Poor Prognosis of Young Adults With Type 1 Diabetes

Abstract

OBJECTIVE -To determine the role of early behavioral and psychological factors on later outcomes in young adults with childhood-or adolescent-onset type 1 diabetes.RESEARCH DESIGN AND METHODS -We conducted a longitudinal cohort study of patients recruited from the register of the young adult outpatient diabetes clinic, Oxford, U.K. A total of 113 individuals (51 male subjects) aged 17-25 years completed assessments, and 87 (77%) were reinterviewed as older adults (aged 28 -37 years). Longitudinal assessments were made of glycemic control (HbA 1c ) and complications. Psychological state at baseline was assessed using the Present State Examination and self-report Symptom Checklist, with corresponding interview schedules administered at follow-up.RESULTS -There was no significant improvement between baseline and follow-up in mean HbA 1c levels (8.5 vs. 8.6% in men, 9.3 vs. 8.7% in women). The proportion of individuals with serious complications (preproliferative or laser-treated retinopathy, proteinuria or more severe renal disease, peripheral neuropathy, and autonomic neuropathy) increased from 3-37% during the 11-year period. Women were more likely than men to have multiple complications (23 vs. 6%, difference 17%, 95% CI 4 -29%, P ϭ 0.02). Psychiatric disorders increased from 16 to 28% (20% in men, 36% in women at follow-up, difference NS), and 8% had psychiatric disorders at both assessments. Baseline psychiatric symptom scores predicted follow-up scores (␤ ϭ 0.32, SE [␤] 0.12, P ϭ 0.008, 95% CI 0.09 -0.56) and recurrent admissions with diabetic ketoacidosis (odds ratio 9.1, 95% CI 2.9 -28.6, P Ͻ 0.0001).CONCLUSIONS -The clinical and psychiatric outcome in this cohort was poor. Psychiatric symptoms in later adolescence and young adulthood appeared to predict later psychiatric problems.

Computerized Automated Reminder Diabetes System (CARDS): E-Mail and SMS Cell Phone Text Messaging Reminders to Support Diabetes Management

“…[8][9][10][11][12] It is critical to maintain BG monitoring frequency through this developmental stage since it has been demonstrated that those with poor adjustment to diabetes in adolescence are likely to continue such behaviors into adulthood. 13,14 Increased involvement with healthcare providers may improve glycemic control and reduce the risk of complications, 15 but these interactions are labor-intensive and expensive. Low-cost clinic-based interventions in younger adolescents have yielded a positive impact on both glycemic control and quality of life.…”

Caracterização de pacientes com diabetes mellitus tipo 1 do sul do Brasil: complicações crônicas e fatores associados

“…After 11 years of DM existence, the prevalence of some degree of DR is around 66.6%, 23 increasing to approximately 100% after 20 years of DM. 24 Recently, a Brazilian group described a prevalence of 21% to DR in a sample of 81 type 1 DM patients.…”

Type 1 diabetes in the young: the harvest of sorrow goes on

“…The paediatric diabetes community has mobilised itself to meet this challenge, but faces the problem that puberty is typically followed by a sharp rise in HbA 1 c and that inadequate control, once established, tends to persist into later life. A follow-up study of teenagers with type 1 diabetes in the UK found that HbA 1 c was unchanged (8.6% in men, 8.7% in women) after 11 years of follow-up, whilst the proportion with serious complications rose from 3 to 37% and psychiatric disorders increased from 16 to 28% [18]. The reasons for poor glucose control in adolescence range from the endocrine and physiological to the social, emotional and psychological; complicated by the natural inclination of young people to assert their autonomy in the face of parental and other constraints.…”