As many as one in five children with newly diagnosed type 2 diabetes also have neuropsychiatric disorders including depression, attention-deficit hyperactivity disorder, autism, developmental delay, schizophrenia, and bipolar disorder, according to an article in the June issue of Pediatric Diabetes.

“Our findings may be important in screening practices for children with either of these conditions,” said the study’s leader, pediatric endocrinologist Lorraine E. Levitt Katz, MD. “Obese children with neuropsychiatric conditions should be screened for diabetes, and children with insulin resistance or type 2 diabetes should be screened for psychiatric conditions.”

The researchers found that 46 (19 percent) of 237 children at Children’s Hospital diagnosed with type 2 diabetes had previously been diagnosed with neuropsychiatric disease (NPD).

The retrospective study was the first to report the frequency of NPD in a cohort of children with type 2 diabetes. The findings suggest that children with a neuropsychiatric disease may be at risk for type 2 diabetes, and vice versa, with linkage through pathophysiology, environmental factors such as medications, or both.

“Of the subset of children in our sample with neuropsychiatric disorders, a substantial number were treated with psychiatric medications reported to cause weight gain,” said Robert Berkowitz, MD, chief of Psychiatry at Children’s Hospital, and senior author of the study. “However, this is not the only factor at work, as not all of the medications cause weight gain. Depression, as well as other neuropsychiatric illnesses, may itself lead to a sedentary lifestyle, which places children at risk for type 2 diabetes.”

Although this study examined previously diagnosed neuropsychiatric disease, the true frequency of neuropsychiatric conditions in children with type 2 diabetes may be considerably higher, said the researchers. “For some children, diabetes may occur first, and help contribute to depression and other NPDs,” Berkowitz added. “Some researchers suspect that both depression and diabetes have a common basis in the neuroendocrine system, and one disease may help to stimulate the other.”

Type 2 diabetes, formerly called adult-onset diabetes and still most common in adults, has been increasing sharply among children over the past decade, in parallel with growing numbers of overweight and obese children.
Although the most effective treatment for type 2 diabetes in children is not known, The Children’s Hospital of Philadelphia is participating in a national multicenter trial, comparing medication with the effects of lifestyle changes such as diet and increased exercise.

“For most children, a diagnosis of diabetes demands dramatic lifestyle changes,” added Katz. “If the child has a neuropsychiatric disease as well, there are additional challenges, which physicians and caregivers need to factor into the child’s treatment to achieve the best results.”