Risk of type 2 diabetes in autism

"Adolescents and young adults with ASD [autism spectrum disorder] were more likely to develop type 2 DM [type 2 diabetes mellitus] during the follow-up. In addition, those with ASD using atypical antipsychotics exhibited a high risk. Therefore, further research is necessary to investigate the common pathophysiology of ASD and type 2 DM."

So said the findings reported by Mu-Hong Chen and colleagues [1] as, yet again, Taiwan and their very useful National Health Insurance Research Database (NHIRD) continues to give to autism and related research.

Type 2 diabetes - the one where the pancreas don't produce enough insulin or the body's cells don't react to insulin - was the focus of NHIRD interrogation this time around, following in the scientific footsteps of previous research looking at both type 1 and type 2 diabetes in relation to autism (see here). Enrolling over 6,000 adolescents and young adults diagnosed with an autism spectrum disorder (ASD) and nearly 25,000 age and sex-matched controls "between 2002 and 2009", researchers followed participants until the end of 2011 watching for who and how many would be diagnosed with type 2 DM.

Dividing groups into adolescents and young adults, researchers reported that those diagnosed with autism were at "higher risk of developing type 2 DM than those without ASD" after adjusting for various potential forms of bias including "atypical antipsychotics use, and medical comorbidities." Further: "Short-term... and long-term... use of atypical antipsychotics were associated with a higher likelihood of subsequent type 2 DM." Ergo, yet another important, growing and potentially life-changing comorbidity appears to be 'over-represented' when it comes to the label of autism.

Accepting that it is not necessarily new news that certain pharmaceutical formulations can affect risk of type 2 diabetes [2], these are interesting and potentially important results. The focus on how maternal diabetes 'exposure' might modify risk of autism in offspring (see here) coupled to ideas about how autoimmunity inferred by type 1 diabetes history might link into some autism (see here) have tended to predominate in this area of the autism research landscape. The Chen results tap into a pretty under-appreciated idea that for one reason or another, a diagnosis of autism could potentially raise the risk of something like type 2 diabetes.

There is additional research to do on this topic. So, in these days of greater appreciation that 'autism genes' might not necessarily just be 'genes for autism' (pleiotropy), one could reasonably ask the question of whether there are subtle genetic (or epigenetic) issues influencing risk of type 2 diabetes. As per my use of the word 'epigenetic' in that last sentence, I'm also minded to bring in the work from people like the late David Barker, and the idea that birth weight might also 'program' for a greater risk for type 2 diabetes and related health issues (see here) given what's known about this area with autism in mind (see here).

That type 2 diabetes is not a wholly genetic issue is something else to bear in mind as issues such as weight and eating patterns come into the frame. Minus any sweeping generalisations, weight issues and particularly obesity are not uncommon research topics when it comes to autism (see here) and as for eating patterns and habits, well, let's just say there is some science there too (see here). Whether singularly or combined (and with potential added mention of exercise) one might already see how screening for type 2 diabetes should be added to the list of monitoring required when a diagnosis of autism is received. I might also mention some recent research chatter about leptin as being important to type 2 diabetes in kids and where that might go with regards to other autism research (see here). I'm sure there other factors too.

And, if and when type 2 diabetes in diagnosed, there are a number of positive changes that can be made to lifestyle including the idea that 'reversal' is not something totally unheard of...

So:  The Force Awakens and Dark Side of the Moon... synch or no synch?

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[1] Chen MH. et al. Risk of Developing Type 2 Diabetes in Adolescents and Young Adults With Autism Spectrum Disorder: A Nationwide Longitudinal Study. Diabetes Care. 2016 Mar 22. pii: dc151807.

[2] Galling B. et al. Type 2 Diabetes Mellitus in Youth Exposed to Antipsychotics: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2016 Mar 1;73(3):247-59.

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Chen, M., Lan, W., Hsu, J., Huang, K., Su, T., Li, C., Lin, W., Tsai, C., Tsai, S., Lee, Y., Chen, Y., Pan, T., Chang, W., Chen, T., & Bai, Y. (2016). Risk of Developing Type 2 Diabetes in Adolescents and Young Adults With Autism Spectrum Disorder: A Nationwide Longitudinal Study Diabetes Care DOI: 10.2337/dc15-1807