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Attention-Deficit Hyperactivity Disorder in Pediatric Patients With Type 1 Diabetes Mellitus

Clinical Outcomes and Diabetes Control

Vinker-Shuster, Michal MD*; Golan-Cohen, Avivit MD, MHM†,‡; Merhasin, Ilia MA; Merzon, Eugene MD†,‡

Journal of Developmental & Behavioral Pediatrics: June 2019 - Volume 40 - Issue 5 - p 330–334
doi: 10.1097/DBP.0000000000000670
Original Article

Objective: To assess the interactions between attention-deficit hyperactivity disorder (ADHD) and type 1 diabetes mellitus (T1DM), including diabetes outcomes and patients' general health status.

Methods: Primary care and hospital records of patients aged 5 to 18 years with T1DM were analyzed using the Leumit Health Services database. The diabetic control and general health of patients with T1DM and ADHD diagnoses were compared with those of patients with T1DM alone in a cross-sectional study. The ADHD group included patients with ADHD diagnosis who purchased at least 3 prescriptions of psychostimulant agents and nootropics. Parameters including demographic, clinical, and laboratory data were collected and assessed.

Results: The study included 230 patients with T1DM; of them, 24 had ADHD (10.4%). Twenty of 24 patients with ADHD (83.3%) had hemoglobin A1C of 9% and higher versus 87 of 206 patients with diabetes alone (43.3%) (p < 0.05). The ADHD group had significantly higher annual emergency department admissions [15/24 (62.5%) vs 77/201 (37.4%); p < 0.05], higher annual hospitalization rates [18/24 (75%) vs 78/206 (37.9%); p < 0.05], and longer hospitalization stays (mean, 2.21 vs 0.65 days; p < 0.05). The total medical annual costs per patient were twice as high in the ADHD group (p < 0.05). In multivariate analysis, these unfavorable outcomes of the ADHD group were preserved.

Conclusion: In this study, having ADHD and T1DM comorbidity was associated with a higher complications rate and poorer diabetes control in comparison to having T1DM alone. Although further research is needed, our data suggest that this group requires special care and attention of the medical staff.

*Department of Pediatrics, Assuta Hospital, Ashdod, Israel;

Leumit HMO, Tel Aviv, Israel;

Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Address for reprints: Michal Vinker-Shuster, MD, Department of Pediatrics, Assuta Hospital, Ashdod, Israel; e-mail:

Disclosure: The authors declare no conflict of interest.

See the Video Abstract at

Received June 29, 2018

Accepted February 12, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.