O62:

Mental disorder and type 1 diabetes:

initiation and discontinuation of CSII in
pediatric and young adult patients with ADHD,
depression, eating disorder, needle phobia,
anxiety/obsessive compulsive disorder or
psychosis.
N. Scheuing1, C. Bchle, M. Becker, G. Berger, H. Haberland,
M. Meusers, J. Mirza, P. Plener, S. von Sengbusch, M. Thienelt,
R.W. Holl
1University

of Ulm, Germany

Dsseldorf, Wiesbaden, Vienna, Berlin, Herdecke, Cologne, Ulm, Lbeck, Coesfeld

September 5, 2014

ISPAD Toronto

Presenter Disclosure Information

Nicole Scheuing and all co-authors:
Disclosed no conflict of interest
related to this study.
September 5, 2014

ISPAD Toronto

Background
Higher prevalence of psychiatric disorders in type 1
diabetes (T1D) compared to the general population
Risk of suicide or manipulation, coping with complex
electronic devices may deter physicians from using
insulin pumps (CSII) in patients with comorbid
mental disorder (MD)
Analysis of use and discontinuation of CSII in
T1D with and without clinically recognized
comorbid MD
September 5, 2014

ISPAD Toronto

Methods I
Multicenter, prospective
German/Austrian diabetes
patient registry (www.d-p-v.eu)
DPVparticipants
03/2014

Inclusion criteria:

T1D
5-<30 years
Patient visits between 2005-2013
Insulin dosage documented

September 5, 2014

ISPAD Toronto

Methods II
2005-2013: 48,716 T1D patients included

Registry was searched for diagnosis and/or specific

treatment of MD by ICD-10, DSM-IV/-5, specific search
terms
Most recent year of care from each patient
Group comparisons
models

using

multivariable

regression

Calculation of adjusted estimates based on observed

margins; adjustments for age, sex, duration of diabetes,
migration background
Statistical package: SAS 9.4
September 5, 2014

ISPAD Toronto

Demographics
Tab. 1: Baseline characteristics (median with quartiles or proportions)
Type 1 diabetes
No MD

MD

45,675

3,041

47.8

42.3

15.6 [11.9;17.7]

15.9 [12.9;17.7]

Duration of diabetes, yrs

5.1 [2.2;8.9]

6.2 [3.0;10.0]

Migration background, %

16.6

15.3

+0.33 [-0.28;+0.92]

+0.28 [-0.38;+0.95]

Number, n
Female sex, %
Age, yrs

BMI-SDS

Except for migration background, all p-values <0.05.

6.2% revealed a clinically recognized comorbid MD

September 5, 2014

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MD frequencies
Attention deficit hyperactivity
disorder (ADHD):

2.9% (n=1,405)

Depression:

0.9% (n= 447)

Eating disorder:

0.8% (n= 397)

Needle phobia:

0.7% (n= 326)

Anxiety/obsessive compulsive
disorder (OCD):

0.5% (n= 260)

Psychosis:

0.4% (n= 206)

September 5, 2014

ISPAD Toronto

Insulin pump use

adjusted for age, sex, duration of diabetes, migration background

September 5, 2014

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Discontinuation of CSII
adjusted for age, sex, duration of diabetes, migration background

September 5, 2014

ISPAD Toronto

Summary
Patients with anxiety/OCD, depression or needle phobia had
a higher frequency of CSII.
Severe psychiatric disorders like psychosis seemed to be
associated with lower use of CSII.
Rate of discontinuation was higher in most patients with
mental disorder.
Comparatively low rates of MDs probably point to difficulties in
recognizing/ documenting MDs in daily routine diabetes care.
Diabetologists should be aware of comorbid MDs in
T1D as most comorbid MDs were associated with
discontinuation of CSII. The initiation and
discontinuation of CSII in MD patients should be
decided individually.
September 5, 2014

ISPAD Toronto

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Acknowledgement

DPVparticipants
03/2014

Working group in Ulm

Financial support:

Thank YOU
for your attention!
September 5, 2014

ISPAD Toronto

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