̽��ֱ�� of Cambridge - Benjamin Perry

‘Diabetes distress’ increases risk of mental health problems among young people living with type 1 diabetes

cjb250 — Wed, 17 Jul 2024 09:00:45 +0000

̽��ֱ��findings highlight the urgent need for monitoring and support for the mental health of young people diagnosed with type 1 diabetes.

According to the charity JDRF, there are 8.7 million people living with type 1 diabetes around the world, including over 400,000 people in the UK. It is a chronic, life-threatening condition, usually diagnosed in childhood, that has a life-long impact.

Currently, people with type 1 diabetes rely on a routine of finger-prick blood tests and insulin injections or infusions, because their pancreas no longer produces insulin itself, although recent developments in artificial pancreas technology are helping transform this care.

Previous studies have shown potential links between childhood-onset type 1 diabetes and a number of mental health disorders in adulthood. However, it is not clear whether these links can be best explained by the impacts of living with the condition and its treatment, or whether underlying common biological mechanisms may be implicated, for example the impact of unstable blood sugar levels on the developing adolescent brain.

To help answer this question, a team of researchers turned to data from over 4,500 children with type 1 diabetes on a national register in the Czech Republic and from large-scale European DNA studies.Their findings are published today in Nature Mental Health.

From the national register data, the researchers found that children diagnosed with type 1 diabetes – compared to children without the condition – were over twice as likely to develop a mood disorder and more than 50% more likely to develop an anxiety disorder. They were also more than four times more likely to develop behavioural syndromes including eating and sleep disorders

Conversely, children with type 1 diabetes were at a much lower risk of developing psychotic disorders, such as schizophrenia – almost half the risk compared to their peers.

̽��ֱ��findings are consistent with the results from two other national register studies in Sweden and in Denmark, suggesting that the results would likely apply to other countries, too, including the UK.

̽��ֱ��team used a statistical technique known as Mendelian Randomisation to probe causal links between type 1 diabetes and these various psychiatric disorders, but found little evidence in support of a common underlying biological mechanism.

Tomáš Formánek, a PhD student at the ̽��ֱ�� of Cambridge and the National Institute of Mental Health, Klecany, Czech Republic, said: “Although we found a concerning increase in the risk of mental health problems among people living with type 1 diabetes, our study – and others before it – suggests this is unlikely to be the result of common biological mechanisms. This emphasises the importance of prevention and sustained attention to the mental health needs of children and young people with type 1 diabetes.”

̽��ֱ��researchers say that mental health problems in later life may be a result of children with type 1 diabetes being forced to make significant changes to their lives, with a constant focus on monitoring their food intake and a need to check blood sugar levels and administer insulin injections. This often leaves these children feeling excluded from social events and singled-out by peers, teachers and even family members.

Dr Benjamin Perry from the Department of Psychiatry, ̽��ֱ�� of Cambridge, said: “We know that people diagnosed with type 1 diabetes can experience ‘diabetes distress’. This can include extreme frustration with blood sugars and feelings of isolation and can lead to burnout, hopelessness, and a feeling of lack of control. It’s little wonder, then, that they are at risk of compounding mental health problems, spanning into their adult lives.”

Professor Peter Jones, also from the Department of Psychiatry, ̽��ֱ�� of Cambridge, added: “Our findings emphasise the urgent need to support children diagnosed with type 1 diabetes, look out for signs of mental health problems and offer timely, expert help. That way, it may be possible to help these children early, before these problems fully take root.”

̽��ֱ��research was supported by the National Institute for Health and Care Research Applied Research Collaboration East of England at Cambridgeshire and Peterborough NHS Foundation Trust and the Ministry of Health, Czech Republic, with additional funding from Wellcome and the UKRI Medical Research Council.

Reference
Formánek, T et al. Childhood-Onset Type 1 Diabetes and Subsequent Adult Psychiatric Disorders: A Nationwide Cohort and Genome-wide Mendelian Randomization Study. Nature Mental Health; 17 July 2024; DOI: 10.1038/s44220-024-00280-8

Children diagnosed with type 1 diabetes are at significantly higher risk of a number of mental health issues, including mood and anxiety disorders, a study from a team in the UK and the Czech Republic has found.

We know that people diagnosed with type 1 diabetes can experience ‘diabetes distress’. It’s little wonder, then, that they are at risk of compounding mental health problems, spanning into their adult lives

Benjamin Perry

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Teenager With Type 1 Diabetes Takes at Home Test

̽��ֱ��text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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High insulin levels during childhood a risk for mental health problems later in life, study suggests

sc604 — Wed, 13 Jan 2021 16:00:00 +0000

̽��ֱ��researchers, led by the ̽��ֱ�� of Cambridge, used a sample of over 10,000 people to study how insulin levels and body mass index (BMI) in childhood may be linked with depression and psychosis in young adulthood.

They found that persistently high insulin levels from mid-childhood were linked with a higher chance of developing psychosis in adulthood. In addition, they found that an increase in BMI around the onset of puberty was linked with a higher chance of developing depression in adulthood, particularly in girls. ̽��ֱ��results were consistent after adjusting for a range of other possible factors.

̽��ֱ��findings, reported in the journal JAMA Psychiatry, suggest that early signs of developing physical health problems could be present long before the development of symptoms of psychosis or depression and show that the link between physical and mental illness is more complex than previously thought.

However, the researchers caution that these risk factors are among many, both genetic and environmental, and that their results do not suggest that one could predict the likelihood of developing adult mental disorders from these physical health measures alone.

̽��ֱ��researchers recommend that healthcare professionals should carry out robust physical assessments of young people presenting with symptoms of psychosis or depression, so that early signs of physical illnesses may be diagnosed and treated early. It has been well-established that people with depression and psychosis can have a life expectancy of up to 20 years shorter than the general population, mostly because physical health problems like diabetes and obesity are more common in adults with those mental disorders.

While psychosis and depression in adulthood are already known to be associated with significantly higher rates of diabetes and obesity than the general population, these links are often attributed to the symptoms of the mental disorder itself.

“ ̽��ֱ��general assumption in the past has been that some people with psychosis and depression might be more likely to have a poor diet and lower levels of physical exercise, so any adverse physical health problems are a result of the mental disorder, or the treatment for it,” said first author Dr Benjamin Perry from Cambridge’s Department of Psychiatry. “In essence, the received wisdom is that the mental disorder comes first. But we’ve found that this isn’t necessarily the case, and for some individuals, it may be the other way around, suggesting that physical health problems detectable from childhood might be risk factors for adult psychosis and depression.”

Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a long-term population-representative birth cohort study set in the west of England, Perry and his colleagues found that disruption to insulin levels can be detected in childhood, long before the onset of psychosis, suggesting that some people with psychosis may have an inherent susceptibility to developing diabetes.

They used a statistical method to group individuals based on similar trajectories of change in insulin levels and BMI from age one to 24, and examined how the different groups related to risks of depression and psychosis in adulthood. About 75% of study participants had normal insulin levels, between 15% and 18% had insulin levels which increased gradually over adolescence, and around 3% had relatively high insulin levels. This third group had a higher chance of developing psychosis in adulthood compared with the average group.

̽��ֱ��researchers did not find that the group who had persistently high BMI through childhood and adolescence had a significantly increased risk of depression in adulthood, and instead suggest that their findings mean that certain factors around the age of puberty which might cause BMI to increase might be important risk factors for depression in adulthood. ̽��ֱ��researchers were not able to determine in their study what those factors might be, and future research will be required to find them. These factors might be important targets to reduce the risk of depression in adulthood.

“These findings are an important reminder that all young people presenting with mental health problems should be offered a full and comprehensive assessment of their physical health in tandem with their mental health,” said Perry. “Intervening early is the best way to reduce the mortality gap sadly faced by people with mental disorders like depression and psychosis.

“ ̽��ֱ��next step will be to work out exactly why persistently high insulin levels from childhood increase the risk of psychosis in adulthood, and why increases in BMI around the age of puberty increase the risk of depression in adulthood. Doing so could pave the way for better preventative measures and the potential for new treatment targets.”

Reference:
Benjamin I. Perry et al: ‘Longitudinal Trends in Insulin Levels and BMI From Childhood and Their Associations with Risks of Psychosis and Depression in Young Adults.’ JAMA Psychiatry (2021). DOI: 10.1001/jamapsychiatry.2020.4180

Researchers have shown that the link between physical and mental illness is closer than previously thought. Certain changes in physical health, which are detectable in childhood, are linked with the development of mental illness in adulthood.

For some individuals, physical health problems detectable from childhood might be risk factors for adult psychosis and depression

Benjamin Perry

Piron Guillaume via Unsplash

Children sitting on park bench

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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