Common Issues Seen in Paediatric Diabetes Clinics, Psychological Formulations, and Related Approaches to Management

Abstract

Diabetes is a chronic disease and its management is associated with multiple challenges. This is particularly the case in children and adolescents. Factors that contribute to difficulties in managing diabetes in youth include psychological characteristics, family dynamics, and social behavior. The purpose of this article is to highlight some psychological issues in children and adolescents with diabetes. We aim to present selected case scenarios encountered by health professionals and to provide tips on strategies for managing psychological aspect of diabetes. We tackle the psychological issues related to diabetes under four main categories: maladaptive disorders, eating disorders, family psychopathology, and family dysfunction. Psychotherapy and psychoanalysis are useful modalities in diabetes management. The psychological intervention is aimed at supporting patients and families to reach a balance between a normal family routine and a good glycemic control. We demonstrate unique requirements in coordinating care for children and adolescents with diabetes and highlight the importance of encouraging a positive behavior. Managing diabetes in children and adolescents needs to be in the form of a collaborative work between health care professionals, children and adolescents, and their families. Caring, supportive family backed up by experienced multidisciplinary team is the best approach to prevent psychological difficulties.

Causative factors of eating problems among adolescents with type 1 diabetes mellitus: A qualitative study

“…Some of the adolescents reported that their eating problems are due to the fear they faced. This finding supports Young-Hyman and Davis (2010) who emphasised that eating problems can be identified when someone has an intense fear of gaining weight or becoming fat (Young-Hyman and Davis, 2010) and this is common in the diabetes clinic (Deeb et al, 2018).…”

Reconsidering a role for attachment in eating disorder management in the context of paediatric diabetes

“…We note that this approach would afford researchers more 'integrated' or 'holistic' models that could incorporate a range of intervening variables and outcome measures (related to both mental and physical health) that impact paediatric diabetes settings (see Deeb, Akle, Al Ozairi, & Cameron, 2018). Two example variables that may be of particular interest are as follows.…”

Psychological Aspects of Diabetes

“…The management of diabetes in children and adolescents presents unique challenges; specifically, its management is complicated by developmental changes taking place, their need for autonomy and psychosocial immaturity, peer pressure, and family dynamics. 56 Nonadherence to medical regimens such as insulin therapy, as well as other self-care behaviours such as not attending physical activity classes, refusing dietary changes, and maladaptive behaviours, may be observed. 56 Risk-taking behaviours such as substance abuse and eating disorders can complicate the management process, or may worsen diabetes outcomes.…”

“…56 Nonadherence to medical regimens such as insulin therapy, as well as other self-care behaviours such as not attending physical activity classes, refusing dietary changes, and maladaptive behaviours, may be observed. 56 Risk-taking behaviours such as substance abuse and eating disorders can complicate the management process, or may worsen diabetes outcomes. Children in families with dysfunctional social interaction patterns have been shown to exhibit poorer control of certain diabetes parameters.…”