Psychological screening in adolescents with type 1 diabetes predicts outcomes one year later

Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Diabetes research and clinical practice (Impact Factor: 2.54). 06/2011; 94(1):39-44. DOI: 10.1016/j.diabres.2011.05.027
Source: PubMed


Adolescents with type 1 diabetes are at increased risk for depression and anxiety, which can adversely affect diabetes management, glycemic control, and quality of life (QOL). However, systematic psychological screening is rarely employed. We hypothesized that higher depression and anxiety screener scores would predict higher HbA1c, less frequent blood glucose monitoring (BGM), and poorer QOL one year later. Raw screener scores were expected to be more robust predictors than cutoff scores.
150 adolescents age 13-18 with type 1 diabetes completed depression and anxiety screeners. One year later, blood glucose meters were downloaded to assess BGM frequency, HbA1c values were obtained, and caregivers rated the participants' QOL. Separate regressions were conducted for each outcome, including demographic and medical covariates.
Higher depression scores predicted less frequent BGM (b=-0.05, p<.05) and poorer QOL (b=-0.71, p<.01), and higher state anxiety scores predicted higher HbA1c (b=0.07, p<.05). Continuous screener scores identified risk for 12-month outcomes more robustly than clinical cut-off scores.
Psychological screeners predict diabetes outcomes one year later. Future clinical research studies should explore whether psychological screening and referral for appropriate intervention can prevent deteriorations in diabetes management and control commonly seen during adolescence.

Download full-text


Available from: Michele Herzer Maddux, Sep 22, 2014
  • Source
    • "This missing data issue with the No Tx group, especially, may be due to their poor clinic follow up that appears consistent with their reduced treatment adherence history and poor glycemic control. Poor medical and psychosocial follow up for a subset of at-risk patients is both common and problematic for adolescents with T1DM (Hilliard et al., 2011). Prospective and clinically controlled methodologies may reduce problems of missing data in future research projects. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Unlabelled: Adolescents diagnosed with Type 1 Diabetes Mellitus often exhibit reduced adherence to their medical regimen and poor glycemic control. A retrospective study examined longitudinal hemoglobin A1c (HgbA1c) outcomes for adolescent patients referred to the psychology service embedded within an endocrinology clinic. Three patient groups were examined: (1) TREATMENT: 59 adolescents referred who engaged in psychotherapy; (2) No Treatment: 40 adolescents referred yet failed to initiate psychotherapy; (3) CONTROL: 58 adolescents not referred for treatment and matched on demographics to the two treatment groups. Over 1 year, the TREATMENT group had a sustained decrease in HgbA1c while the No TREATMENT and CONTROL groups had an overall increase in HgbA1c. At study end, the TREATMENT group had HgbA1c values that were not significantly different from patients who were not considered in need of psychological treatment (CONTROL). Adolescents that utilized the pediatric psychology service saw decreased HgbA1c values over time.
    Full-text · Article · May 2013 · Journal of Clinical Psychology in Medical Settings
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Type 1 diabetes (T1DM) is a chronic illness that requires intensive treatment to improve glycemic control and limit the risk of diabetes-related complications. The management of T1DM is challenging for adolescents as the diabetes self-care activities invade all aspects of their life. Older adolescents frequently have poor glycemic control which places them at increased risk for diabetes-related complications. Study Aim:The goal of this study was to explore diabetes self-care practices among older adolescents, 15 through 18 years old, with T1DM. Specifically, this study sought to determine if there was a difference in diabetes self-care practices between adolescents who exhibited good (HbA1c < 9%) versus poor (HbA1c > 9%) glycemic control. Study Design:This study used an exploratory, focus group design to gain a better understanding of diabetes self-care among older adolescents and how they integrate diabetes self-care activities into their lives. Six focus groups were conducted and adolescents (n = 21) participated in either a good (HbA1c < 9%, n = 13) or poor (HbA1c > 9%, n = 8) control focus group according to their reported HbA1c. Results: Inductive analysis revealed 17 themes for adolescents in good control and 16 themes for those with poor glycemic control which were categorized as life with T1DM; diabetes self-care; interactions with parents, teachers/coaches, or others; or interactions with the healthcare team. Nursing Implications:Understanding the older adolescent's views about having diabetes and incorporation or lack thereof of diabetes self-care provides valuable information for nurses to develop a trusting relationship with them which may assist with improvement of glycemic control. Conclusions: Teens with good control believed they were stronger than the disease and that diabetes self-care is something they have to do to feel good physically. In contrast, teens with poor control often forgot to perform diabetes self-care activities and had to adjust their lifestyle to fit their chronic hyperglycemia. Teens in good control have accepted the disease and diabetes self-care as part of their identity where teens in poor control described having diabetes and its self-care activities as a burden and something that made them different from their peers.
    Full-text · Article · Jan 2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: Diabet. Med. 30, 199–208 (2013) Aims To determine: (1) prevalence of depression among young people with Type 1 diabetes compared with control groups or population norms; (2) implications of depression for HbA1c level; and (3) the relationship between history of depressive symptoms and future depressive symptoms. Background Among adults with Type 1 diabetes depression is higher than the general population, and has been associated with adverse implications for self-care and HbA1c level. The last published review of depression among young people with Type 1 diabetes only included studies up to 1999. Method Systematic searches were conducted for articles published from January 1999 to December 2011 including young people (up to 25 years old) with Type 1 diabetes. Results Twenty-three articles met the inclusion criteria. Of five studies that reported prevalence of depression compared with control groups, three found no differences. Of the three studies that investigated prevalence of depression making reference to population norms, all three showed higher rates of depressive symptoms. Fourteen of 15 studies found associations between more depressive symptoms and higher HbA1c level either cross-sectionally or longitudinally. Past depressive symptoms were associated with later depressive symptoms. Conclusions Current evidence is inconclusive about whether there is increased prevalence of depression among young adults with Type 1 diabetes, as established among adults, but those who are more depressed have higher HbA1c level. This review is limited by methodological problems and no identified work in the UK met the inclusion criteria. Given the adverse clinical outcomes, we conclude there is a case for routine mental health screening for young adults with Type 1 diabetes.
    No preview · Article · Jun 2012 · Diabetic Medicine
Show more