Multi-informant path models of the influence of psychosocial and treatment-related variables on adherence and metabolic control in adolescents with type 1 diabetes mellitus

Abstract

BackgroundWe assessed the associations between metabolic control and adherence and a broad range of adolescent and family characteristics (e.g., gender, family structure), treatment-related variables (e.g., disease duration, treatment modality), and psychosocial factors (e.g., symptoms of depression and anxiety, parental support, self-efficacy) in a nationwide study of Danish adolescents (age 12–17 years) with type 1 diabetes mellitus (T1DM).MethodsSixty-four percent of invited families participated by completing a survey and providing a blood sample. Two path models of associations between generic and diabetes-related family factors, adolescent self-efficacy, emotional difficulties, and metabolic control and adherence were tested, one for adolescents and one for caregivers. Demographic variables were included as covariates.ResultsBoth path models demonstrated a satisfying model fit. In both models, metabolic control was associated with adherence, age, and T1DM duration. In the adolescent model, metabolic control was also related to treatment modality, single-parent household, caregiver non-support, and anxiety, whereas in the caregiver model metabolic control was associated with family conflict and caregiver support. In both models, adherence was related to age, duration, treatment modality, family conflict, caregiver support, family functioning, and emotional difficulties of the adolescent. In the adolescent model, adherence was also related to adolescent self-efficacy, whereas in the caregiver model adherence was associated with adolescent gender and caregiver non-support and support. Adolescent self-efficacy, emotional well-being, and difficulties related to adolescent/caregiver interaction appeared to be particularly important, as indicated by their stronger association with adherence and/or metabolic control.ConclusionThe results highlight the value of applying a multi-informant approach to address the psychosocial well-being of adolescents with diabetes in a large national sample. Self-efficacy, emotional, and family-related difficulties are important aspects to address in both clinical care and future research regarding adolescents with T1DM.

Worse glycemic control, higher rates of diabetic ketoacidosis, and more hospitalizations in children, adolescents, and young adults with type 1 diabetes and anxiety disorders

“…depressive symptoms or depression) 13 . Studies in youth with anxiety symptoms also demonstrate positive correlations between symptoms of anxiety and poor glycemic control 6,7,12,14‐17 . Symptoms of anxiety often accompany poor diabetes self‐management and insufficient coping strategies 6,12 .…”

“…agoraphobia, social phobia, and specific phobias including needle phobia)', 'panic disorders', and 'generalized anxiety disorder'. Despite the fact that fear of needles and needle phobia appear to be very common in children, adolescents, and young adults with type 1 diabetes, only sparse data are available about the impact of needle phobia on glycemic control and other outcome parameters in youth with type 1 diabetes 14‐20 . The prevalence of fear of self‐testing, fear of injections in multiple injection therapy or fear of changing infusion‐sites in insulin pump therapy ranges from 10% to 30% in individuals with type 1 diabetes up to the age of 21 years 14,19,20 .…”

Paediatric Type1 Diabetes Management and Mothers’ Emotional Intelligence Interactions

“…Metabolic control from caregivers is associated with emotional difficulties in adolescents. Adolescent emotional well-being is associated with adherence and/or metabolic control [ 18 ].…”

Psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes

“…Die psychische Komorbidität beeinflusst des Weiteren den Krankheitsverlauf des T1DM negativ. Dies äußert sich in Verschlechterungen im Krankheits-und Glukosemanagement, in einer verminderten Behandlungsadhärenz, in einer Reduktion der glykämischen Kontrolle, einem erhöhten Risiko für schwere Hypoglykämien und vermehrten Hospitalisierungen aufgrund von diabetischen Komplikationen [4,30,33,37,44,50,[58][59][60]. Studien berichten auch von einer Assoziation depressiver Symptome mit einer reduzierten Einhaltung von Ernährungsempfehlungen und einem verstärkten Substanzkonsum bei Jugendlichen mit T1DM [61,62].…”

“…Angstsymptome können die Therapieumsetzung sowohl positiv als auch negativ beeinflussen [73]. In einem Teil der Studien konnte gezeigt werden, dass ein höherer Angstwert mit einer Verbesserung der glykämischen Kontrolle einhergeht [60], während sich in weiteren Studien der umgekehrte Zusammenhang ergab [16,50,63]. Einerseits scheinen Jugendliche mit Symptomen von Angst, insbesondere vor Hypoglykämien, gezielt einen höheren Glukosewert anzustreben, um so das Risiko einer Hypoglykämie und damit einhergehend auch der Angst zu senken [66].…”