# Attention-Deficit/Hyperactivity Disorder Symptoms Are Common and Associated with Worse Glycemic Control in Adults with Type 1 Diabetes

## TL;DR

Many adults with type 1 diabetes have ADHD symptoms, which are linked to worse blood sugar control and depression.

## Contribution

Identifies a novel association between ADHD symptoms and poor glycemic control in adults with type 1 diabetes.

## Key findings

- ADHD symptoms are common in adults with type 1 diabetes, with 31.9% scoring positive on the ASRS.
- Higher ADHD symptom scores correlate with worse glycemic control (HbA1c) and increased depression scores.
- No significant associations were found between ADHD symptoms and cardiometabolic diseases.

## Abstract

Objective: to assess the association between attention-deficit/hyperactivity disorder (ADHD), type 1 diabetes mellitus (T1D), and cardiovascular comorbidities in adults. Methods: The Adult Self-Report Scale V1.1 (ASRS) for ADHD symptoms was electronically sent to 2069 adults with T1D. Cardiometabolic conditions, laboratory measurements, and PHQ-2/PHQ-9 depression scores were obtained from the electronic medical record. Results: In total, 292 (14.1%) individuals responded and 279 consented to medical records extraction. The average age was 47.4 years (SD: ±18.9), 64.2% were women, 95.7% were non-Hispanic white, and the mean HbA1c level was 7.7% (±1.5%). Of 273 completing ASRS, 87 med ADHD criteria (ASRS positive, 31.9%), and 42 (15.4%) had an ADHD diagnosis or medication. Women had higher scores than men. ADHD symptoms decreased with age, but remained significantly higher than the general population levels. HbA1c levels were positively associated with the ASRS scores (Spearman’s r = 0.28, p < 0.0001). ASRS positive individuals had worse glycemic control (HbA1c ≥ 8.0%, adjusted OR 2.3, 95%CI: 1.3–4.1, p < 0.0001) and higher PHQ-9 scores (10 ± 7.3 vs. 6.1 ± 6, χ2(1) = 9.2, p = 0.002) than the ASRS negative group. No associations were found between ASRS scores and cardiometabolic diseases, or other laboratory or clinical measurements. Conclusions: Many adults with T1D exhibit undiagnosed ADHD symptoms, which correlate with poorer glycemic control and depression. Further research with larger samples is needed to investigate ADHD prevalence and impacts in this group.