Mental ills often affect kids with type 2 diabetes

Nearly one out of every five children with Type 2 diabetes (which is associated with being overweight) also has a psychiatric illness or behavioral disorder, according to a study conducted at Children's Hospital of Philadelphia.

It's not clear which comes first, the mental problems or Diabetes. For one thing, the medications used to treat some mental conditions often cause weight gain and high blood sugar levels.

"We started seeing pediatric patients who had gained a tremendous amount of weight while they were on some of the newer atypical antipsychotic agents," said lead investigator Dr. Lorraine E. Levitt Katz. "We thought initially this would all be medication related, but it appears to be more multifactorial than that."

Katz and her associates reviewed the medical charts of their young patients who had Type 2 diabetes to determine how many were being treated for a neuropsychiatric disease at the time of their diabetes diagnosis.

Among the 237 patients, 46 (19 percent) had been diagnosed with a neuropsychiatric disease and 29 were prescribed at least one psychotropic medication, the team reports in the journal Pediatric Diabetes.

However, the children with mental illness were actually no heavier, on average, than the kids with no mental problems and therefore no history of treatment with antipsychotic drugs.

The authors say a number of mechanisms besides drug side effects might explain the link between Type 2 diabetes and mental ills. They theorize that "diabetes could appear in these patients due to a common neuroendocrine basis between the two diseases, a sudden increase in weight, overeating related to poor impulse control, and altered brain physiology due to neuropsychiatric disease."

They recommend that obese children with neuropsychiatric conditions be tested for diabetes, and that those with diabetes or insulin resistance be screened for psychiatric disorders.

"Before putting children on medications that may cause weight gain and an increase in insulin resistance, a risk-benefit analysis needs to be done," Katz stressed.

She noted that children with psychiatric diagnoses may be more sedentary and less prone to regular physical activity. "I think there needs to be an individualized lifestyle-related program," she added, "because for these kids there are more challenges associated with their additional diagnoses."

SOURCE: Pediatric Diabetes, June 2005.