1. In a retrospective review of over 30 000 adolescents and young adults, patients with autism spectrum disorder (ASD) demonstrated significantly higher risk of developing type 2 diabetes (T2DM) compared to healthy controls
2. This increased risk of T2DM among patients with ASD remained significant after adjusting for atypical antipsychotic use and other medical comorbidities
Evidence Rating Level: 3 (Average)
Study Rundown: ASD is a neurological disorder consisting of diminished interaction, communication, cognition, and increased repetitive behavior. Previous studies have recognized the association between ASD and metabolic syndrome risk factors such as obesity and dyslipidemia. However, there is limited information on the association between ASD and T2DM. The purpose of this study was to explore this potential association in a large population database.
The study analyzed the health outcomes of over 6000 adolescents and young adults with ASD and 24 000 age- and sex-matched controls. At the conclusion of the study, individuals with ASD demonstrated a significantly higher risk of developing T2DM compared to healthy controls. This risk remained significant after adjustments for patient demographics, atypical antipsychotic use, as well as other medical comorbidities. Furthermore, the use of atypical antipsychotics was independently associated with an increased risk of T2DM in this patient population. The study is limited by the retrospective nature of the data, which lacks important confounding information including ASD severity, family history, and personal lifestyle. Additionally, the data is collected from a single country in Asia, and may not be generalizable to other ethnic populations. This was one of the largest studies associating an increased risk of T2DM in patients with ASD and supports the use of increased vigilance and monitoring in managing this patient population.
In-Depth [retrospective cohort]: This was a retrospective review of the Taiwan National Health Insurance Research Database from 2002 to 2009. Individuals between the ages of 10 to 29 who received a diagnosis of ASD were enrolled along with healthy age- and sex-matched controls. Overall, 6122 participants with ASD and 24 488 controls were enrolled in the study. The primary endpoint was the development of T2DM based on laboratory examinations. At the conclusion of the study, adolescents (HR: 2.71; 95% CI: 1.64 to 4.48) and young adults (HR: 5.31; 95% CI: 2.85 to 9.90) with ASD demonstrated an increased incidence of T2DM compared to controls. Additionally, patients with ASD demonstrate earlier age of T2DM onset (mean age: 3.42 vs. 5.35 years; p < 0.001). The ASD cohort also demonstrated higher incidences of obesity (p < 0.001), dyslipidemia (p = 0.017) and long term antipsychotic use (p < 0.001). The use of short-term and long-term antipsychotics, (HR 1.97; 95% CI: 1.20–3.23) and (HR 1.64; 95% CI: 1.02–2.63) were associated with elevated risk of T2DM.
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