Psychological functioning of children with insulin-dependent diabetes mellitus: a longitudinal study

Depression, anxiety, eating problems, and diabulimia risk in adolescents with type 1 diabetes: a case-control study

OBJECTIVES

Type 1 diabetes (T1D) causes psychological distress, negatively impacting normal childhood activities. Depression, anxiety disorders, and eating problems are commonly observed in this population.

METHODS

The study population consisted of 40 adolescents (22 females and 18 males) who had been diagnosed with T1D and 41 healthy adolescents (21 females and 20 males). The aim of this study was to compare adolescents with T1D to healthy controls in terms of depression, anxiety, and eating problems and subsequently examine the T1D group in relation to the risk of diabetes-specific eating disorders. Eating Attitudes Test (EAT-40), Revised Children's Anxiety and Depression Scale (RCADS), and Diabetes Eating Problem Survey - Revised (DEPS-R) scales were used to compare the case and control groups.

RESULTS

The case group exhibited significantly higher scores in EAT-40 total score, RCADS parent form major depressive disorder (MDD), social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder (PD), total anxiety score, total scale scores, RCADS child form MDD, PD, and total scale scores compared to the control group. Individuals at high risk of diabetes-specific eating disorder within the case group demonstrated significantly higher RCADS (child and parent form) MDD scores and RCADS parent form separation anxiety (SA) and total scale scores. Binary logistic regression analysis revealed that the RCADS parent form total scale score could predict DEPS-R.

CONCLUSIONS

Routine screening of children and adolescents diagnosed with T1D for depression, anxiety, and eating disorder risk may facilitate early detection of possible psychopathologies, allowing for early intervention to address factors that may disrupt treatment adherence. Further longitudinal studies with larger samples are needed to investigate psychopathologies, particularly eating disorders, in children and adolescents with T1D.

Prevalence of Depression in Patients with Type 1 Diabetes between 10 and 17 Years of Age in Jordan

METHODS

The study was conducted by distributing the Center for Epidemiological Studies Depression Scale for Children (CES-DC) to adolescents with T1D seen at Jordan University Hospital between February 2019 and February 2020. Demographic, clinical, and socioeconomic data were collected using electronic clinical charts. Possible predictors of depression were assessed using logistic regression analysis.

RESULTS

A total of 108 children were enrolled in the study with mean age of 13.7 ± 2.3 years. Fifty-eight children (53.7%) had a CES depression score less than 15, and 50 children (46.3%) had a depression score of 15 or more. The number of diabetes-related hospital admissions and the frequency of self-monitoring of blood glucose (SMBG) were significantly different between the two groups. In the multivariable analysis, both gender and SMBG frequency were statistically significant. Girls were more likely to have a depression score ≥ 15 (OR = 3.41, p = 0.025) than boys. Patients who were rarely testing blood glucose levels were more likely to have a depression score ≥ 15 compared to those who were testing regularly (OR = 36.57, p = 0.002).

CONCLUSION

The prevalence of depressive symptoms is relatively high in adolescents with T1D, especially in those living in developing countries. Longer diabetes duration, higher glycated hemoglobin level, and less frequent blood glucose monitoring are associated with higher depression scores.

50 Years of Behavioral Science in Diabetes: A 2020 Vision of the Future

This article is adapted from a speech Dr. de Groot delivered in June 2020 as President, Health Care & Education, of the American Diabetes Association at the Association's 80th Scientific Sessions, which was held online as a result of coronavirus disease 2019. Dr. de Groot is an Associate Professor of Medicine in the Division of Endocrinology, Diabetes and Metabolism at Indiana University (IU) School of Medicine. She serves as the Acting Director of the IU Diabetes Translational Research Center. Dr. de Groot is the 2020 recipient of the Rachmiel Levine Medal for Leadership from the American Diabetes Association.In the year 2020, we marked the 50th anniversary of the field of behavioral science in diabetes in the modern era. Over this relatively short period of time, this field has charted the psychosocial landscape of prediabetes and diabetes by establishing the prevalence and impact of emotional and behavioral aspects of diabetes. Interventions to address these conditions have been developed that span the T2 to T4 translational research spectrum ranging from the intrapsychic to population-based interventions. Policies ranging from standards of care to Medicare benefits have been implemented. A review of research in the area of diabetes and depression is provided as an example of innovations in this field. Behavior is the foundation of all interventions we make in diabetes and prediabetes. As a mature science, it is critical to stemming the tide of diabetes and its outcomes. To make additional strides, we must rebalance our focus and augment funding for behavioral interventions for individuals, communities, and health care systems in conjunction with other forms of treatment.

50 Years of Behavioral Science in Diabetes: A 2020 Vision of the Future

Editor's Note: This article is adapted from a speech Dr. de Groot delivered in June 2020 as President, Health Care & Education, of the American Diabetes Association. She delivered her address at the Association's 80th Scientific Sessions, which was held online as a result of the coronavirus disease 2019.

The psychosocial experience and needs of children newly diagnosed with type 1 diabetes from their own perspective: a systematic and narrative review

AIM

To understand the psychosocial experience of children and identify their primary support needs following a type 1 diabetes diagnosis.

METHODS

A systematic review and narrative synthesis of the literature in this area was conducted.

RESULTS

A total of 32 studies were included in the review. At diagnosis, the majority of children experienced high distress, including grief, anxiety, anger, irritation and injection anxiety. The intensity of this reaction decreased rapidly over the following weeks. At diagnosis, rates of depressive symptoms, anxiety, stress disorders and suicidal ideation were elevated. The initial reaction tended to peak shortly after diagnosis and declined over the following year. Thereafter, symptoms of depression and anxiety appeared to increase once again, corresponding with the children's experience of diabetes management and implications as being more difficult and upsetting. Injection anxiety, distress and depressive symptoms persisted for a smaller group of children.

CONCLUSION

The initial high prevalence of depressive symptoms following diagnosis is transitional and should be regarded as a normal adaptive response. To facilitate this adaptive process, specific child-centred support should be prioritized as an integrated part of early diabetes care. Our findings point to five inter-related support needs following a type 1 diabetes diagnosis: (1) children need time to adjust to the diagnosis; (2) children need supportive relationships; (3) children need an opportunity for meaningful participation and appropriate protection; (4) children need to engage and explore; and (5) children need to feel supported, but not different.

Systematic Review: Anxiety in Children and Adolescents With Chronic Medical Conditions

OBJECTIVE

Youth with chronic medical conditions (CMCs) have been reported to be at increased risk for developing anxiety disorders. Importantly, suffering from anxiety may also have an impact on their disease-related outcomes. This study set out to systematically review the literature on anxiety and seven CMCs (asthma, congenital heart disease, diabetes, epilepsy, inflammatory bowel disease, juvenile idiopathic arthritis, and sickle cell disease) among youth.

METHOD

A systematic review was performed according to the PRISMA statement. Searches were conducted across PubMed, PsycNET, Embase, and reference lists of the included studies (1990-2018). Three independent reviewers screened titles and abstracts and conducted full-text assessment. Studies were included if they reported the prevalence of anxiety or the association of anxiety on disease-related outcomes in children and/or adolescents with the focal CMCs.

RESULTS

A total of 53 studies met the predetermined inclusion criteria. Across the CMCs, the prevalence of anxiety disorder was increased in youths with CMCs compared to the general population. Evidence for a relationship between anxiety and adverse disease-related outcomes was limited. For asthma, inflammatory bowel disease, and sickle cell disease, there was some evidence indicating that anxiety was associated with adverse outcomes; supported by two longitudinal studies, one in asthma and one in inflammatory bowel disease. For diabetes, results were inconsistent; with some studies indicating that anxiety was associated with worse and others with better treatment adherence.

CONCLUSION

The prevalence of anxiety disorders in youth with CMCs is higher than that in the general population. Anxiety may also be associated with adverse disease-related outcomes for youths, but it is not possible to draw definitive conclusions. Longitudinal studies making use of parent/youth composite anxiety measures and a combination of parent/youth reported and objective measures of disease-related outcomes are needed. Given the burden of disease of anxiety disorders, regardless of the impact on the disease outcomes, screening for and treatment of anxiety is recommended in youths with CMCs.

Social anxiety in insulin-dependent diabetic girls

The purpose of this study was to investigate the relationship of social anxiety and insulin-dependent diabetes mellitus (n = 40 girls between 13 and 19 years of age). Mean duration of diabetes was 7 years. We supposed that this chronic illness may provoke feelings of friendlessness and sadness, social withdrawal and fear of social situations because diabetes entails a series of demands which differentiate the diabetic child from healthy children. Our population was compared with 35 healthy young girls. All were administered the Schedule for Affective Disorders and Schizophrenia for School-Age-Children and completed the State Trait Anxiety Inventory for Children, the Self-Consciousness Scale and the Imaginary Audience Scale. Diagnoses of anxiety disorders across DSM-IIIR do not show significant differences between groups. In self-report inventories, our findings do not support the hypothesis that social anxiety is a pathological symptom in diabetic subjects. However, they were more depressed than the control group. Furthermore, social functioning of the diabetic group did not differ from that of the control group. They were more concerned with their illness than with social anxiety.

Family Support and Its Association with Glycemic Control in Adolescents with Type 1 Diabetes Mellitus in Riyadh, Saudi Arabia

The prevalence of type 1 diabetes mellitus (T1DM) among children in Saudi Arabia is increasing with unfavorable outcomes. Therefore, in addition to pharmacotherapy, other measures should be studied regarding psychological aspects mainly among adolescents. The family, which acts as the primary caregiver at this age, may play a major role in disease management. Thus, this study is aimed at assessing the perception of adolescents about the behaviors of their families initially and at investigating the correlation between these behaviors and glycemic control. Up to our knowledge, there was no study in Saudi Arabia that addressed this issue previously. This cross-sectional observational study assessed adolescents aged 10-19 years diagnosed with T1DM on insulin and receiving follow-up care at the King Saud University Medical City in Riyadh, Saudi Arabia. Data were collected via telephone interview and the verified "Modified Diabetes Social Support Questionnaire-Family version". Glycemic control was then assessed using the most recent hemoglobin A1c (HbA1c) level recorded in their electronic files. Fifty-six adolescents participated in this study with an equal sex distribution (each n = 28). Almost all participants were Saudis, and the majority were living in Riyadh (n = 41). The mean age was 16.1 ± 2.41 years with a mean of 6.1 ± 4.14 years history of diabetes. The mean HbA1c level was 9.6 ± 2.12%. Participants perceived all behaviors as supportive with "support in critical situations" being the highest (77.3%) and the only factor significantly related to HbA1c (p = 0.017). Age was significantly related to all factors (p > 0.05). Family plays a major role in the management of diabetes. Their supportive behaviors are perceived by their family members diagnosed with T1DM, but there has been no optimal association with disease control. However, the involvement of the family can aid in decreasing possible complications of the disease by intervening in critical situations.

Effectiveness of home or hospital initiation of treatment at diagnosis for children with type 1 diabetes (DECIDE trial): a multicentre individually randomised controlled trial

OBJECTIVE

To determine whether, in children with newly diagnosed type 1 diabetes who were not acutely unwell, management at home for initiation of insulin treatment and education of the child and family, would result in improved clinical and psychological outcomes at 2 years postdiagnosis.

DESIGN

A multicentre randomised controlled trial (January 2008/October 2013).

SETTING

Eight paediatric diabetes centres in England, Wales and Northern Ireland.

PARTICIPANTS

203 clinically well children aged under 17 years, with newly diagnosed type 1 diabetes and their carers.

INTERVENTION

Management of the initiation period from diagnosis at home, for a minimum of 3 days, to include at least six supervised injections and delivery of pragmatic educational care.

MAIN OUTCOME MEASURES

Primary outcome was glycosylated haemoglobin (HbA1c) concentration at 24 months postdiagnosis. Secondary outcomes included coping, anxiety, quality of life and use of NHS resources.

RESULTS

203 children, newly diagnosed, were randomised to commence management at home (n=101) or in hospital (n=102). At the 24 month primary end point, there was one withdrawal and a follow-up rate of 194/202 (96%). Mean HbA1c in the home treatment arm was 72.1 mmol/mol and in the hospital treated arm 72.6 mmol/mol. There was a negligible difference between the mean HbA1c levels in the two arms adjusted for baseline (1.01, 95% CI 0.93 to 1.09). There were mostly no differences in secondary outcomes at 24 months, apart from better child self-esteem in the home-arm. No home-arm children were admitted to hospital during initiation and there were no adverse events at that time. The number of investigations was higher in hospital patients during the follow-up period. There were no differences in insulin regimens between the two arms.

CONCLUSIONS

There is no evidence of a difference between home-based and hospital-based initiation of care in children newly diagnosed with type 1 diabetes across relevant outcomes.

TRIAL REGISTRATION NUMBER

ISRCTN78114042.

Chronic Anterior Uveitis in Children: Psychosocial Challenges for Patients and Their Families

PURPOSE

To describe issues of concern to children with chronic anterior uveitis; to consider the psychological impact of chronic anterior uveitis on children's lives; and to understand the effect of a child's chronic illness on other family members.

DESIGN

Expert commentary.

METHODS

Author experiences were supplemented by a review of pertinent medical literature and by consideration of content from semi-structured, separate patient and parent interviews.

RESULTS

Vision loss and the fear of blindness are not the only stressors for children with chronic anterior uveitis and their families; of additional concern are the burdens of examinations and treatment regimens, as well as drug toxicities. Children with chronic anterior uveitis experience medical, academic, interpersonal, psychological, and developmental challenges. The impact of disease extends to other members of a patient's family as well; parents experience challenges in similar domains. Problems with adherence to medical regimens are common. Both the disease and its treatment affect quality of life, and can interfere with successful management of disease and transition to autonomy in adulthood, as reported for other chronic conditions. Coping processes vary greatly between different families.

CONCLUSIONS

Eye examinations and the rigors of long-term treatment often influence the psychosocial health of patients and families; physicians who are aware of these issues can help patients and families cope with chronic illness and may improve outcomes. Further psychosocial research to understand the experiences of children dealing with chronic anterior uveitis is warranted; this commentary can serve as a foundation for development of age- and disease-specific research questions.

Depressive Symptoms at Critical Times in Youth With Type 1 Diabetes: Following Type 1 Diabetes Diagnosis and Insulin Pump Initiation

PURPOSE

Depressive symptoms occur at various times during the life cycle in persons with type 1 diabetes. We investigated depressive symptoms prospectively in youth with new-onset type 1 diabetes and in those beginning pump therapy.

METHODS

Youth with type 1 diabetes (N = 96), ages 10-17 years, completed the Children's Depression Inventory (CDI) at baseline and at 1, 6, and 12 months after diabetes onset or pump start; scores ≥13 indicated clinical elevation. The change in depressive symptoms and the association between CDI score and hemoglobin A1c (HbA1c) level were assessed over 1 year.

RESULTS

The new-onset group (n = 54) had an HbA1c level of 11.4% ± 2.5%. The pump group (n = 42) had a diabetes duration of 4.1 ± 3.4 years and an HbA1c level of 8.3% ± 1.3%. The baseline median CDI was 5.0 in both groups and remained low over time (ranging from 2.0 to 3.5). Most youth (new onset 72%, pump 81%) scored <13 at all times. Those with a CDI score of ≥13 in month 1 had 9-fold (95% confidence interval: 3-28) and 11-fold (95% confidence interval: 3-38) higher risks of CDI score of ≥13 at 6 and 12 months, respectively, than those with a CDI score of <13. New-onset youth with a CDI score of ≥13 in month 1 had a higher HbA1c level at 6 months (8.3% ± 1.7%) than new-onset youth with a CDI score of <13 (7.2% ± 1.6%, p = .04).

CONCLUSIONS

CDI scores over 1 year were similar in the new-onset and pump groups. Youth with elevated CDI in the first month after diagnosis or pump start were significantly more likely to have a CDI score of ≥13 at 6 or 12 months, supporting recommendations to screen for depressive symptoms because of persistence over time. Those with new-onset diabetes and depressive symptoms in the first month had higher HbA1c at 6 months; confirmatory research is needed.

Common Issues Seen in Paediatric Diabetes Clinics, Psychological Formulations, and Related Approaches to Management

Diabetes is a chronic disease and its management is associated with multiple challenges. This is particularly the case in children and adolescents. Factors that contribute to difficulties in managing diabetes in youth include psychological characteristics, family dynamics, and social behavior. The purpose of this article is to highlight some psychological issues in children and adolescents with diabetes. We aim to present selected case scenarios encountered by health professionals and to provide tips on strategies for managing psychological aspect of diabetes. We tackle the psychological issues related to diabetes under four main categories: maladaptive disorders, eating disorders, family psychopathology, and family dysfunction. Psychotherapy and psychoanalysis are useful modalities in diabetes management. The psychological intervention is aimed at supporting patients and families to reach a balance between a normal family routine and a good glycemic control. We demonstrate unique requirements in coordinating care for children and adolescents with diabetes and highlight the importance of encouraging a positive behavior. Managing diabetes in children and adolescents needs to be in the form of a collaborative work between health care professionals, children and adolescents, and their families. Caring, supportive family backed up by experienced multidisciplinary team is the best approach to prevent psychological difficulties.

Anxiety in Youth With Type 1 Diabetes

PROBLEM

Mental health conditions are prevalent in youth with type 1 diabetes (T1D). Anxiety symptoms and depressive symptoms are highly correlated and are two of the most prevalent mental health conditions in youth in the general population. The detrimental effect of depressive symptoms in youth with T1D has been well documented, but the effects of anxiety symptoms are not well understood.

ELIGIBILITY CRITERIA

Studies were included if they were published between 1990 and 2015, and evaluated anxiety symptoms in a population of youth with T1D.

SAMPLE

A total of 20 studies were identified from a sample of 338 papers.

RESULTS

Anxiety symptoms were prevalent in youth with T1D. Anxiety symptoms were associated with higher glycosylated hemoglobin (HbA1c) levels, poorer self-management and coping behaviors, depressive symptoms, fear of hypoglycemia, and lower blood glucose monitoring frequency. State anxiety and trait anxiety symptoms affected health outcomes differently. Girls were at a higher risk of anxiety symptoms than boys.

CONCLUSIONS

Anxiety symptoms in youth with T1D have detrimental effects on health outcomes, including self-management, quality of life, and HbA1c.

IMPLICATIONS

Future research should aim to improve our current screening and treatment practices.

Efficacy and implementation of an Internet psychoeducational program for teens with type 1 diabetes

OBJECTIVE

The purpose of the study was to evaluate the participation and preliminary efficacy of an Internet psychoeducational program (Teens.Connect) shown to be efficacious under controlled conditions compared with an open-access diabetes website for youth (Planet D) on the primary outcomes of A1C and quality of life (QoL), and secondary outcomes of psychosocial and behavioral factors.

RESEARCH DESIGN AND METHODS

Teens with type 1 diabetes (n = 124, 11-14 yr) from two clinical sites were randomly prescribed one of the programs and completed baseline, 3-month and 6-month data. A1C was obtained from clinic records. Participation data included number of log ins, posts to the discussion board, and lessons completed (Teens.Connect only). Descriptive and mixed model analyses were used.

RESULTS

Eighty-five percent (85%) of consented teens registered for their prescribed program. Satisfaction and log ins were similar between groups (satisfaction ranged 3.3-3.5/5; mean log ins = 14/teen). Posts to the discussion forum were higher in Planet D (mean = 28 vs. 19). Participation in the Teens.Connect lessons was low, with only 69% of teens completing any lesson. After 6 months there were no significant differences in A1C, QoL or secondary outcomes between groups. Teens in the Teens.Connect group reported lower perceived stress over time (p < 0.01).

CONCLUSIONS

Teens do not actively participate in an Internet psychoeducational program when they do not have frequent reminders, which may have contributed to a lack of treatment effect. Teens have many competing demands. Strategic implementation that includes targeted reminders and family support may be necessary to assure participation and improvement in health outcomes.

Risks of psychiatric disorders and suicide attempts in children and adolescents with type 1 diabetes: a population-based cohort study

OBJECTIVE

To assess the risk of psychiatric disorders and suicide attempts in children with type 1 diabetes and their healthy siblings.

RESEARCH DESIGN AND METHODS

We performed a population-based case-cohort study of individuals born in Sweden between 1973 and 2009. Children with type 1 diabetes (n = 17,122) and their healthy siblings (n = 18,847) were identified and followed until their 18th birthday. Their risk of psychiatric disorders was compared with that of matched control subjects.

RESULTS

The risk of psychiatric morbidity in children with type 1 diabetes compared with the general population was tripled within 6 months after the onset of diabetes (hazard ratio [HR] 3.0 [95% CI 2.7-3.4]) and doubled within the total observation period (HR 2.1 [95% CI 2.0-2.2]). An increased risk was noted in suicide attempts (HR 1.7 [95% CI 1.4-2.0]) and in most categories of psychiatric disorders. The risk of psychiatric disorders in probands declined from HR 2.7 (95% CI 2.2-3.3) for those in the cohort born 1973-1986 to 1.9 (95% CI 1.8-2.0) in those born 1997-2009. The risk for any psychiatric disorders among siblings of patients with type 1 diabetes was estimated to be HR 1.1 (95% CI 1.0-1.1), and there was no increased risk in any of the specific category of disorders.

CONCLUSIONS

Children with type 1 diabetes are at high risk of psychiatric disorders, which seems to be a consequence of the disease rather than due to a common familial etiology. The results support recommendations on comprehensive mental health surveillance in children with type 1 diabetes, especially in recently diagnosed children.

Glycaemic control, treatment satisfaction and quality of life in type 2 diabetes patients in Greece: The PANORAMA study Greek results

AIM

To provide an update on glycaemic control in European patients with type 2 diabetes mellitus (T2DM). We present the Greek population data of the study.

METHODS

An observational multicenter, cross-sectional study evaluating glycaemic control and a range of other clinical and biological measures as well as quality of life (QoL) and treatment satisfaction in 375 patients with T2DM enrolled by 25 primary care sites from Greece.

RESULTS

The mean age of the patients was 63.5 years and the male/female ratio 48.9%/51.1%. 79.7% of the patients exerted none or light physical activity, 82.4% were overweight or obese and 32.9% did not meet HbA1c target of less than 7.0% (53 mmol/mol). Patients reported high satisfaction to continue with treatment, high satisfaction with administered treatment and increased willingness to recommend treatment to others (mean Diabetes Treatment Satisfaction Questionnaire score 29.1 ± 5.6). However, 80% of the patients reported that their QoL would be better without diabetes. Finally, the most challenging parameter reported was the lack of freedom to eat and drink.

CONCLUSION

This analysis of the Greek Panorama study results showed that a considerable percentage of T2DM patients in Greece do not achieve glycaemic target levels, despite the favourably reported patient satisfaction from administered therapy. Additionally, the majority of primary care T2DM patients in Greece depict the negative effect of the disease in their QoL.

Eating problems in adolescents with Type 1 diabetes: a systematic review with meta-analysis

AIMS

We report a systematic review to determine (1) prevalence of eating problems compared with peers and (2) the association between eating problems and glycaemic control in young adults with Type 1 diabetes.

METHOD

  We conducted a systematic literature search via electronic databases and meta-analysis. Cohen's d (the mean difference score between Type 1 diabetes and comparison groups) was calculated for 13 studies that met inclusion criteria.

RESULTS

  Eating problems [both disordered eating behaviour (39.3 and 32.5%; d = 0.52, 95% CI 0.10-0.94) and eating disorders (7.0 and 2.8%; d = 0.46, 95% CI 0.10-0.81)] were more common in adolescents with Type 1 diabetes compared with peers and both were associated with poorer glycaemic control (d = 0.40, 95% CI 0.17-0.64). In restricted analyses involving measures adapted for diabetes, associations between eating problems and poorer glycaemic control remained (d = 0.54, 95% CI 0.32-0.76). Disordered eating behaviour (51.8 and 48.1%; d = 0.06, 95% CI -0.05 to 0.21) and eating disorders (6.4 and 3.0%; d = 0.43, 95% CI -0.06 to 0.91) were more common in adolescents with Type 1 diabetes compared with peers, but differences were non-significant.

CONCLUSIONS

  Eating problems are common among this age group. Future work in populations with Type 1 diabetes should develop sensitive measures of eating problems and interventions, and establish predictors of eating problems. Screening in clinics is recommended.

Longitudinal invariance of measurement and structure of global self-concept: a population-based study examining trajectories among adolescents with and without chronic illness

OBJECTIVE

The objectives of this study were to determine whether a measure of global self-concept demonstrated longitudinal measurement invariance between adolescents aged 10-19 years with and without chronic illness and to document differences in their global self-concept trajectories over time.

METHODS

Data were obtained from the National Longitudinal Survey of Children and Youth (N = 10,064). Global self-concept was measured using a scale based on the Self-Determination Questionnaire.

RESULTS

16 percent of adolescents had chronic illness. There was evidence of partial longitudinal invariance in global self-concept between adolescents with and without chronic illness. Controlling for sociodemographic characteristics, adolescents with a chronic illness exhibited lower levels of global self-concept and more precipitous declines over time.

CONCLUSIONS

The results from this study suggest that comparisons of global self-concept between adolescents with and without chronic illness are meaningful and, compared to healthy controls, adolescents with chronic illness are at risk for low global self-concept.

The reliability of the Health Related Quality Of Life questionnaire PedsQL 3.0 Diabetes Module™ for Swedish children with type 1 diabetes

AIM

The overall aim of the study was to assess reliability and accomplish a limited validation of the Pediatric Quality of Life Inventory 3.0 Diabetes Module Scales (PedsQL 3.0), Swedish version in a sample of Swedish children diagnosed with Type 1 diabetes (T1DM). A secondary aim was to assess whether the children's Health Related Quality of Life (HRQOL) was associated with children's gender and age and whether the child self- and parent proxy reports were consistent.

METHODS

One hundred and thirty families from four diabetes centres participated in this study. The Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL 4.0) and the PedsQL 3.0 were administered to 108 children (aged 5-18 years) with T1DM and 130 parents (of children with T1DM aged 2-18 years).

RESULTS

The internal consistency of the PedsQL 3.0, Swedish version, reached or exceeded Cronbach's alpha values of 0.70 for both child self- and proxy reports- and parent proxy-reports. The PedsQL 4.0 and PedsQL 3.0 were highly correlated (r = 0.76), indicating convergent validity. The parents reported lower diabetes-specific HRQOL than the children themselves (p < 0.01). The girls in the study reported lower psychological functioning and treatment adherence compared with the boys (p < 0.05). The oldest children (between 13 and 18 years of age) reported significantly lower diabetes-specific HRQOL, as compared with younger children (p < 0.05).

CONCLUSIONS

PedsQL 3.0 Diabetes Module can be used as a valuable tool for measuring diabetes-specific HRQOL in child populations, both in research and in clinical practice.

Working with young adults with Type 1 diabetes: views of a multidisciplinary care team and implications for service delivery

AIMS

Young adults with Type 1 diabetes experience difficulties achieving glucose targets. Clinic attendance can be poor, although health and self-care tend to be better among those who attend regularly. Our aims were to describe staff views about challenges working with this age-group (16-21 years).

METHODS

Semistructured interviews were conducted with 14 staff from Sheffield Teaching Hospitals diabetes care team. Interviews were audio-recorded, transcribed and analysed using thematic analysis.

RESULTS

Three main themes emerged. Unique challenges working with young adults included staff emotional burden, the low priority given to self-care by young adults and the complexity of the diabetes regimen. Working in a multidisciplinary team was complicated by differences in consultation styles, poor team cohesion and communication. An ideal service should include psychological support for the professional team, identification of key workers, and development of individualized care plans.

CONCLUSIONS

Staff differed in their views about how to achieve optimal management for young adults, but emphasized the need for greater patient-centred care and a range of interventions appropriate for individual levels of need. They also wanted to increase their own skills and confidence working with this age-group. While these results reflect the views of staff working in only one diabetes centre, they are likely to reflect the views of professionals delivering care to individuals of this age; replication is needed to determine their generalizability.

A comparison of two internet programs for adolescents with type 1 diabetes: design and methods

Implementing psycho-educational programs for youth with type 1 diabetes in clinical care and reaching diverse youth with type 1 diabetes is challenging due to youth, provider, and organizational barriers. This study was designed to compare the effectiveness of an internet coping skills training program with a control condition of internet diabetes education. Each program consists of 5 weekly interactive lessons; the coping skills training program also provides the ability for youth to interact with each other as well as a health coach. Approximately 300 youths with type 1 diabetes will be recruited to participate in this multi-site clinical trial. The primary outcomes are metabolic control, quality of life, and family conflict. Secondary outcomes include stress, coping, self-efficacy, and social competence. Usage, satisfaction, and cost will also be evaluated. In addition, mediators and moderators to intervention effects will be explored. An internet based psycho-educational program for youth with type 1 diabetes may be a promising approach that can be easily be integrated into clinical care.

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

BACKGROUND

It is not clear from the literature whether children with diabetes have more psychological difficulties than their peers.

PURPOSE

This study aims to use meta-analysis to determine if children with diabetes differ from children without a chronic illness in a variety of domains reflecting psychological well-being.

METHOD

A meta-analysis was undertaken of 22 studies that compared children with diabetes to a comparison group. Outcomes included depression, anxiety, behavioral problems, and related constructs.

RESULTS

Children with diabetes were more likely than comparison groups to experience a variety of psychological difficulties. However, these effects were small to medium in magnitude and were typically smaller among more recent studies and studies with well-matched comparison groups.

CONCLUSIONS

This meta-analysis suggests that children with diabetes are at slightly elevated risk for psychological difficulties. Future work will need to help identify children at the highest risk, and to identify factors associated with resilience.

Effect of intensive glycemic lowering on health-related quality of life in type 2 diabetes: ACCORD trial

OBJECTIVE

To compare the effect of intensive versus standard glycemic control strategies on health-related quality of life (HRQL) in a substudy of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.

RESEARCH DESIGN AND METHODS

A randomly selected subsample of 2,053 ACCORD participants enrolled in the HRQL substudy was assessed at baseline and 12-, 36-, and 48-month visits. HRQL assessment included general health status (the 36-Item Short Form Health Survey [SF-36]), diabetes symptoms (the Diabetes Symptom Distress Checklist), depression (Patient Health Questionnaire [PHQ]-9), and treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire [DTSQ]). Repeated-measures ANOVA models were used to estimate change in HRQL outcomes by treatment group over 48 months adjusting for model covariates. The effects of early discontinuation of the ACCORD intensive glycemic control arm on study results were explored.

RESULTS

A total of 1,956 (95%) completed the self-report HRQL instrument(s) at baseline. The intensive arm had a larger decrease in SF-36 physical health component score than the standard arm (-1.6 vs. -1.1, P = 0.0345). Treatment satisfaction (DTSQ) showed larger improvement with intensive than standard (P = 0.0004). There were no differences in mean scores of the Diabetes Symptom Checklist and PHQ-9. Effects of participant transition following discontinuation of the intensive arm on HRQL were not significant.

CONCLUSIONS

The ACCORD trial strategy of intensive glycemic control did not lead to benefits in HRQL and was associated with modest improvement in diabetes treatment satisfaction. Thus patient acceptability was apparently not compromised with intensive and complex interventions such as those used in ACCORD.

Factors influencing the quality of life of young patients with diabetes

BACKGROUND

Diabetes is a significant challenge for pediatric health care professionals because it affects youths' psychoemotional functioning and, consequently, the quality of life (QOL). The aim of the present study was to evaluate the QOL in young patients with diabetes, as well as the factors affecting it.

METHODS

The study was conducted from April to September 2008 in 98 young patients, 11-18 years of age, who were under the supervision of Diabetological Center, General Pediatric Hospital (Athens, Greece). The Diabetes Quality of Life for Youths Questionnaire was used to evaluate the QOL of youths with diabetes.

RESULTS

The mean QOL score was 97.5. There was a negative correlation between the QOL and age (P = 0.02), the duration of diabetes (P = 0.05), body mass index (BMI; P = 0.04), and comorbidities (P = 0.03). In contrast, there was a positive correlation between QOL and increased metabolic control (P = 0.03), participating in sports activities (P = 0.007), and a greater number of insulin infusions (P = 0.04).

CONCLUSIONS

The QOL of young diabetics was influenced by demographic, somatometric, and other characteristics of diabetes. Increased metabolic control, participating in sports activities, and a greater number of insulin infusions resulted in better QOL. Increased patient age, duration of diabetes, HbA1c values, BMI, and the coexistence of various health problems, as well as the use of an insulin pump, decreased QOL.

Glycemic control, coping, and internalizing and externalizing symptoms in adolescents with type 1 diabetes: a cross-lagged longitudinal approach

OBJECTIVE

This study examines how active coping and withdrawal, psychological (internalizing and externalizing) symptoms, and glycemic control (A1C values) influence each other across time in adolescents with type 1 diabetes.

RESEARCH DESIGN AND METHODS

One hundred and nine adolescents participated in a four-wave longitudinal study spanning four years (mean age at Time 1 was 13.77). Patients were visited at home and completed questionnaires measuring coping and psychological symptoms. The treating physicians were contacted to obtain A1C values. Cross-lagged path analysis from a structural equation modeling approach was used for data analysis.

RESULTS

Clinically meaningful pathways between coping and glycemic control were found across time. Active coping prospectively predicted lower A1C levels, which, in turn, predicted active coping. Higher A1C levels and higher psychological symptoms consistently predicted avoidance coping across time. Finally, psychological symptomatology constituted an important link in the observed longitudinal chain of effects. More specifically, higher A1C values and symptomatology at Time 1 positively predicted withdrawal at Time 2, which, in turn, positively predicted symptomatology at Time 3. Next, symptomatology at Time 3 positively predicted higher A1C values at Time 4, thus coming full circle.

CONCLUSIONS

Coping with everyday stress, psychological symptoms, and glycemic control were interrelated across time. Evidence was obtained for reciprocal pathways and mutually reinforcing mechanisms, indicating the need to monitor coping strategies and psychological symptoms along with glycemic control in optimizing clinical care in adolescents with type 1 diabetes.

Effects of coping skills training in school-age children with type 1 diabetes

Children with type 1 diabetes are at risk for negative psychosocial and physiological outcomes, particularly as they enter adolescence. The purpose of this randomized trial (n = 82) was to determine the effects, mediators, and moderators of a coping skills training intervention (n = 53) for school-aged children compared to general diabetes education (n = 29). Both groups improved over time, reporting lower impact of diabetes, better coping with diabetes, better diabetes self-efficacy, fewer depressive symptoms, and less parental control. Treatment modality (pump vs. injections) moderated intervention efficacy on select outcomes. Findings suggest that group-based interventions may be beneficial for this age group.

A multifaceted school-based intervention to reduce risk for type 2 diabetes in at-risk youth

OBJECTIVE

To evaluate the impact of a multifaceted, school-based intervention on inner city youth at high risk for type 2 diabetes mellitus (T2DM) and to determine whether the addition of coping skills training (CST) and health coaching improves outcomes.

METHOD

198 students in New Haven, CT at risk for T2DM (BMI>85th percentile and family history of diabetes) were randomized by school to an educational intervention with or without the addition of CST and health coaching. Students were enrolled from 2004 to 2007 and followed for 12 months.

RESULTS

Students in both groups showed some improvement in anthropometric measures, lipids, and depressive symptoms over 12 months. BMI was not improved by the intervention. Students who received CST showed greater improvement on some indicators of metabolic risk than students who received education only.

CONCLUSION

A multifaceted, school-based intervention may hold promise for reducing metabolic risk in urban, minority youth.

Parent-adolescent discrepancies in adolescents' competence and the balance of adolescent autonomy and adolescent and parent well-being in the context of Type 1 diabetes

This study examined whether intrafamily discrepancies in perceptions of the adolescent's competence and independence were associated with autonomy and well-being for adolescents and parents. The ways in which mothers and fathers consistently differed from their adolescent across measures of independence and competence regarding Type 1 diabetes, a stressful context for families, were examined with the latent discrepancy model. A sample of 185 adolescents (mean age = 12.5 years, SD = 1.3), their mothers, and participating fathers completed measures of the adolescent's independence in completing diabetes tasks, problems with diabetes management, adherence to the medical regimen, measures of well-being, and metabolic control. The latent discrepancy model was conducted via structural equation modeling that generated latent discrepancies from the adolescent for mothers and fathers. Both mothers and fathers viewed the adolescent's competence more negatively than did the adolescent. These discrepancies related to more parental encouragement of independence and adolescent autonomy but also to poorer metabolic control and poorer parental psychosocial well-being. The results are interpreted within a developmental perspective that views discrepancies as reflecting normative developmental processes of autonomy but as being associated with disruptions in well-being in the short term.

Correlates of depressive symptoms in urban youth at risk for type 2 diabetes mellitus

BACKGROUND

Rates of overweight in youth have increased at an alarming rate, particularly in minority youth, and depressive symptoms may affect the ability of youth to engage in healthy lifestyle behaviors to manage weight and reduce their risk for health problems. The purpose of this study was to examine the relationships between depressive symptoms, clinical risk factors, and health behaviors and attitudes in a sample of urban youth at risk for type 2 diabetes mellitus (T2DM).

METHODS

We obtained self-report questionnaire data on depressive symptoms and health attitudes and behaviors related to diet and exercise and clinical data on risk markers (eg, fasting insulin) from 198 youth from an urban setting. Seventh-grade students were eligible if they were at risk for developing T2DM because they had a body mass index (BMI) in the 85th percentile or higher and a family history of diabetes.

RESULTS

Clinically significant levels of depressive symptoms were evident in approximately 21% of the sample, and Hispanic youth reported higher levels of depressive symptoms than black youth. Higher levels of depression were associated with several health behaviors and attitudes, in particular less perceived support for physical activity and poorer self-efficacy for diet. Depressive symptoms were also related to some clinical risk markers, such as higher BMI and fasting insulin levels.

CONCLUSIONS

Because depressive symptoms may affect ability to engage in healthy behavior changes, evaluation and treatment of depressive symptoms should be considered in preventive interventions for youth at risk for T2DM.

Perceived diabetes task competence mediates the relationship of both negative and positive affect with blood glucose in adolescents with type 1 diabetes

BACKGROUND

Adolescents dealing with type 1 diabetes experience disruptions in affect and diabetes management that may influence their blood glucose.

PURPOSE

A daily diary format examined whether daily fluctuations in both negative and positive affect were associated with adolescents' perceived diabetes task competence (DTC) and blood glucose, and whether perceived DTC mediated the relationship between daily affect and blood glucose.

METHODS

Sixty-two adolescents with type 1 diabetes completed a 2-week daily diary, which included daily measures of affect and perceived DTC, then recorded their blood glucose readings at the end of the day. We utilized hierarchical linear modeling to examine whether daily perceived DTC mediated the relationship between daily emotion and blood glucose.

RESULTS

Daily perceived DTC mediated the relationship of both negative and positive affect with daily blood glucose.

CONCLUSIONS

This study suggests that within the ongoing process of self-regulation, daily affect may be associated with blood glucose by influencing adolescents' perception of competence on daily diabetes tasks.

Assessment of an illness-specific dimension of self-esteem in youths with type 1 diabetes

OBJECTIVE

The initial validation of a brief assessment of a diabetes-specific self-esteem dimension in adolescents with type 1 diabetes.

METHODS

Youths with type 1 diabetes (n = 87) aged 10-16 years were administered the multidimensional Self-Esteem Questionnaire (SEQ) and a newly designed assessment of diabetes-specific self-esteem (DSSE). Their parents completed parallel forms. Adherence to the diabetes regimen and glycemic control were also assessed.

RESULTS

In factor analysis, DSSE items formed a distinct dimension of self-esteem in addition to the SEQ dimensions. This factor uniquely contributed to differences in youths' global self-esteem. Significant associations with adherence and glycemic control suggested its concurrent validity. Agreement between youth- and parent-report DSSE forms supported inter-rater reliability.

CONCLUSIONS

The findings provide preliminary support for recognizing the importance of a DSSE dimension in adolescents' adjustment to diabetes, and for the reliability and validity of the proposed assessment strategy.

Short-term effects of coping skills training in school-age children with type 1 diabetes

OBJECTIVE

Little is known about the use of psychosocial interventions in children younger than adolescence with type 1 diabetes (T1D) and their parents. We report preliminary short-term outcomes of a randomized controlled trial of coping skills training (CST) compared with group education (GE) in school-aged children with T1D and their parents.

METHODS

One hundred and eleven children (range = 8-12 yr) with T1D for at least 6 months (3.71 +/- 2.91 yr) were randomized to CST (55.6% female (F); 81.5% white (W)) or GE (69.7% F; 90.9% W). Children and parents (n = 87) who completed the intervention, baseline, 1- and 3-month data are included. Children completed measures of self-efficacy, coping, and quality of life; parents completed measures of family functioning (adaptability and cohesion), diabetes-related conflict, parent depression, and parent coping. Metabolic control was assessed with glycosylated hemoglobin A1c. Mixed-model repeated measures anova was used to analyze the data.

RESULTS

CST and GE group composition was generally comparable. Children had good psychosocial adaptation and metabolic status. CST parents reported significantly more improvement in family adaptability compared with GE parents, and a trend was seen indicating that CST children showed greater improvement in life satisfaction than GE children. Effect sizes for this short-term follow-up period were small, but group participants were receptive to the intervention and reported positive gains.

CONCLUSIONS

In these preliminary results, CST and GE were more similar than different across multiple measure of psychosocial adaptation, although CST showed promising statistical trends for more adaptive family functioning and greater life satisfaction. Longer term follow-up is underway.

Mediators of depressive symptoms in children with type 1 diabetes and their mothers

OBJECTIVE

To examine the relationships among maternal and child depressive symptoms and child and family psychosocial factors.

METHOD

Secondary analysis of baseline data for a coping skills intervention for school-age children (ages 8-12) with type 1 diabetes (T1D) and their mothers. Children and mothers completed measures of depressive symptoms, coping, quality of life, and family functioning.

RESULTS

There was a strong relationship between maternal and child depressive symptoms (r = .44, p < .001). Maternal depressive symptoms were negatively related to child quality of life, perceptions of coping, and family functioning. Impact of diabetes on quality of life, finding coping with diabetes upsetting, and family warmth mediated the relationship between maternal and child depressive symptoms.

CONCLUSIONS

Maternal depression may negatively affect child adjustment through its influence on quality of life, coping, and family functioning. Implications for interventions to improve psychosocial adjustment in children with T1D are discussed.

Factors associated with depression and resilience in asthmatic children

The purposes of this study were to examine relationship between depression and resilience in children with asthma and identify factors associated with depression. Data were collected from 86 children who ranged in age from 10 to 15 years and who had been diagnosed with asthma for over 6 months. Resilience was measured with an instrument developed by Kim (2002) and depression with the Child Depression Inventory by Kovac (1985). The results showed that older children, children with lower resilience scores, and children whose parents were rigid and restrictive had significantly more depression. Education on parenting should be included in comprehensive care programs for asthmatic children.

Medical specialty camps for youth with diabetes

Camps for children with medical conditions have been in existence for decades. With the advent of new medical technology and research advances, children with medical illnesses are living long lives with chronic conditions. Camp provides an ideal setting to help these youth manage and cope with their disease. Using camps for children who have diabetes as a model, this article reviews the history of medical specialty camps and the psychosocial and medical aspects of the disease that are unique to this population and describes the intentional programming and special considerations within this camping environment. The article concludes with a review of research and recent studies conducted at camps for youth who have diabetes that investigate the benefits of these specialized camping programs.

Psychological adjustment in young children with chronic medical conditions

Children with chronic medical conditions are at higher risk for behavioral and emotional problems compared to physically healthy children. This study used a conceptual model to examine factors associated with psychological adjustment in children aged 7-11 years old with any of four chronic illnesses. The variables most closely associated with child adjustment included the following: mothers' evaluation of the impact of the child's illness on the family; child's perceptions of parental acceptance; and child's self-perceptions of physical appearance, social acceptance, and athletic competence. These findings confirm the importance of maternal and child perceptions in understanding the psychological adjustment of children with chronic conditions.

Prevalence and correlates of depressed mood among youth with diabetes: the SEARCH for Diabetes in Youth study

OBJECTIVE

The objective of this study was to determine if depressed mood among youth with diabetes was associated with type and duration of diabetes, mean glycosylated hemoglobin (HbA1c) level, and the frequency of diabetic ketoacidosis (DKA) and hypoglycemic episodes, hospitalizations, and emergency department (ED) visits.

METHODS

A total of 2672 youth (aged 10-21 years) who had diabetes for a mean duration of 5 years completed a SEARCH study visit, in which their HbA1c was measured and information about their demographic characteristics, diabetes type and duration, and episodes of DKA, hypoglycemia, hospitalizations, and ED visits over the previous 6 months was collected. Their level of depressed mood was measured using the Center for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

Among these youth, 14% had mildly (CES-D 16-23) and 8.6% had moderately or severely (CES-D > or =24) depressed mood. Females had a higher mean CES-D score than males. After adjusting for demographic factors, and duration of diabetes, we found the prevalence of depressed mood to be higher among males with type 2 diabetes than those with type 1 diabetes and to be higher among females with comorbidities than those without comorbidities. Higher mean HbA1c and frequency of ED visits were associated with depressed mood. The prevalence of depressed mood among youth with diabetes was similar to that of published estimates of depressed mood among youth without diabetes.

CONCLUSIONS

Physicians and other health care professionals should consider screening youth with diabetes for depressed mood in clinical settings, particularly youth with poor glycemic control, those with a history of frequent ED visits, males with type 2 diabetes, and females with comorbidities.

Learned helplessness in children and adolescents with juvenile rheumatic disease

OBJECTIVE

To examine a learned helplessness conceptualization of psychological sequela in children and adolescents with juvenile rheumatic diseases (JRD) via an experimental procedure utilizing behavior-outcome contingent and noncontingent feedback.

METHODS

Thirty-eight children and adolescents with JRD completed measures of transient affect, self-efficacy for functional ability, and causal attributions prior to and immediately following a computerized learned helplessness induction procedure.

RESULTS

Children across contingent and noncontingent feedback conditions experienced decreased positive affect with a slightly more pronounced decline in the noncontingent condition. Noncontingent feedback resulted in poorer internalization of success for problem solving, while contingent feedback resulted in greater internalization of success for problem solving. Additionally, posttreatment control self-efficacy was significantly greater for children in the contingent condition that initially endorsed higher levels of internal task attributions.

CONCLUSIONS

Children with JRD who experience behavior-outcome contingency in their environment may develop increased perceptions of control over functional ability. Furthermore, environmental noncontingency may result in poorer internalization of success, whereas contingent reinforcement may enhance cognitive appraisal mechanisms (i.e., causal attributions) associated with favorable disease outcome. Despite a modest decline in positive affect for children in the noncontingent condition, mood dysfunction is not entirely explicable within the context of noncontingent reinforcement.

Insulin analogues in children and teens with type 1 diabetes: advantages and caveats

This article reviews the advantages to and caveats of the use of newer insulin formulations (insulin analogues) and regimens in children and teens who have type 1 diabetes, their affect on glycemic control, frequency of hypoglycemic events, daily insulin requirements, and adverse affects such as excessive weight gain, which provides a further major challenge in adolescents. We also address briefly the use of adjunctive agents in the treatment of type 1 diabetes in children and teens.

Cognitive functioning in children with early onset type 1 diabetes and severe hypoglycemia

OBJECTIVE

To investigate whether severe hypoglycemia in young children with early-onset type 1 diabetes (T1DM) is associated with subsequent abnormalities in cognitive status.

STUDY DESIGN

Recruitment was from a large population-based database of children and adolescents with T1DM. Children and adolescents with early-onset T1DM (<6 years) were eligible for the study. Diabetic individuals (n = 41) with a prospectively documented history of seizure or coma were compared with peers with no history of severe hypoglycemic events (n = 43). A comprehensive test battery of learning and memory was used together with intellectual and behavioral measures.

RESULTS

No significant group differences were revealed on the intellectual, memory, or behavioral measures. Similarly, those participants with a history of early first seizure did not differ from their peers with no seizures. There were no significant group differences on the memory subtests that were examined given their potential sensitivity to compromised hippocampal function.

CONCLUSIONS

There was no clear evidence from this cohort that episodes of seizure or coma, even those occurring in very early childhood, resulted in broad cognitive dysfunction, nor was there evidence of specific memory difficulties at the time of testing in children and adolescents with early-onset T1DM.

Predictors of Youth Diabetes Care Behaviors and Metabolic Control: A Structural Equation Modeling Approach

OBJECTIVE

To empirically test a biopsychosocial model of predictors of youth diabetes care behaviors and metabolic control.

METHODS

A cross-sectional multisite study of youths (N = 222) with T1D (mean age = 12.6) used structural equation modeling to examine interrelations among predictors, with follow-up analyses of covariance (ANCOVAs).

RESULTS

Youths' memory skills related to diabetes knowledge which, along with self-efficacy and age, was associated with greater youth responsibility that in turn predicted poorer self-care behaviors. Less frequent/briefer exercise and less frequent blood glucose monitoring/eating were found; the latter directly related to poorer metabolic control. Behavior problems also were associated directly with poorer metabolic control. A parsimonious model found memory directly related to blood glucose testing.

CONCLUSIONS

Continued parental supervision of adolescents, along with monitoring diabetes knowledge and efficacy, may help optimize transfer of diabetes care from parents to youths. Behavior problems warrant immediate attention because of their direct and adverse relation to metabolic control.

Health-related quality of life and metabolic control in adolescents with diabetes: the role of parental care, control, and involvement

This questionnaire-based study explored the role of parenting in health-related quality of life in a population of 115 adolescents with type 1 diabetes (aged 11-18 years, 48% girls). Healthy adolescents (n = 9,345) and physically disabled adolescents (n = 291) were included as controls. The adolescents with diabetes reported their parents as being more controlling and involved than did adolescents in the 2 other groups. In multiple regression analyses, age, gender, and a higher degree of parental care and involvement explained 46% of the variation in mental health. Age, gender, a higher degree of parental care and involvement, and a lower perception of parental control explained 52% of the variation in diabetes life-satisfaction. Neither glycosylated hemoglobin nor the other clinical variables studied were significantly related to the perception of health-related quality of life. Family support should be provided to facilitate coping with everyday management and demands of diabetes.