Psychosocial factors affecting the etiology and management of type 1 diabetes mellitus: A narrative review

Abstract

Type 1 diabetes (T1D) is one of the most common chronic diseases in children and adolescents worldwide. Its etiopathogenesis results from the interplay of genetic and environmental variables. Among the latter, psychological stress has been implicated in disease onset as well as disease management. Various studies, including large population-based studies, have highlighted the role of stressful life events in the etiopathogenesis of T1D. In this article, we also emphasize the importance of attachment in the early child-caregiver relationship, which can be seen as a measure of the quality of the relationship and is crucial for stress and emotional regulation. It serves as a model for all subsequent relationships in one’s life. We summarize some of the few studies performed in the field of attachment and T1D etiopathogenesis or management. T1D management demands a lifelong therapeutic regimen to prevent acute and chronic complications. In addition to psychological stress, psychological factors such as family functioning, developmental adjustment, autonomy, mental health problems and other factors have been found to relate to metabolic control. Psychological factors need to be understood not as a single directional causality-based principle but as a dynamic bi- or multidirectional system that is affected by the normal developmental transitions of childhood and adolescence.

Prevalence and predictors of diabetes-related distress in adults with type 1 diabetes

“…Some studies confirmed that elevated diabetes-related distress was experienced by 20–30% of people with T1DM, suggesting a widespread clinical problem in this population as well 5 . Unlike type 2, the onset of T1DM is linked to a younger age and is often associated with stressful life events; psychosocial factors were shown to play a role in both its etiopathogenesis and disease management 6 . Diabetes-related distress in adults with T1DM is associated with suboptimal glycemic control and tends to be higher for women and relatively younger adults 2 .…”

Association Between Psychosocial Acuity and Glycemic Control in a Pediatric Type 1 Diabetes Clinic

“…22 These findings add to a growing body of literature demonstrating the importance of psychosocial factors—both at the individual/family and community/society levels—in self-management and diabetes-related health outcomes for individuals with T1D. 23 This study advances this line of current literature by examining such factors within the standard of clinical care.…”

Educational Outcomes in Children and Adolescents With Type 1 Diabetes and Psychiatric Disorders

“…Second, the interplay between T1D and psychiatric disorders on brain functions may be another explanation. Having psychiatric disorders may considerably impair one's diabetes management, 43,44 resulting in poor glycemic control, elevated risks of hypoglycemia and ketoacidosis, and frequent diabetes-related hospitalizations. Evidence showed that chronic hyperglycemia, acute hypoglycemia, and ketoacidosis could affect central nervous system development, 45 causing neurocognitive dysfunctions, such as in attention, working memory, and psychomotor functions.…”