Diabetes Related Distress in Children with Type 1 Diabetes before and during the COVID-19 Lockdown in Spring 2020

Abstract

Our aim was to compere diabetes-related distress (DD) in young patients with type 1 diabetes mellitus (T1DM) and in their parents before and during the national COVID-19-related lockdown when schools operated on-line. Problems Areas in Diabetes-Child (PAID-Ch), Teen (PAID-T) and Parent (P-PAID-Ch, P-PAID-T) questionnaires in paper version were used to evaluate DD before COVID-19 pandemic (November 2019–February 2020) and during the lockdown (April 2020) the same surveys were performed by phone. We enrolled 76 patients (median age (Q1–Q3): 13.6 (11.8–15.2) years; 21 children, 55 adolescents; T1DM duration 3.7 (1.7–6.8) years). Initial PAID score was lower in teenage boys than in girls (34.0 (24.0–42.0) vs. 44.5 (40.0–50.5), p = 0.003). In teens PAID score decreased significantly during the lockdown (−3.0 (−11.0–3.0), p = 0.018), more in girls than boys (p = 0.028). In children (−3.0 (−14.0–7.0), p = 0.131) and parents PAID did not change (teens’ parents: 3.0 (−9.0–10.0), p = 0.376; children’s parents: −5.0 [−9.0–1.0], p = 0.227). In the studied group COVID-19 pandemic-related lockdown was associated with decrease in DD in teens with T1DM, particularly in girls, while no significant change in DD was observed in children or parents. DD decrease in teens during the pandemic should attract attention to the potential “rebound” of DD related to return to regular on-site school routine.

Self-Regulation as a Protective Factor for Diabetes Distress and Adherence in Youth with Type 1 Diabetes During the COVID-19 Pandemic

“…Pandemic-related family stress moderated parents’ diabetes-related distress, consistent with prior work finding decreases in diabetes-related distress during lockdown among parents reporting no COVID-19-related worries ( Mianowska et al, 2021 ). Unlike parents, youth did not report much change in emotional functioning overall from pre- to during- pandemic or in relation to family pandemic-related stress, also consistent with a prior study ( Goethals et al, 2021 ).…”

“…Findings contribute to literature on COVID-19 pandemic impacts on youth mental health ( Goethals et al, 2021 ; Magson et al, 2021 ) and T1D self-management ( Mianowska et al, 2021 ; O’Donnell et al, 2022) . In future work, it will be helpful to detail which aspects of SR are most strongly linked to T1D self-management to identify skills to promote adherence in youth T1D populations.…”

“…Some youth may have experienced these initial months as a break and/or as more boring than stressful ( Janssen et al, 2020 ). Youth with T1D may have felt less diabetes-related distress at home compared to school; other work also found decreased youth diabetes-related distress during lockdown ( Mianowska et al, 2021 ). It may be that the pandemic-related stressors assessed were more salient for parents than youth (e.g.…”

“…Finally, changes in daily activities, such as the lack of in-person school or school-based activities may have altered T1D self-management routines ( Novak et al, 2020 ; Plevinsky et al, 2020 ). Studies of the pandemic’s impact on youth with T1D and their caregivers have found mixed results, with some U.S. youth and caregivers reporting higher stress but also healthier eating habits ( Goethals et al, 2021 ) and global work finding high caregiver stress ( Alessi et al, 2021 ), but decreased diabetes distress in youth during lockdown ( Mianowska et al, 2021 ). A recent study of U.S. teens with T1D found that although youth endorsed high anxiety about COVID-19, they also reported use of coping strategies that helped with their anxiety as well as limited diabetes-specific distress or impacts on diabetes management ( O’Donnell et al, 2022) .…”

The Impact of the Covid-19 Pandemic on the Well-Being and Diabetes Management of Adolescents With Type 1 Diabetes and Their Caregivers: A Scoping Review

“…More specifically, N = 4 studies (29)(30)(31)34) reported the Time in Range (TIR), comprising also the Time Above Range (TAR) and the Time Below Range (TBR) which were reported by N = 3 (30,31,34) studies. Hemoglobin A1c (HbA1c) was instead reported by N=6 studies (29,(31)(32)(33)(34)(35), with N = 2 studies also reporting information about the Glucose Management Indicator (GMI) (30,31) representing the estimates A1c (eA1c). The Low and High Blood Glucose Indices (LBGI and HBGI, respectively) were reported by N = 2 studies (29,31), while the Mean Glucose by N = 3 studies (29,31,34); of these, N = 2 (29, 31) also provided the sample's glucose SD.…”