ADHD Symptoms Linked to Poor Glycemic Control in Adults With Type 1 Diabetes
Key Takeaways
- Nearly one-third of surveyed adults with type 1 diabetes (T1D) screened positive for attention-deficit/hyperactivity disorder (ADHD) symptoms, far exceeding documented diagnosis rates.
- Positive ADHD screening was associated with more than double the odds of poor glycemic control (HbA1c ≥8.0%) and higher depression scores.
- No significant associations were observed between ADHD symptoms and most cardiometabolic comorbidities after statistical correction.
Adults with type 1 diabetes (T1D) frequently report symptoms of attention-deficit/hyperactivity disorder (ADHD), and these symptoms are associated with worse glycemic control, according to a cross-sectional study conducted at the Joslin Diabetes Center at SUNY Upstate Medical University in Syracuse, New York. The findings highlight a potential gap in recognition and management of ADHD in adult diabetes care.
Study Details and Results
Investigators electronically distributed the Adult Self-Report Scale (ASRS v1.1) to 2069 adults with T1D receiving care between January 2020 and May 2022. Of these, 292 individuals (14.1%) responded, and 273 completed the ADHD assessment and consented to electronic medical record review.
The cohort had a mean age of 47.4 years (±18.9), 64.2% were women, and 95.7% were non-Hispanic White. Mean HbA1c was 7.7% (±1.5%). Overall, 87 participants (31.9%) met ASRS criteria for ADHD symptoms. However, only 14 individuals (5.1%) had a documented ADHD diagnosis, and 42 (15.8%) had either a diagnosis or were taking ADHD medication.
ADHD symptoms declined with age but remained significantly higher across most age groups compared with normative US adult data. Women reported higher symptom counts than men, particularly in younger age groups.
Although mean HbA1c levels did not significantly differ between ASRS-positive and ASRS-negative groups, a greater proportion of ASRS-positive individuals had HbA1c levels ≥8.0% (52.9% vs 25.4%; P < .0001). After adjustment, ADHD symptom positivity was associated with more than twice the odds of poor glycemic control (adjusted OR 2.3; 95% CI, 1.3–4.1; P < .0001). ASRS total scores also correlated positively with HbA1c (Spearman’s r = 0.28; P < .0001).
Depressive symptoms were more pronounced among ASRS-positive participants, with higher mean PHQ-9 scores (10 ± 7.3 vs 6.1 ± 6; P = .002). Higher ASRS scores were significantly associated with increased depression severity.
No significant associations were found between ADHD symptom scores and most cardiometabolic diagnoses—including hypertension, ischemic heart disease, stroke, or kidney dysfunction—after adjustment and correction for multiple comparisons. Although peripheral vascular disease and overall cardiovascular disease showed initial associations with ADHD diagnosis, these did not remain significant after Bonferroni correction.
Clinical Relevance
For managed care professionals, the findings underscore the potential impact of undiagnosed ADHD symptoms on diabetes outcomes in adults with T1D. Nearly one-third of respondents met ADHD screening criteria, yet only a small fraction had a documented diagnosis, suggesting substantial underrecognition.
Poor glycemic control is a key driver of long-term diabetes complications and health care utilization. The observed association between ADHD symptoms and HbA1c ≥8.0% suggests that executive dysfunction, inattention, and related symptoms may interfere with adherence to complex insulin regimens, glucose monitoring, and lifestyle recommendations.
The strong relationship between ADHD symptoms and depression further supports integrated behavioral health screening in T1D care. Given that depression in T1D has been linked to worse glycemic control in prior research, coexisting ADHD symptoms may compound this risk.
Although this study did not demonstrate robust links between ADHD symptoms and established cardiometabolic comorbidities, the authors note that larger longitudinal studies are needed. The cross-sectional design and modest response rate limit causal inference.
Conclusion
ADHD symptoms are common and frequently undiagnosed in adults with type 1 diabetes and are associated with poorer glycemic control and higher depression scores. These findings support consideration of routine ADHD and mental health screening as part of comprehensive, multidisciplinary T1D management.
Reference
Zhang-James Y, Draytsel D, Carguello B, Faraone SV, Weinstock RS. Attention-deficit/hyperactivity disorder symptoms are common and associated with worse glycemic control in adults with type 1 diabetes. J Clin Med. 2025 May 21;14(10):3606. doi:10.3390/jcm14103606.
