The specific aims of this study were to (1) evaluate the ability of a psychosocial stressor to induce an adequate stress response among adolescents with T1D; (2) examine predictors of stress responsiveness in this population and (3) evaluate the relationship of these factors with diabetes control. Based on previous research demonstrating the ability of a psychosocial stressor to elicit a cortisol response among children with a chronic inflammatory disorder, we hypothesized that the Trier Social Stress Task for Children 17]) would be an adequate stressor that causes a significant and reliable increase in cortisol levels among adolescents with T1DM. Further, we hypothesized that greater burden of stressful life events and increased family dysfunction would be associated with stress responsiveness and poorer overall diabetes control.
Methodology ParticipantsSeventeen adolescents (nine male, eight female) with T1DM, followed in the diabetes clinic of a large paediatric hospital, participated in the study. The clinic provides routine diabetes care to 70% of the children and adolescents with T1DM in the Toronto area. English speaking participants aged 11-18 years were included in the study if they had a history of T1DM of at least one year. Clinic patients with comorbid medical illnesses, (apart from treated hypothyroidism or mild asthma), developmental delay, or taking psychotropic medication at the Abstract Objectives: The hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the relationship between increased stress and poor diabetes control in children with type 1 diabetes mellitus (T1DM).The objectives of this study were two-fold: (1) To evaluate the effectiveness of the Trier Social Stress Test for Children (TSST-C) in inducing psychosocial stress in children with T1DM; (2) To investigate predictors of the cortisol stress response to the TSST-C.Methods: Seventeen adolescents with T1DM were exposed to the TSST-C. Salivary cortisol was sampled pre-TSST-C and at six 10-minute intervals following the stress procedure. Measures of anxiety, depression, family functioning and early adversity were completed.
Results:The TSST-C induced a significant increase in cortisol response (p<0.01). Early adversity predicted cortisol response to the stressor (p=0.01). Early adversity was also associated with poorer diabetes control (p=0.05).
Conclusion:The TSST-C was effective in producing a stress response in children with diabetes. Whereas previous research has emphasized psychological pathways which contribute to the relationship between psychosocial stressors and poor diabetes control, this study suggests that biological dysfunction may also underlie the association.