uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Children and adolescents with type 1 diabetes and high HbA1c: a neurodevelopmental perspective
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). (Barnendokrinologisk forskning/Gustafsson)
Department of Paediatrics, Skaraborg Hospital, Skövde, Sweden.
Centre for Research and Development, Skaraborg Hospital, Skövde, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
Show others and affiliations
2013 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 4, 410-415 p.Article in journal (Refereed) Published
Abstract [en]

Aim

To examine the association between neurodevelopmental problems and high HbA1c among paediatric patients with type 1 diabetes.

Methods

A population-based study was performed among patients with type 1 diabetes (5–16 years) in two Swedish counties (n = 233). The Five to Fifteen (FTF) questionnaire targeted neurodevelopmental qualities. Scores above the 90th percentile in the various domains are considered as definitive problems and scores above the 75th percentile as mild. FTF scores were compared with regard to HbA1c ≤73 mmol/mol and >73 mmol/mol (8.0%).

Results

The response rate was 190 (82%). Neurodevelopmental problems were not overrepresented among patients in general. Memory and learning problems were associated with HbA1c >73 mmol/mol (p = 0.01). This correlation was especially seen in adolescents (12–16 years) where mild executive problems (adjOR 3.1), definite memory problems (adjOR 5.0) and definite learning problems (adjOR 5.0) were associated with HbA1c >73 mmol/mol after adjustment for gender, diabetes duration and age of onset.

Conclusion

Our findings that high HbA1c is more common in adolescent diabetes patients with neurodevelopmental problems generate the hypothesis that these problems might precede poor metabolic control. If so, early detection of neurodevelopmental problems would allow individually tailored treatment that may improve metabolic control and prevent complications.

Place, publisher, year, edition, pages
2013. Vol. 102, no 4, 410-415 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-196581DOI: 10.1111/apa.12128ISI: 000316325400030PubMedID: 23278767OAI: oai:DiVA.org:uu-196581DiVA: diva2:610370
Available from: 2013-03-11 Created: 2013-03-11 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Protective factors, health-risk behaviours and the impact of coexisting ADHD among adolescents with diabetes and other chronic conditions
Open this publication in new window or tab >>Protective factors, health-risk behaviours and the impact of coexisting ADHD among adolescents with diabetes and other chronic conditions
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Mental health problems are increasing in Swedish adolescents and mortality rates are higher in this age group than among younger. 10-20% of all adolescents suffer from a chronic medical condition (CC). Few protective factors (PF) and clustering of health-risk behaviours (HRB) are frequent among adolescents with CCs.

One of the most common CC in Swedish adolescents is type 1 diabetes mellitus (T1DM). Metabolic control often deteriorates during adolescence, especially in girls. Poor metabolic control is associated with increased risk for long-term complications, of which cognitive problems are common. However, the implication of cognitive/executive problems in patients with T1DM has not been sufficiently studied. Neither has the impact of neurodevelopmental problems (NDP), such as ADHD, on HRB in adolescents with CCs been analysed.

Methods: In paper I and II the questionnaire ”Life and Health in Youth” was distributed to all students in year nine and year two of the upper secondary school in the county of Sörmland, 2008 (n=5771) and 2011 (n=5550). Adolescents with CCs were compared to healthy peers with regard to PFs and HRBs. In paper III, the ”Five to Fifteen” questionnaire was used in 175 paediatric patients with T1DM. Patients with indications of NDPs were compared with patients without such problems with regard to metabolic control. In paper IV, the BRIEF questionnaire and the ADHD Rating Scale as well as data from the Swedish Childhood Diabetes Registry was used in 241 adolescents with T1DM. Patients with indications of executive problems were compared with patients without such problems with regard to diabetes control.

Results: CCs were associated with few PFs and clustered HRBs. The combination of CCs and low numbers of PFs was found to be associated with an increased risk of clustered HRBs. In the presence of coexisting ADHD the pattern of few PFs and clustering of HRBs was aggravated. ADHD was more common among adolescents with other CCs.

Definite memory and learning problems as well as mild executive problems were associated with poor metabolic control, especially among adolescents. Executive problems were also associated with many outpatient visits and low physical activity. Girls with T1DM tended to self-report executive problems to a larger extent than boys, while parents more often reported these problems in boys.

Conclusion: Knowledge about factors influencing treatment adherence and life in general is essential in the work with chronically ill adolescents. Focus must be put on enhancing PFs in order to avoid HRBs. Identification of coexisting NDPs, such as ADHD, is crucial, since such problems can adversely influence treatment adherence, HRBs and school achievements

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 75 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1213
Keyword
Adolescent development, adolescent medicine, health behaviour, protective factors, risk-taking, type 1 diabetes, HbA1c, neurodevelopmental problems and ADHD
National Category
Pediatrics
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-282964 (URN)978-91-554-9553-4 (ISBN)
Public defence
2016-06-03, Rosénsalen, Ingång 95/96 nbv, Uppsala Akademiska Sjukhus, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-05-13 Created: 2016-04-08 Last updated: 2016-06-01

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Authority records BETA

Nylander, CharlotteTindberg, Ylva

Search in DiVA

By author/editor
Nylander, CharlotteTindberg, Ylva
By organisation
PediatricsCentrum för klinisk forskning i Sörmland (CKFD)
In the same journal
Acta Paediatrica
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 622 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf