̽��ֱ�� of Cambridge - Tomáš Formánek

‘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

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Substance use disorders linked to poor health outcomes in wide range of physical health conditions

cjb250 — Fri, 04 Nov 2022 00:13:39 +0000

In a study published today in ̽��ֱ��Lancet Psychiatry, researchers looked at the risk of mortality and loss of life-years among people who developed 28 different physical health conditions, comparing those who had previously been hospitalised with substance use disorder against those who had not.

They found that patients with most of the health conditions were more likely than their counterparts to die during the study period if they had been hospitalised with substance use disorder prior to the development of these conditions. For most subsequent health conditions, people with substance use disorders also had shorter life-expectancies than did individuals without substance use disorders.

One in twenty people worldwide aged 15 years or older lives with alcohol use disorder, while around one in 100 people have psychoactive drug use disorders. Although substance use disorders have considerable direct effects on health, they are also linked to a number of physical and mental health conditions. Consequently, the presence of these contributes to higher risk of mortality and shorter lifespan in people with substance use disorders.

To explore this link further, researchers analysed patient records from Czech nationwide registers of all-cause hospitalisations and deaths during the period from 1994-2017. They used a novel design, estimating the risk of death and life-years lost after the onset of multiple specific physical health conditions in individuals with a history of hospitalisation for substance use disorders, when compared with matched counterparts without substance use disorder but with the same physical health condition.

Although the study only looked at people living in Czechia, the researchers believe the results are likely to be similar in other countries, too.

They found that people with pre-existing substance use disorders were more likely than their counterparts to have died during the study following the development of 26 out of 28 physical health conditions. For seven of these conditions – including atrial fibrillation, hypertension, and ischaemic heart disease – the risk was more than doubled. In most cases, people with substance use disorders have shorter life-expectancies than their counterparts.

Lead author Tomáš Formánek, a PhD student at the National Institute of Mental Health, Czechia, and the ̽��ֱ�� of Cambridge, said: “Substance use disorders seem to have a profound negative impact on prognosis following the development of various subsequent physical health conditions, in some cases dramatically affecting the life expectancy of the affected people.”

It is not clear why this should be the case, though the researchers say there are a number of possible reasons. It is already known that substance use has a direct negative impact on physical health and is associated with lifestyle factors that affect our health, such as smoking, lack of exercise, and poor diet. Similarly, people with substance use disorders are less likely to take part in screening and prevention programmes for diseases such as cancer and diabetes and are less likely to use preventive medication, such as drugs to prevent hypertension. There are also some factors not directly related to substance use, such as diagnostic overshadowing, meaning the misattribution of physical symptoms to mental disorders. Such misattribution can subsequently contribute to under-diagnosis, late diagnosis, and delayed treatment in affected individuals.

Senior author Professor Peter Jones from the Department of Psychiatry, ̽��ֱ�� of Cambridge, added: “These results show how important it is not to compartmentalise health conditions into mind, brain or body. All interact leading here to the dramatic increases in mortality from subsequent physical illnesses in people with substance use disorders. There are clear implications for preventive action by clinicians, health services and policy developers that all need to recognise these intersections.”

Co-author Dr Petr Winkler from the National Institute of Mental Health, Czechia, said: “It is also important to consider that the majority of people with substance use disorders go undetected. They often do not seek a professional help and hospitalisations for these conditions usually come only at very advanced stages of illness. Alongside actions focused on physical health of people with substance use disorders, we need to equally focus on early detection and early intervention in substance use disorders.”

̽��ֱ��research was funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration East of England at Cambridge and Peterborough NHS Foundation Trust.

Reference
Formánek, T et al. Mortality and life-years lost following subsequent physical comorbidity in people with pre-existing substance use disorders: a national registry-based retrospective cohort study of hospitalised individuals in Czechia. ̽��ֱ��Lancet Psychiatry; 3 Nov 2022; DOI: 10.1016/S2215-0366(22)00335-2

People who have a past history of hospitalisation because of substance use disorders have much worse outcomes following the onset of a wide range of physical health conditions, according to researchers in the UK and Czechia.

Substance use disorders seem to have a profound negative impact on prognosis following the development of various subsequent physical health conditions, in some cases dramatically affecting the life expectancy of the affected people

Tomáš Formánek

aire images (Getty Images)

Woman holding a glass of whisky

̽��ֱ��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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