Is Autism a Risk Factor for Type 2 Diabetes?

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Type 2 diabetes appears to be more common in adolescents with autism spectrum disorders.
Type 2 diabetes appears to be more common in adolescents with autism spectrum disorders.

Adolescents and young adults with autism spectrum disorder (ASD) appear to have a significantly higher risk for developing type 2 diabetes later in life than those without the disorder, according to data published in Diabetes Care.

“Growing evidence has revealed the association between ASD and type 2 diabetes mellitus–related risk factors, such as obesity and dyslipidemia,” the researchers wrote.

However, they noted that despite the studies assessing risk factors for type 2 diabetes, there is a lack of studies evaluating the potential link between ASD and the disease itself. Further, the researchers highlighted the limitations, including small sample size and cross-section design, of the few that have.

For this study, the researchers enrolled 6122 adolescents, aged 10 to 17 years, and young adults, aged 18 to 29 years, from the Taiwan National Health Insurance Research Database who were diagnosed with ASD, as well as 24 488 age- and sex-matched controls. At 80%, patients were predominantly male.

Enrollment occurred from 2002 to 2009, and patients were followed until the end of 2011.

Results revealed an increased incidence of type 2 diabetes among patients with ASD (2.63 vs 0.63 per 1000 person-years; P<.001). Duration at onset of the disease was also shorter, with a mean of 3.42 vs 5.35 years in the ASD group vs the control group, respectively (P<.001).

According to the data, the likelihood of developing type 2 diabetes was significantly higher among adolescents and young adults with ASD, as compared with controls (P<.001). ASD also appeared to increase the risk for type 2 diabetes after adjustment for demographic data, use of atypical antipsychotics, and medical comorbidities (hazard ratio [HR]=3.25; 95% CI, 2.23-4.75).

After excluding the first year (HR=3.03; 95% CI, 2.03-4.51) or first 3 years (HR=2.62; 95% CI, 1.62-4.51) of observation, sensitivity analyses showed that ASD was consistently linked to an increased risk for type 2 diabetes later in life, the researchers found.

When evaluated by age group, both adolescents (HR=2.71; 95% CI, 1.64-4.48) and young adults (HR=5.31; 95% CI, 2.85-9.9) with ASD were more likely to develop type 2 diabetes during follow-up than the control patients.

When stratified according to sex, risk for type 2 diabetes was increased among both male (HR=2.93; 95% CI, 1.87-4.59) and female patients (HR=4.44; 95% CI, 2.14-9.21) with ASD vs those without the disorder. Risk for type 2 diabetes, however, did not differ significantly according to sex.

Additionally, among patients with ASD compared with controls, the researchers noted more dyslipidemia, (prevalence, 2% vs 1.6%; P=.017), obesity (2.7% vs 1.1%; P<.001), and long-term use of atypical antipsychotics (16% vs 0.1%; P<.001).

The researchers found that risk for type 2 diabetes was related to hypertension (HR=2.09; 95% CI, 1.22-3.58), dyslipidemia (HR=11.11; 95% CI, 7.65-16.13), and obesity (HR=3.46; 95% CI, 2.16-5.53).

Type 2 diabetes risk was also elevated for both short-term (HR=1.97; 95% CI, 1.2-3.23) and long-term users (HR=1.64; 95% CI, 1.02-2.63) of atypical antipsychotics, as compared with nonusers.

Data also indicated that patients with ASD lived in less urbanized regions (P<.001) and had a lower income-related insured amount (P<.001).

“These results may remind the clinicians working with patients with ASD to more closely monitor their body weight and lipid profiles and to try to prevent or delay the onset of type 2 diabetes,” the researchers concluded. “Furthermore, additional studies are necessary to investigate the mechanism underlying the association between ASD and subsequent type 2 diabetes and to elucidate whether a prompt intervention for ASD reduces the risk of type 2 diabetes in later life.”

Reference

  1. Chen M-H, Lan W-H, Hsu J-W, et al. Risk of Developing Type 2 Diabetes in Adolescents and Young Adults With Autism Spectrum Disorder: A Nationwide Longitudinal Study. Diabetes Care. 2016. doi:10.2337/dc15-1807.
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