Sugar level affects behavior of diabetic children

By Michelle Rizzo

NEW YORK (Reuters Health) - In children with type 1 diabetes, high blood glucose (sugar) levels are associated with an increase in externalizing behaviors, such as aggression, delinquency, and hyperactivity, the results of a study published in a recent issue of Diabetes Care indicate.

"It has always been important to try and normalize blood glucose levels for long-term health," Dr. Fergus J. Cameron commented to Reuters Health. "In addition to this it now appears that it is also important to normalize blood glucose levels to optimize behavior."

Cameron, of the Royal Children's Hospital, Melbourne, Australia, and colleagues note in their paper that "parents of children with type 1 diabetes often report that they can detect elevations in their child's blood glucose due to changes in outward behavioral patterns. These reports, however, are entirely anecdotal, and to date, there has been little direct inquiry in this phenomenon."

The researchers therefore investigated this issue in a study of 42 children ages 5 to 10 years who had type 1 diabetes for more than 2 years. The average A1C at recruitment was 8.2 percent. A1C is a commonly used measure of blood sugar that reflects the average levels in the past 2 to 3 months; a normal level is less than 7.0. Forty children were receiving insulin in a twice-daily mixing regime and two were receiving insulin in a three to four injection regime.

Each subject wore a continuous glucose monitor over a 72-hour period on two occasions 6 months apart. Parents completed the Behavior Assessment System for Children at both time points.

The overall average blood glucose value was higher than normal, as was the average externalizing behavior score. The overall average percentage of time spent in the high glycemic ranges was 42.4 percent.

A statistically significant association was observed between the average blood glucose and the average externalizing behavior score. "For every 5-percent increase in time in the normal glycemic range, there was a decrease in the externalizing behavior score of 1.0 and that for every 5-percent increase in time in the high glycemic range, there was an increase in the externalizing behavior score of 1.0," Cameron's team reports. "

"Externalizing behaviors in children such as aggression, hyperactivity, disruptiveness, etc., can impact upon family quality of life and the classroom environment," Cameron commented to Reuters Health. "Thus, our research has implications both for parents and teachers of primary school-aged children with diabetes."

SOURCE: Diabetes Care, September 2007.