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Elevated diabetes distress linked to higher HbA1c in adolescent diabetes

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February 2, 2018

Virginia Hagger
Virginia Hagger

Adolescents with type 1 diabetes who report a high level of diabetes distress are more likely to have higher HbA1c vs. patients reporting lower levels of distress, independent of depressive symptoms, according to findings published in Pediatric Diabetes.

“Among adolescents with type 1 diabetes, the association with diabetes management — self-monitoring of blood glucose, self-reported HbA1c — is stronger for diabetes-specific distress than depressive symptoms,” Virginia Hagger, RN-CDE, MPH, of the Australian Centre for Behavioural Research in Diabetes in Melbourne, Australia, told Endocrine Today. “Clinicians and researchers need to consider diabetes distress as well as depression when assessing and supporting optimal mental health and diabetes management outcomes in young people.”

Although closely correlated with depressive symptoms, diabetes distress is not the same construct, Hagger and colleagues wrote in the study background, adding that diabetes distress is a heterogeneous construct, with research suggesting that regimen-related items are more closely related to HbA1c than other dimensions.

Hagger and colleagues analyzed data from 450 adolescents aged 13 to 19 years with type 1 diabetes participating in the Diabetes MILES Youth study, a national, cross-sectional survey of the psychosocial aspects of type 1 diabetes conducted in Australia (mean age, 16 years; 38% boys; mean diabetes duration, 6.9 years; 53% on pump therapy). Participants answered questionnaires regarding well-being and quality of life, and completed the 26-item Problem Areas in Diabetes scale for teens (diabetes distress scores range from 26 to 156, with higher scores indicating greater distress) and the 8-item Patient Health Questionnaire for Adolescents to assess depressive symptoms (scores range from 0 to 24, with higher scores indicating more depressive symptoms). Researchers assessed the relationships between self-reported HbA1c and demographics, self-monitoring blood glucose, insulin delivery mode, depressive symptoms and diabetes distress using hierarchical multiple regression models.

Within the cohort, mean HbA1c was 8.1%; 21% reported moderate to severe depressive symptoms, and 36% reported high diabetes distress. Additionally, 41% experienced moderate to severe depressive symptoms and/or high diabetes distress, with 17% reporting diabetes distress and depressive symptoms, 19% reporting only diabetes distress and 5% reporting only depressive symptoms.

Researchers found that teens reporting both diabetes distress and depressive symptoms had higher median HbA1c vs. those reporting only diabetes distress or only depressive symptoms (median, 8.5% vs. 7.5% vs. 7.5%, respectively).

In the final regression model, researchers found that diabetes distress was the strongest contributor to HbA1c (P < .001), whereas the contribution of depression symptoms did not rise to significance. The model explained 18% of the variance in HbA1c (P < .001).

“While depressive symptoms made an initial contribution to the variance in self-reported HbA1c, this was no longer significant when diabetes distress was added to the model, corroborating studies among adults with [type 1 diabetes],” the researchers wrote.

Sex did not moderate the association (P = .17), nor did depressive symptoms (P = .24), and diabetes distress moderated the association between SMBG and HbA1c among adolescents with elevated diabetes distress (P = .028).

“A greater proportion of adolescents reported elevated diabetes-related emotional distress, which in our study was more relevant to clinical outcomes than depression,” Hagger told Endocrine Today. “For example, negative emotions about diabetes may lead to avoiding checking blood glucose or attending to diabetes while at school. Frustration or feeling guilty about self-care may increase distress.”

Hagger said clinicians should ask adolescent patients about the aspects of diabetes they find the most difficult, and tailor support and educational strategies accordingly. An age-appropriate measure of diabetes distress in an annual health assessment for screening and monitoring the level of distress should also be conducted, she said.

“Effective interventions to prevent and reduce diabetes distress in adolescents are needed,” Hagger said. “Adolescents are not easy to engage in self-management programs, so designing and evaluating effective, brief strategies that clinicians and/or parents can routinely implement is needed.” – by Regina Schaffer

For more information:

Virginia Hagger, RN-CDE, MPH, can be reached at the Australian Centre for Behavioural Research in Diabetes, 206 Queensberry St., Melbourne VIC 3000, Australia; email: vhagger@acbrd.org.au.

Disclosures: The authors report no relevant financial disclosures.