title: Hyperglycemia and externalizing behavior in children with type 1 diabetes.
abstract: OBJECTIVE
  Ancedotally, parents report behavioral changes in their diabetic children who have fluctuating blood glucose levels. This study aimed to test associations between intercurrent glycemia and child behavior in an ambulant setting.
  
  
  METHODS
  Prepubertal children attending the Royal Children's Hospital, Melbourne, Australia, with type 1 diabetes received glycemic assessment and simultaneous behavioral assessment on two occasions 6 months apart. Subjects wore a continuous glucose monitor over a 72-h period, and parents completed the Behavior Assessment System for Children at the two study time points.
  
  
  RESULTS
  There was a high correlation between intra-individual externalizing and internalizing behavior scores (r = 0.88, P < 0.001 and r = 0.81, P < 0.001, respectively) at the two time points. Mean blood glucose (MBG) was significantly associated with the mean externalizing behavior score (beta = 1.7 [95% CI 0.6-2.8], adjusted r(2) = 0.088). Percentage of time in the normal (r = -0.2 [-0.3 to -0.5], adjusted r(2) = 0.068) and high (r = 0.2 [0.07-0.3], adjusted r(2) = 0.089) glycemic ranges were significantly associated with the mean externalizing behavior score. For every 5% increase in time in the normal glycemic range, there was a decrease in the externalizing behavior score of 1.0, and for every 5% increase in time in the high glycemic range there was an increase in the externalizing behavior score of 1.0. There was no significant association between MBG and the mean internalizing behavior score.
  
  
  CONCLUSIONS
  Externalizing behaviors were associated with intercurrent glycemic status. These findings underscore the importance of understanding the mechanisms of this association and how it might impact ultimate diabetes outcomes.
authors.affiliation: Department of Endocrinology and Diabetes, Royal Children's Hospital, University of Melbourne, Parkville, Melbourne, Victoria, Australia.
authors.forename: Ciara M
authors.initials: CM
authors.lastname: McDonnell
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Northam
authors.forename: Susan M
authors.initials: SM
authors.lastname: Donath
authors.forename: George A
authors.initials: GA
authors.lastname: Werther
authors.forename: Fergus J
authors.initials: FJ
authors.lastname: Cameron
mesh_terms: D001519:Behavior; D015190:Blood Glucose Self-Monitoring; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000209:etiology / Q000523:psychology*; D008297:Male; D018670:Monitoring, Ambulatory; D011446:Prospective Studies