Psychosocial Burden and Glycemic Control During the First 6 Years of Diabetes: Results From the SEARCH for Diabetes in Youth Study

doi:10.1016/j.jadohealth.2014.03.011

Journal of Adolescent Health

Volume 55, Issue 4, October 2014, Pages 498-504

https://doi.org/10.1016/j.jadohealth.2014.03.011 Get rights and content

Abstract

Purpose

To evaluate the psychosocial burden of adolescents with diabetes, determine the trajectory of psychosocial burden, and examine the interdependent relationships between psychosocial burden and glycemic control across the first 6 years of diabetes.

Methods

Data from SEARCH for Diabetes in Youth, an observational study of U.S. children diagnosed with diabetes before the age of 20, were collected during study visits conducted at baseline and then at 12, 24, and 60 months after baseline. Blood was drawn, clinical and demographic information was collected, and psychosocial burden was evaluated using standardized depression and generic and diabetes-specific health-related quality of life (QOL) surveys.

Results

Among the 1,307 adolescents (mean age, 14.1±2.5 years) with baseline data, 1,026 had type 1 diabetes and 281 had type 2 diabetes. For those with a 60-month follow-up visit, glycated hemoglobin (A_1c) values rose 1.5% from baseline (type 1, 7.7%–9.3% and type 2, 7.3%–8.8%). Adolescents with type 2 diabetes reported more depression and poorer QOL than adolescents with type 1 diabetes. For each diabetes type, there were similar baseline risk factors for higher A_1c values: longer diabetes duration, ethnic minority status, and declining diabetes QOL (p < .05). However, youth with type 2 diabetes had higher A_1c values with increasing generic QOL, an unexpected finding. Younger adolescents with type 1 diabetes had higher A_1c values at the end of the study.

Conclusions

Significant deterioration in glycemic control marks the first 6 years of diabetes for adolescents. Psychosocial burden, particularly poor diabetes-specific QOL, is a contributor to suboptimal glycemic outcomes.

Section snippets

Methods

SEARCH is an observational longitudinal study of youth with diabetes diagnosed before the age of 20 in the United States. SEARCH participants are drawn from four geographically defined populations in Ohio, Washington, South Carolina, and Colorado; health plan enrollees in Hawaii and California; and Indian Health Service beneficiaries from four American-Indian populations in Arizona and New Mexico. Before protocol implementation, local institutional review board approval was obtained for each

Results

The mean ± standard deviation age of the 1,307 participants included in this analysis was 14.1 ± 2.5 years, and the mean diabetes duration at the baseline visit was 10.6 ± 6.7 months (type 1 diabetes duration, 10.4 ± 6.5 months and type 2 diabetes duration, 11.4 ± 7.1 months). The sample comprised 50% female patients, 65% non-Hispanic white, and 78% of the youth who had type 1 diabetes (Table 1). The following are the total numbers of participants completing each visit: type 1 diabetes, 1,026

Discussion

Data from SEARCH study participants show that the first 6 years of diabetes are marked by significant deterioration in glycemic control. This is the first study to document the longitudinal trajectories of psychosocial burden and glycemic control in such a large sample of youth with type 1 diabetes or type 2 diabetes. Furthermore, worsening glycemic control is predicted by sociodemographic variables evident at diagnosis and changing psychosocial burden over time. These findings were consistent

Acknowledgments

The SEARCH for Diabetes in Youth Study is indebted to the many youth and their families, and their health care providers, whose participation made this study possible.

The authors wish to acknowledge the involvement of General Clinical Research Centers (GCRC) at the South Carolina Clinical & Translational Research (SCTR) Institute, at the Medical University of South Carolina (National Institutes of Health [NIH]/National Center for Research Resources [NCRR] grant number UL1RR029882); Children's

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Prevalence of Mental, Behavioral, and Developmental Disorders Among Children and Adolescents with Diabetes, United States (2016–2019)
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Whether a more severe endotype associated with earlier type 1 diabetes diagnosis is also associated with more severe mental health comorbidities warrants future investigation. Higher prevalence of depression has been reported among youth with type 2 diabetes than with type 1 diabetes.32,33 More than one-third of children and adolescents with diabetes were reported to have a mental, emotional, and/or behavioral disorder.
To assess the association of diabetes and mental, behavioral, and developmental disorders in youth, we examined the magnitude of overlap between these disorders in children and adolescents.
In this cross-sectional study, we calculated prevalence estimates using the 2016–2019 National Survey of Children's Health. Parents reported whether their child was currently diagnosed with diabetes or with any of the following mental, behavioral, or developmental disorders: attention-deficit/hyperactivity disorder, autism spectrum disorder, learning disability, intellectual disability, developmental delay, anxiety, depression, behavioral problems, Tourette syndrome, or speech/language disorder. We present crude prevalence estimates weighted to be representative of the US child population and adjusted prevalence ratios (aPRs) adjusted for age, sex, and race/ethnicity.
Among children and adolescents (aged 2–17 years; n = 121 312), prevalence of mental, behavioral, and developmental disorders varied by diabetes status (diabetes: 39.9% [30.2–50.4]; no diabetes: 20.3% [19.8–20.8]). Compared with children and adolescents without diabetes, those with diabetes had a nearly 2-fold higher prevalence of mental, behavioral, and developmental disorders (aPR: 1.72 [1.31–2.27]); mental, emotional, and behavioral disorders (aPR: 1.90 [1.38–2.61]) and developmental, learning, and language disorders (aPR: 1.89 [1.35–2.66]).
These results suggest that approximately 2 in 5 children and adolescents with diabetes have a mental, behavioral, or developmental disorder. Understanding potential causal pathways may ultimately lead to future preventative strategies for mental, behavioral, and developmental disorders and diabetes in children and adolescents.
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Type 1 diabetes (T1D), type 2 diabetes, and prediabetes are increasing in incidence. Adolescents and young adults with diabetes experience psychosocial comorbidities at an increased incidence. As such, exploring interventions that can improve psychosocial and glycemic outcomes are needed. The purpose of this integrative review is to examine and synthesize the literature on mindfulness in adolescents and young adults with type 1 or type 2 diabetes or prediabetes.
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We identified 137 articles in our initial search and 74 articles remained after removing for duplicates. Ten articles were included in the review, with 5 including adolescents and young adults with T1D and 5 including adolescents and young adults with prediabetes. No studies evaluated mindfulness in adolescents and young adults with type 2 diabetes.
Mindfulness is an acceptable intervention in adolescents and young adults with T1D and prediabetes, resulting in positive psychosocial and glycemic outcomes. There were issues with feasibility of the intervention and mobile health technology delivery methods should be evaluated.
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For example, series of psychological risk factors for poorer blood glucose control have been proposed. Stress levels also affect metabolic control in diabetes regardless of the degree of treatment adherence.7 Lifestyle changes and treatment adherence are needed to achieve good metabolic control in diabetes mellitus.
The diagnosis of type 1 diabetes mellitus (DM1) has a major impact on young people and their families. Psychosocial factors, patient motivation, participation and acceptance of the disease are essential to achieve good blood glucose control. Our aims were to analyse personality traits and how they are related to blood glucose control in patients with DM1.
Sixty-two patients with DM1 over 18 years of age, with at least one-year disease duration and absence of advanced chronic complications were studied. Clinical, biological and personality parameters were measured. The Millon Index of Personality Styles was administered for personality assessment.
Significant correlations between different personality variables and glycated haemoglobin (HbA1c) values were found. Individuals with poor blood glucose control had significantly higher scores on the Feeling-guided (53.6 ± 25.7 vs 36.2 ± 26.8, p = 0.021), Innovation-seeking (36.7 ± 24.1 vs 21.9 ± 21.4, p = 0.025), Dissenting (41.1 ± 24.4 vs 15.6 ± 16.6, p = 0.001), Submissive (41.5 ± 25.1 vs 28.3 ± 14.7, p = 0.038) and Dissatisfied (37.5 ± 27.5 vs 19.5 ± 20.2, p = 0.015) scales. This psychological profile is characterised by greater focus on emotions and personal values (feeling-guided), the tendency to reject conventional ideas (innovation-seeking), an aversion to complying with norms and a preference for autonomy (unconventional/dissenting), labile self-confidence (submissive/yielding) and expressed disagreement with others (dissatisfied/complaining). Factor analysis based on the main components of the variance yielded four factors. Factor characterised as related to rebelliousness or independent judgement and action was correlated with poor blood glucose control (r = 0.402, p < 0.05).
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Se estudiaron 62 pacientes adultos con DM1, con al menos un año de duración de la enfermedad y ausencia de complicaciones crónicas avanzadas. Se midieron parámetros clínicos, biológicos y de personalidad (índice Millon de estilos de personalidad [MIPS]).
Hubo correlaciones significativas entre diferentes variables de personalidad y hemoglobina glucosilada (HbA1c). Se observó peor control glucémico en pacientes con mayores puntuaciones en las escalas de perfil psicológico caracterizadas por un mayor enfoque en las emociones y los valores personales (53,6 ± 25,7 vs 36,2 ± 26,8; p = 0,021), la tendencia al rechazo de ideas convencionales (36,7 ± 24,1 vs 21.9 ± 21,4; p = 0,025), la aversión al cumplimiento de las normas y una preferencia por la autonomía (41,1 ± 24,4 vs 15,6 ± 16,6; p = 0,001), autoconfianza lábil (41,5 ± 25,1 vs 28,3 ± 14,7; p = 0,038) y desacuerdo expresado con los demás (37,5 ± 27,5 vs 19,5 ± 20,2; p = 0,015). El análisis factorial basado en los componentes principales de la varianza arrojó cuatro factores. El factor caracterizado como relacionado con la rebeldía o el juicio y la acción independiente se correlacionaron con un control glucémico deficiente (r = 0,402; p < 0,05).
El tipo de personalidad rebelde o inconformista está estrechamente asociado con un mal control glucémico en pacientes con DM1.
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: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases.

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Original articlePsychosocial Burden and Glycemic Control During the First 6 Years of Diabetes: Results From the SEARCH for Diabetes in Youth Study

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Acknowledgments

J Psychosom Res

J Pediatr

J Pediatr

J Am Acad Child Adolesc Psychiatry

J Pediatr

J Pediatr

Children with diabetes compared to peers: Depressed? Distressed? A meta-analytic review

Ann Behav Med

Major depressive disorder in youths with IDDM. A controlled prospective study of course and outcome

Diabetes Care

Depressive symptoms in children and adolescents with type 1 diabetes: Association with diabetes-specific characteristics

Diabetes Care

Depressive symptoms and glycemic control in adolescents with type 1 diabetes: Mediational role of blood glucose monitoring

Diabetes Care

Depression and diabetes treatment nonadherence: A meta-analysis

Diabetes Care

Original article
Psychosocial Burden and Glycemic Control During the First 6 Years of Diabetes: Results From the SEARCH for Diabetes in Youth Study