Relations between age, metabolic control, disease adjustment and psychological aspects in insulin-dependent diabetes mellitus

Can integrated technology improve self-care behavior in youth with type 1 diabetes? A randomized crossover trial of automated pump function

Automated blood glucose (BG) and insulin pump systems allow wireless transmission of all BG readings to a user's pump. This study aimed to assess whether use of such a system, as compared with a manual BG entry insulin pump, resulted in higher mean daily frequency of BGs recorded after 6 months. A 12-month randomized crossover trial, comprising 2 phases, was conducted. All participants used insulin pump devices with automated vs manual BG entry for 6 months each; order of system use was randomly assigned. Device interactions were assessed from pump and glucometer downloads. Thirty-five participants were enrolled; 9 withdrew during the study. Use of the automated insulin pump system resulted in higher mean daily BG recorded over 6 months of use when compared to a manual BG entry system (5.8 ± 1.7 vs 5.0 ± 1.9; P = .02 [95% confidence interval, 0.14 to 1.58]). Bolus frequency was similar between groups. No HbA1c difference was observed between groups at 6 months (8.0% [64 mmol/l] ± 1.3 automated vs 7.7% [61 mmol/l] ± 0.9 manual; P = .38). Post hoc analysis demonstrated improved ΔHbA1c with automated system use in an adolescent subgroup with suboptimal baseline BG frequency (-0.9% vs + 0.5%; P = .003). Use of an automated glucometer/insulin pump resulted in higher number of BGs recorded over 6 months when compared to an insulin pump with manual BG entry. This may be especially beneficial for adolescent manual system users who enter <5 BGs per day into their pump.

Association between emotional and behavioral problems and metabolic control in children and adolescents with Type 1 diabetes

OBJECTIVE

We aimed to investigate the differences in emotional and behavioral problems and to explore the association between the level of psychiatric problems and the metabolic control in Type 1 diabetes.

METHODS

The children with Type 1 diabetes (no.=42) and the "healthy" control group (no.=42), their parents and endocrinology specialist completed the forms prepared for the study. The parents completed the Child Behavioral Checklist (CBCL/4- 18).

RESULTS

The groups had significant differences in CBCL activities (p<0.001), social competence (p<0.001), total competences (p<0.001), withdrawal (p=0.036), anxiety/depression (p=0.033), social problems (p=0.009), and aggressive behavior (p=0.04) scores. We did not find significant differences in CBCL scores between the groups with good, moderate and bad metabolic control (p>0.05).

DISCUSSION

The parents of children with Type 1 diabetes reported emotional and behavioral problems significantly more. We did not find any significant association between the level of metabolic control and the emotional and behavioral problems.

Anxiety and depression in juvenile diabetes: a critical review

A critical examination of the recent literature on anxiety and depression in juvenile diabetes is presented. The objectives of this review are: (1) to determine the general association of psychological factors, especially anxiety and depression, with diabetes, (2) to examine the specific association of anxiety and depression with metabolic control, and (3) to propose methodological changes that are needed to advance future research in this field. The major conclusions of this review support the notion of a general association of psychological disorders with juvenile diabetes. However, while anxiety and depression appear to play an important and complex role in determining adaptation to the disease, their relationship to metabolic control does not yet appear clear. Additional prospective and controlled studies as well as multivariate models of chronic disease are now necessary to more fully understand the etiology and impact of these disorders in the adolescent population.

Psychosocial factors associated with levels of metabolic control in youth with type 1 diabetes

This study sought to determine the relationship between Youth Self Report (YSR) scores for behavior problems, YSR scores for social competence, and metabolic control in children and adolescents with Type 1 diabetes. Using a cross sectional design, 234 individuals between 11 and 18 years old were given the YSR at regular clinic appointments; glycosylated hemoglobin (GHb) was also measured. More than 50% of subjects showed GHb levels above 9%; the normal GHb level is 4.2% to 5.8%. Individuals reporting a greater number of behavior problems, though not in the pathological range on the aggression, delinquent behaviors, and attention problems subscales of the YSR, were more than twice as likely to have GHb levels above 9%. Using logistic regression the externalizing scale (aggression and delinquent behaviors combined) predicted elevated GHb at 2.41, p =.003. Youth in this study were middle-class and were receiving subspecialty care. Yet, over half of them had GHb levels above the recommended 9%. The psychological health of youth should be monitored at regular intervals. Longitudinal studies are needed to determine whether aggression, delinquent behaviors, and attention problems in children and adolescents with Type 1 diabetes result later in depression and elevated levels of GHb in these same individuals or whether these elevations are transient. Interviews could be supplemented with instruments such as the YSR and care given for those with a higher number of self-reported problems.

Child and parental mental ability and glycaemic control in children with Type 1 diabetes

AIMS

Many psycho-social factors can affect the glycaemic control of children with Type 1 diabetes, but the influence of the intelligence of the child and their parents has not been reported.

METHODS

Seventy-eight children and adolescents with Type 1 diabetes and their mothers performed standardized tests to assess psychometric intelligence. The children were aged (median (range)) 12.0 (5-17) years with duration of diabetes 5.0 (1.0-13.0) years and required an insulin dose of (mean +/- SD) 1.0 +/- 0.3 U/kg per day. The children completed the Wide Range Achievement Test 3 reading test (WRAT3) and Raven's Standard Progressive Matrices (RSPM). A mean annual HbA1c was calculated for each subject (8.6 +/- 1.4%). The mothers performed the National Adult Reading Test (NART) and provided details of the occupation of the main wage-earner in the family from which social class (SC) was derived.

RESULTS

The HbA1c of the child correlated with their age (r = 0.26, P = 0.02), SC (Kendall's rank correlation, tau = 0.17, P = 0.03) and with the NART error score of their mother (r = 0.28, P = 0.01), but no correlation was observed with the child's WRAT3 or RSPM score. Stepwise regression revealed that age and NART error score were the strongest independent determinants of glycaemic control (total adjusted r2 = 0.117).

CONCLUSIONS

Parental intelligence appears to have a significant influence on the glycaemic control of a child with Type 1 diabetes, accounting for 7.6% of the reliable variance in HbA1c.

Symptoms of depression are important to psychological adaptation and metabolic control in children with diabetes mellitus

AIMS

Sixty-two children (37 girls, 25 boys) between 9 and 18 years of age were enrolled to investigate: (1) the relationship between adaptation to diabetes mellitus (DM) and psychological functioning; (2) if adaptation or psychological functioning was related to metabolic control; and (3) if the patients' ability to cope with diabetes as assessed by physicians, was correlated to adaptation or psychological functioning.

METHODS

Psychological functioning was measured by three general psychological instruments for depressive symptoms, self-esteem and fear. Diabetes adaptation was evaluated by questionnaires and coping with diabetes by an assessment of the physicians. Metabolic control was expressed by the individual HbA1c measured during the last year.

RESULTS

Adaptation to diabetes correlated to psychological functioning (depression, P<0.001; self-esteem, P<0.01; and fear, P<0.01). Multiple regression analyses showed that metabolic control was predicted by adaptation (P=0.0013) with monitoring of diabetes as the only significant aspect of the adaptation (P < or = 0.0001). In turn, adaptation was predicted by symptoms of depression and metabolic control (P<0.0001). In support of this observation, a depressed (n = 9) and a non depressed (n= 53) group showed significant differences in metabolic control (P < or = 0.01), adaptation (P < or = 0.001) and self-esteem (P < or = 0.001). The only significant variable for the physicians assessment was metabolic control, which explained 35 % of the variance (P < 0.001).

CONCLUSIONS

The major conclusion is that symptoms of depression affect both adaptation and metabolic control. It should be of concern to identify patients with depressive symptoms, offer treatment for their emotional difficulties and increase the support for taking care of their diabetes.