Background About 36,000 children in the UK have diabetes, 90% is type 1. There are co-morbidities associated with it including autoimmune disorders, vascular complications, and psycho-social conditions.

Objectives

• Evaluate the prevalence of chronic co-morbidities – thyroid disease, coeliac disease and psychosocial co-morbidities in Children and Young Person with type 1 (CYPD T1) in our paediatric diabetic unit (PDU).

• Assess impact of having co-morbidities on glycaemic control.

Methods Our PDU cares for 245 CYPD under 19 years of age. We retrospectively collected and analysed data of mean HbA1c (mmol/mol) for CYPDT1 with and without co morbidities over 18-month period from 1st April 2019 to 30th September 2020. Data was collected from our database Filemake Pro. It consisted of multiple validated point of care HbA1c tests and laboratory results. The psycho-social co-morbidities were anxiety, depression, eating disorders, behaviour disorders, adjustment difficulties, anger management issues and autistic spectrum disease. We also looked at prevalence of retinopathy and nephropathy.Some CYPDT1 had more than one co-morbidity.

Results

• 232 have T1 and 13 have non-T 1 diabetes. 6 moved out of our service during the period of study. CYPD with T1 included were 226.

• 121 (53.53%) had associated co-morbidities versus 105 (46.4%) who had none.

• Thyroid disease was noted in 19 (8.40%), coeliac disease in 9 (3.98%) and psycho-social co-morbidities in 80 (35%). 1 (0.04%) had nephropathy, 19 (8.4%) retinopathy (grade 1) and 15 (6.4%) had others.

• Mean HbA1c for all CYPD T1 with co -morbidities was 73.65 mmol/ml versus 66.14 for CYPD without (Difference of means 6.81, 95%CI [ 4.44, 9.17], p <0.0001).

• Mean HbA1c for thyroid disease was 72.93 mmol/mol (Difference of means 14.4, 95%CI [ 5.23, 25.37], p 0.002).

• Mean HbA1c for psycho-social co-morbidities was 72.82 mmol/mol (Difference of means 8.49, 95%CI [ 3.666,13.24], p 0.0006).

• Mean HbA1c for coeliac disease was 66.6 mmol/ml (Difference of means 2.09, 95%CI [ -12.03- 16.21], p 0.77).

Conclusions

• Having a chronic comorbidity worsens glycaemic control as it adds to the burden of care.

• CYPDT1 have high prevalence of co-morbidities as previously reported.

• CYPD with associated psychosocial co-morbidities had poor glycaemic control as it negatively affects disease management also seen in other studies.

• CYPD with thyroid disease had poor glycaemic control.

• CYPD with coeliac disease had glycaemic control similar to CYPD with no co-morbidities, which is likely due to protective effect of gluten free diet.