Magazine article Clinical Psychiatry News

Watch for Neuropsychiatric Disorders at Diabetes Dx: Retrospective Study of 237 Children, Adolescents with Type 2 Diabetes Finds Depression Is Top Diagnosis

Magazine article Clinical Psychiatry News

Watch for Neuropsychiatric Disorders at Diabetes Dx: Retrospective Study of 237 Children, Adolescents with Type 2 Diabetes Finds Depression Is Top Diagnosis

Article excerpt

ORLANDO, FLA. -- Nearly 20% of children and adolescents have a neuropsychiatric diagnosis at the time they are diagnosed with type 2 diabetes, according to a retrospective study presented at the annual scientific sessions of the American Diabetes Association.

"Adolescents with neuropsychiatric disease and other risk factors may have a higher risk for glucose intolerance or type 2 diabetes, and may benefit from screening," Lorraine E. Levitt Katz, M.D., said. "The risk of type 2 diabetes may be greatest for obese children on atypical antipsychotics."

The relationship between neuropsychiatric illness and type 2 diabetes is not completely clear and is likely multifactorial. Weight gain, caused by neuropsychiatric illness or antipsychotic medication, may play a role; obesity is a risk factor for type 2 diabetes in children and adolescents. Neuropsychiatric illness may promote a sedentary lifestyle, another factor associated with weight gain. Some medications may cause hyperglycemia through insulin resistance or effects on beta cells. Other risk factors for pediatric type 2 diabetes include family history, ethnicity, and female gender, said Dr. Levitt Katz, a pediatric endocrinologist at the Children's Hospital of Philadelphia.

"At [Children's Hospital of Philadelphia], we've seen an increase in new type 2 diabetes cases. The number has increased steadily each year, up to 55 in 2002," said Dr. Levitt Katz, also of the University of Pennsylvania.

She and her colleagues reviewed the charts of 237 children and adolescents newly diagnosed with type 2 diabetes, to determine the prevalence of neuropsychiatric illness. They identified 46 such patients (19%). Diagnoses included depression, behavioral disorders (including attention-deficit hyperactivity disorder), mental retardation, autism, and developmental delay.

"A large number of pediatric patients with type 2 diabetes have neuropsychiatric disease," Dr. Levitt Katz said. Pediatric endocrinologists diagnosed most of the diabetes in the study population, but primary care physicians diagnosed some patients. The study findings may not even reflect the true prevalence. "We would argue our data are an underestimation of neuropsychiatric illness among children with diabetes."

Depression was the leading diagnosis (13 patients). A meeting attendee asked whether preexisting depression interferes with a patient's motivation regarding diabetes. "It's an enormous challenge that will require creative thinking to address," Dr. …

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