‘Diabetes stress’ may increase risk of mental health problems in young people with type 1 diabetes

A study by a team in the UK and the Czech Republic has found that children with type 1 diabetes are at significantly higher risk of a number of mental health problems, including mood and anxiety disorders.

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

The work appears in Nature Mental Health.

According to the charity JDRF, 8.7 million people worldwide are living with type 1 diabetes, including more than 400,000 in the UK. It is a chronic, life-threatening condition, usually diagnosed in childhood and with lifelong impact.

Currently, people with type 1 diabetes rely on routine blood tests via finger pricks and insulin injections or infusions because their pancreas no longer produces insulin. Recent advances in artificial pancreas technology are helping to 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 unclear whether these links are best explained by the impact of living with the condition and its treatment, or whether underlying common biological mechanisms might be involved; for example, the impact of unstable blood sugar levels on the developing adolescent brain.

To answer this question, a team of researchers used data from over 4,500 children with type 1 diabetes from a national registry in the Czech Republic and from large-scale European DNA studies.

The national registry data found that children diagnosed with type 1 diabetes (compared with children without the condition) were more than twice as likely to develop a mood disorder and more than 50 percent more likely to develop an anxiety disorder. They were also more than four times more likely to develop behavioral syndromes, including eating and sleep disorders.

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

The findings are consistent with the results of two other national register studies in Sweden and Denmark, suggesting that the results are likely to apply to other countries, including the United Kingdom.

The team used a statistical technique known as Mendelian randomization to examine causal links between type 1 diabetes and these different psychiatric disorders, but found little evidence for a common underlying biological mechanism.

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

The researchers say mental health problems later in life may result from children with type 1 diabetes being forced to make significant changes in their lives, with a constant focus on monitoring their food intake and the need to check their blood sugar levels and administer insulin injections. As a result, these children often feel excluded from social events and ostracized by peers, teachers and even family members.

Dr Benjamin Perry from the University of Cambridge’s Department of Psychiatry said: “We know that people diagnosed with type 1 diabetes can experience ‘diabetes stress’. This can include extreme frustration with blood sugars and feelings of isolation, and can lead to burnout, hopelessness and a sense of lack of control. It’s no wonder then that they are at risk of worsening mental health problems, which continue into adulthood.”

Professor Peter Jones, also from the University of Cambridge’s Department of Psychiatry, added: “Our findings highlight the urgent need to support children diagnosed with type 1 diabetes, look out for signs of mental health problems and get them early, expert help. That way, it’s possible to help these children early, before these problems become fully entrenched.”