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Hyperglycemia and Externalizing Behavior in Children With Type 1 Diabetes

¹ Department of Endocrinology and Diabetes, Royal Children's Hospital, University of Melbourne, Parkville, Melbourne, Victoria, Australia
² Department of Psychology, Royal Children's Hospital, University of Melbourne, Parkville, Melbourne, Victoria, Australia
³ Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, University of Melbourne, Parkville, Melbourne, Victoria, Australia

Address correspondence and reprint requests to Associate Professor Fergus Cameron, Endocrinology and Diabetes, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia. E-mail: fergus.cameron{at}rch.org.au

OBJECTIVE—Ancedotally, parents report behavioral changes in their diabetic children who have fluctuating blood glucose levels. This study aimed to test associations between intercurrent glycemia and child behavior in an ambulant setting.

RESEARCH DESIGN AND METHODS—Prepubertal children attending the Royal Children's Hospital, Melbourne, Australia, with type 1 diabetes received glycemic assessment and simultaneous behavioral assessment on two occasions 6 months apart. Subjects wore a continuous glucose monitor over a 72-h period, and parents completed the Behavior Assessment System for Children at the two study time points.

RESULTS—There was a high correlation between intra-individual externalizing and internalizing behavior scores (r = 0.88, P < 0.001 and r = 0.81, P < 0.001, respectively) at the two time points. Mean blood glucose (MBG) was significantly associated with the mean externalizing behavior score (ß = 1.7 [95% CI 0.6–2.8], adjusted r² = 0.088). Percentage of time in the normal (r = –0.2 [–0.3 to –0.5], adjusted r² = 0.068) and high (r = 0.2 [0.07–0.3], adjusted r² = 0.089) glycemic ranges were significantly associated with the mean externalizing behavior score. For every 5% increase in time in the normal glycemic range, there was a decrease in the externalizing behavior score of 1.0, and for every 5% increase in time in the high glycemic range there was an increase in the externalizing behavior score of 1.0. There was no significant association between MBG and the mean internalizing behavior score.

CONCLUSIONS—Externalizing behaviors were associated with intercurrent glycemic status. These findings underscore the importance of understanding the mechanisms of this association and how it might impact ultimate diabetes outcomes.

Abbreviations: BASC, Behavior Assessment System for Children • CGMS, continuous glucose monitor system • MBG, mean blood glucose • RCH, Royal Children's Hospital

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