Poor quality of life may affect teens’ diabetes management
In the years after being diagnosed with diabetes, adolescents struggling with social and psychological burdens of managing the disease are likely to do a worse job of controlling it, according to a new U.S. study.
Teens who reported a lower quality of life were more likely to have rising levels of hemoglobin A1c, a marker of elevated blood sugar over time and a sign of poor diabetes control.
“We need to intervene from a prevention standpoint,” said Korey Hood, a psychologist at the University of California, San Francisco and lead author of the study. “We need to do systematic screening of these psychosocial issues.”
Teens who are psychologically stressed are less likely to take care of themselves, which could explain the rise in A1c levels, added Michael Scharf, a psychiatrist at the University of Rochester Medical Center who was not involved in the study.
By catching the problem early, it might be possible to keep the disease from getting worse, he told Reuters Health.
“When I see them, people are stressed out by how sick they are,” Scharf said. “The sad part is that if we could have intervened earlier we may have been able to help prevent the negative medical consequences of poorly controlled diabetes.”
The new study followed youth with either type 1 or type 2 diabetes for about six years from the time they were diagnosed. Type 1 diabetes, formerly known as juvenile diabetes, typically appears in childhood or adolescence and results from a failure to make insulin, a hormone that helps the body use blood sugar for energy.
Type 2 diabetes, more commonly seen in adults and often linked to obesity, happens when the body makes insulin but is unable to use it. Over time, too much sugar in the blood can cause damage to the eyes, kidneys and to nerves throughout the body. Too little blood sugar can lead to coma.
Altogether, about 151,000 people younger than 20 years old in the U.S. have diabetes, according to the Centers for Disease Control and Prevention. Out of the general population in 2009, 19 kids per 10,000 had type 1 diabetes and 3 per 10,000 had type 2 diabetes.
Managing the disease is similar for kids with type 1 and type 2, and particularly in type 1 it involves taking insulin daily to keep blood sugar levels steady. For kids with type 2 disease, there’s more focus on diet, exercise and medications, according to Hood and his coauthors.
Past research has shown that young people with diabetes are more prone than their peers without the disease to experience psychosocial difficulties in general and depression in particular. Hood and his colleagues wanted to find out if those problems affected the teens’ ability to manage their blood sugar.
They analyzed medical records and interviews for 1,307 kids who were over age 10 at the beginning of the study period and had been diagnosed within the previous year. The researchers then followed the childrens’ mental and physical health, looking for connections between the two.
Across the entire group, A1c levels rose by about 1.5 percent over the study period.
Among the teens who reported poor quality of life related to their disease - such as diabetes causing difficulties with their social life or school performance - A1c levels tended to run higher than in kids without quality of life issues.
A1c was also higher among kids whose quality of life worsened from the start of the study period to the end, according to the findings published in the Journal of Adolescent Health.
Teens with type 2 diabetes tended to be worse off in general, reporting more mental health issues, including depression, and a lower quality of life than the kids with type 1 disease, the researchers note.
The constant presence of health problems could isolate teens from their peers and make them feel frustrated, said Ingrid Libman, a pediatric endocrinologist at the Children’s Hospital of Pittsburgh.
However, the mental health differences could also be caused by outside stress. Adolescents with type 2 diabetes are often born into families who are poor and don’t have insurance. Either way, Hood said, teens and their relatives could benefit from counseling.
“I hope that a study like this can help raise awareness that monitoring a patient and a family’s stress level should really be part of care before it becomes a problem,” Scharf said.
Hood and his team say doctors should talk to teens about their quality of life and mental health issues at every check up.
SOURCE: Journal of Adolescent Health, online May 12, 2014
Psychosocial Burden and Glycemic Control During the First 6 Years of Diabetes: Results From the SEARCH for Diabetes in Youth Study
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.
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.
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 (A1c) 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 A1c values: longer diabetes duration, ethnic minority status, and declining diabetes QOL (p
< .05). However, youth with type 2 diabetes had higher A1c values with increasing generic QOL, an unexpected finding. Younger adolescents with type 1 diabetes had higher A1c values at the end of the study.
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.
Korey K. Hood, Ph.D.,
Daniel P. Beavers, Ph.D.,
Joyce Yi-Frazier, Ph.D.,
Ronny Bell, Ph.D.,
Dana Dabelea, M.D., Ph.D.,
Robert E. Mckeown, Ph.D.,
Jean M. Lawrence, Sc.D., M.P.H., M.S.S.A.
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