Psychosocial Burden and Glycemic Control During the First 6 Years of Diabetes: Results From the SEARCH for Diabetes in Youth Study

Abstract

Purpose 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 six years of diabetes. Methods Data from SEARCH for Diabetes in Youth, an observational study of U.S. children diagnosed with diabetes before age 20 years, were collected during study visits conducted at baseline and then 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. Results 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, A1c values rose 1.5% from baseline (type 1 - 7.7% to 9.3%; type 2 - 7.3% to 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<0.05). However, youth with type 2 had higher A1c values with increasing generic QOL, an unexpected finding. Younger adolescents with type 1 diabetes had higher A1c values at study's end. Conclusions Significant deterioration in glycemic control marks the first six years of diabetes for adolescents. Psychosocial burden, particularly poor diabetes-specific QOL, is a contributor to suboptimal glycemic outcomes.

Depressive Symptoms in Youth With Type 1 or Type 2 Diabetes: Results of the Pediatric Diabetes Consortium Screening Assessment of Depression in Diabetes Study

“…Higher prevalence of depressive symptoms in adolescents with T2D versus T1D has been reported in the SEARCH study, with socioeconomic factors noted as contributing causes (11). The obesity epidemic has not spared adolescents with T1D (12), and our findings indicate that the adverse consequences of obesity in patients with T1D extends beyond insulin resistance to include an increased risk for depressive symptomatology, especially in low-income families.…”

12. Children and Adolescents: Standards of Medical Care in Diabetes—2018

“…A Rapid and dynamic cognitive, developmental, and emotional changes occur during childhood, adolescence, and emerging adulthood. Diabetes management during childhood and adolescence places substantial burdens on the youth and family, necessitating ongoing assessment of psychosocial status and diabetes distress during routine diabetes visits (10)(11)(12)(13)(14). Early detection of depression, anxiety, eating disorders, and learning disabilities can facilitate effective treatment options and help minimize adverse effects on diabetes management and disease outcomes (15).…”

Psychosocial aspects of type 1 diabetes in Latino- and Asian-American youth

“…Depression and low quality of life in youth with T1D adversely affect glycemic control (117). The Hispanic/Latino and Asian youth population experience higher rates of depressive symptoms than other racial/ethnic groups (118)(119)(120).…”