded and 279 consented to medical records extraction. The average age was 47.4 years (SD: ±18.9), 64.2% were women, 95.7% were non-Hispanic white, and the mean HbA1c level was 7.7% (±1.5%).  Of 273 completing ASRS, 87 med ADHD criteria (ASRS-positive, 31.9%), and 42 (15.4%) had an ADHD diagnosis or medication. Women had higher scores than men.  ADHD symptoms decreased with age but remained significantly higher than the general population levels. ASRS-positive individuals had worse glycemic control(HbA1c≥8.0%, adjusted OR 2.3, 95%CI:1.3-4.1, p<.0001) and higher PHQ-9 scores (10±7.3 vs. 6.1±6, c2(1)=9.2, p=0.002) than the ASRS-negative group. No associations were found between ASRS scores and cardiometabolic diseases, or other laboratory or clinical measurements. Conclusion: Many adults with T1D exhibit undiagnosed ADHD symptoms, which correlate with poorer glycemic control and depression. Further research with larger samples is needed to investigate ADHD prevalence and impacts in this group.

Note:
Funding Declaration: The project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 965381. This report reflects only the author’s view, and the European Union is not responsible for any use that may be made of the information it contains.

Conflicts of Interest: All authors have completed the Unified Competing Interest form and declare that (1) Dr. Faraone, in the past year, received income, potential income, travel expenses continuing education support and/or research support from Aardvark, Aardwolf, AIMH, Akili, Atentiv, Axsome, Genomind, Ironshore, Johnson & Johnson/Kenvue, Kanjo, KemPharm/Corium, Noven, Otsuka, Sky Therapeutics, Sandoz, Supernus, Tris, and Vallon. With his institution, he has US patent US20130217707 A1 for the use of sodium-hydrogen exchange inhibitors in the treatment of ADHD. He also receives royalties from books published by Guilford Press: Straight Talk about Your Child’s Mental Health, Oxford University Press: Schizophrenia: The Facts and Elsevier: ADHD: Non-Pharmacologic Interventions. He is Program Director of www.ADHDEvidence.org and www.ADHDinAdults.com. (2) Dr Weinstock participates in multicenter clinical trials, through her institution, sponsored by Eli Lilly, Tandem, Insulet, Amgen, Diasome, MannKind, and Novo Nordisk. DexCom continuous glucose monitors were used in some clinical studies. She also receives royalties for her contributions to Up-to-Date. (3) Dr. Yanli Zhang-James, Dan Draytsel and Ben Carguello have no competing interests to report.

Ethical Approval: This work was approved by the Institutional Review Board for the Protection of Human Subjects of SUNY Upstate Medical University.

Keywords: Adult ADHD Self-Report Scale (ASRS), Attention-deficit/hyperactivity disorder, Cardiometabolic disease, Type 1 diabetes mellitus