Hyperglycaemia and externalising behaviour in children with type 1 diabetes

Abstract

Objective: Anecdotally parents report behavioural changes in their diabetic children with fluctuating blood glucose levels. This study aimed to test associations between intercurrent glycaemia and child behavior in an ambulant setting.

Research design and methods: Prepubertal children attending the Royal Children's Hospital, Melbourne with type 1 diabetes received glycaemic assessment and simultaneous behavioural assessment on 2 occasions 6 months apart. Subjects wore a continuous glucose monitor over a 72 hour period and parents completed the Behavioral Assessment System for Children (BASC) at the 2 study time points.

Results: There was a high correlation between intra-individual externalising and internalising behaviour scores (r=0.88, p<0.001; r=0.81, p<0.001 respectively) at the 2 time points. Mean blood glucose was significantly associated with the mean externalising behaviour score (Regression coef = +1.7 (95%CI 0.6 to 2.8) Adj r2 value = 0.088). Percent times in the normal (Coef = -0.2 (95%CI -0.3 to -0.5), Adj r2 value = 0.068) and high (Coef = +0.2 (95%CI 0.07 to 0.3), Adj r2 value = 0.089) glycaemic ranges were significantly associated with the mean externalising behaviour score. For every 5% increase in time in normal glycemic range there was a decrease in the externalising behaviour score of 1.0 and for every 5% increase in time in high glycemic range there was an increase in the externalising behaviour score of 1.0. There was no significant association between MBG and the mean internalising behaviour score.

Conclusions: Externalising behaviours were associated with intercurrent glycaemic status. These findings underscore the importance of understanding the mechanisms of this association and how it might impact upon ultimate diabetes outcomes.