Psychiatric Comorbidities in Pediatric Monogenic Diabetes due to GCK Mutation: Impact on Diabetes-Related Quality of Life

Arkadiusz Michalak; Agnieszka Szadkowska; Wojciech Mlynarski; Małgorzata Myśliwiec; Grażyna Deja; Eliza Skała-Zamorowska; Przemysława Jarosz-Chobot; Maciej Borowiec; Adam Zalepa; Malwina Musiał-Paździor; Anna Gierak; Anna Kaźmierczak-Mytkowska; Tomasz Wolańczyk; Wojciech Fendler; Agnieszka Butwicka

doi:10.1016/j.jaclp.2022.03.005

Psychiatric Comorbidities in Pediatric Monogenic Diabetes due to GCK Mutation: Impact on Diabetes-Related Quality of Life

J Acad Consult Liaison Psychiatry. 2022 Nov-Dec;63(6):548-556. doi: 10.1016/j.jaclp.2022.03.005. Epub 2022 Apr 2.

Authors

Arkadiusz Michalak¹, Agnieszka Szadkowska², Wojciech Mlynarski³, Małgorzata Myśliwiec⁴, Grażyna Deja⁵, Eliza Skała-Zamorowska⁵, Przemysława Jarosz-Chobot⁵, Maciej Borowiec⁶, Adam Zalepa², Malwina Musiał-Paździor⁴, Anna Gierak⁵, Anna Kaźmierczak-Mytkowska⁷, Tomasz Wolańczyk⁷, Wojciech Fendler⁸, Agnieszka Butwicka⁹

Affiliations

¹ Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland; Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland.
² Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland.
³ Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland.
⁴ Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Poland.
⁵ Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland.
⁶ Department of Clinical Genetics, Medical University of Lodz, Lodz, Poland.
⁷ Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland.
⁸ Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA.
⁹ Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland; Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden. Electronic address: agnieszka.butwicka@ki.se.

PMID: 35381380
DOI: 10.1016/j.jaclp.2022.03.005

Abstract

Background: Monogenic diabetes caused by mutation in the glucokinase gene (GCK-MD) is a rare disorder manifesting in childhood as mild, prevalent hyperglycemia. By consensus, it is managed by dietary supervision and infrequent consultations. However, its impact on the mental health of the affected children is largely unknown.

Objective: To estimate the prevalence of psychiatric comorbidities in children with monogenic glucokinase-related diabetes (GCK-MD) and evaluate their association with quality of life (QoL).

Methods: The study invited children with GCK-MD aged 5-18 years identified in the Central National Registry and treated in 3 pediatric diabetes centers in Poland. The control group comprised children with type 1 diabetes (T1D, the most common diabetes type in youth) matched for age and family history of diabetes. Participants underwent a semistructured clinical interview diagnostic for psychiatric comorbidities, questionnaires assessing behavioral problems, depressive symptoms, parental stress, and measuring general and diabetes-related QoL (PedsQl).

Results: We included 35 patients with GCK-MDMD and 199 with T1D. Eight (22.9%) GCK-MD patients were diagnosed with psychiatric disorder in their lifetime, compared with 16 (8.1%) in the T1D group (odds ratio 3.4 [95% confidence interval: 1.3-8.7]). Patients with GCK-MD showed better parent-reported general QoL (87.1 ± 11.9 vs 82.0 ± 14.0, P = 0.0060) and higher diabetes-related QoL in both parental (84.5 ± 13.8 vs 74.1 ± 15.2, P < 0.0001) and child's perspective (87.6 ± 10.9 vs 77.3 ± 13.9, P < 0.0001). Psychiatric disorders (+P) were associated with worse child-reported diabetes QoL (T1D+P 66.6 ± 16.7, T1D-P 78.2 ± 13.3, GCK-MD+P 79.6 ± 16.3, GCK-MD-P 90.1 ± 7.5, P = 0.0002).

Conclusions: High prevalence of psychiatric disorders in children with GCK-MD and lower QoL emphasizes the need for psychologic surveillance in those otherwise mildly-treated patients.

Keywords: GCK-MD; glucokinase; monogenic diabetes; psychiatric disorder; quality of life; type 1 diabetes.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Comorbidity
Databases, Genetic
Diabetes Mellitus, Type 1* / complications
Diabetes Mellitus, Type 1* / epidemiology
Diabetes Mellitus, Type 1* / genetics
Glucokinase* / genetics
Humans
Hyperglycemia* / complications
Hyperglycemia* / genetics
Mental Disorders* / genetics
Mutation / genetics
Poland / epidemiology
Quality of Life

Substances

Glucokinase