SAT-266 A Retrospective Study Investigating the Association Between ADHD and Glycemic Control in Children and Adolescents with Type 1 Diabetes Mellitus

Background: Attention deficit hyperactivity disorder (ADHD) is a chronic neuropsychiatric disorder of childhood that often persists into adulthood. Common symptoms of ADHD include difficulty in sustaining attention, failure to give attention to detail, forgetfulness and avoiding tasks requiring mental effort, as well as lower executive functioning. Management of diabetes involves complex multistep tasks, requiring good cognitive and executive functioning. We hypothesized that patients with Type 1 diabetes mellitus (T1DM) who have a concurrent ADHD diagnosis, may encounter difficulty in managing their diabetes on a daily basis thereby leading to poor glycemic control. Objective: We compared average HbA1C values and number of diabetic ketoacidosis (DKA) episodes in patients between ages 6-25 years with T1DM with ADHD (case cohort) and T1DM without ADHD (control group). Methods: The study was designed as a retrospective review of data obtained from the electronic health record in our medical system. Cohort identification was performed through a combination of ICD 9/10 codes, problem list search and medication use. Results were grouped by age. Results: In the age range between 6-18 years, there were 334 controls and 25 cases. Between ages 18-25 years, there were 443 controls and 30 cases. There was an increased number of boys with ADHD in the age group 6-18 years (p=0.0035). There was no significant difference between the average HbA1C over a 2 year period between the two groups in either of the age ranges (p=0.6 and 0.8 respectively). There was no difference in the number of DKA episodes in either group. We did find a significant difference in the type of insurance coverage between the groups. The population with T1DM and ADHD had higher rates of commercial versus public insurance as compared to the control group with T1DM and no diagnosed ADHD in both age groups (p=0.004). Conclusions: The main limitation of the study is its retrospective nature and the possibility of undiagnosed ADHD symptoms in the control group. Diagnosis of ADHD in the Medicaid population with T1DM may be lower due to infrequent clinic visits, long waiting time for specialists or lack of resources and knowledge. Future studies could clarify whether screening for symptoms of inattention and school/work performance in this particular population may identify patients with ADHD who could benefit from therapeutic or medical intervention for the ADHD that could improve T1DM outcome. Funding: Pediatrics Research Grant, Center for Research Informatics.