Greater disease-related distress can adversely affect HbA1c levels and depressive symptoms for young adults with early-onset type 1 diabetes, according to findings published in Diabetic Medicine.
“Diabetes-related emotional distress (diabetes distress) is considered one of the most important psychosocial concerns in people with diabetes because it is regarded as a major barrier to optimal diabetes management,” Anna Stahl-Pehe, PhD, of the Institute for Biometrics and Epidemiology of the German Diabetes Centre and Leibniz Centre for Diabetes Research in Germany, and colleagues wrote. “Until now, no data existed on the association between diabetes distress and relevant outcomes of diabetes care among young adults with early-onset type 1 diabetes, meaning that no data are available on people who have had diabetes nearly their entire lives.”
Stahl-Pehe and colleagues based their findings on answers to questionnaires assessing diabetes distress, depressive symptoms and health status from three groups of young adults from the Clinical Course of Type 1 Diabetes in Children, Adolescents and Young Adults with Disease Onset at Preschool Age cohort in Germany. All participants were diagnosed with type 1 diabetes before age 5 years. Higher scores on the questionnaires for distress and depressive symptoms implied higher levels of these conditions, whereas a high score on the health status questionnaire equated to improved health.
Among the cohort, 208 participants (mean age, 20.8 years; 62.5% women) who were diagnosed with diabetes between 1993 and 1999 completed baseline questionnaires in 2009-2010 and follow-up questionnaires in 2012-2013. In this group, 13.9% of participants reported diabetes distress, 6.4% reported high levels of depressive symptoms and 4.9% reported both.
A second group of 303 participants, which included 142 participants from the first group, (mean age, 22.4 years; 58.4% women) who were diagnosed between 1993 and 1999 completed follow-up questionnaires in 2015-2016. Rates of diabetes distress, high levels of depressive symptoms and both were 12.2%, 6.6% and 4.3%, respectively.
A third group of 73 participants (mean age, 18.6 years; 60.3% girls) who were diagnosed between 2000 and 2002 completed follow-up questionnaires in 2015-2016. This group had the highest proportion of reported diabetes distress (16.4%), depressive symptoms (6.6%) and a combination of the two (5.6%).
The researchers found that women tended to have higher scores on the diabetes distress questionnaire than men when adjusting for sex, age and socioeconomic status (P < .001). Participants with higher socioeconomic status reported less diabetes distress (P < .012) than those of lower socioeconomic status. Participants who considered themselves healthier both mentally and physically reported lower distress compared with those who did not report such health statuses (P < .001).
Scores on the diabetes distress questionnaire were 0.28 points higher when HbA1c was increased by 1 mmol/mol (95% CI, 0.2-0.36), according to the researchers. Additionally, every 10-U rise in diabetes distress score at baseline was associated with an HbA1c increase of 1.82 mmol/mol (95% CI, 0.43-3.2), and each unit increase in depressive symptom score at baseline was linked to a 0.49-mmol/mol increase in HbA1c levels (95% CI, 0.07-0.91).
“The cross-sectional analysis results indicated that interventions against diabetes distress should specifically target women and people with lower [socioeconomic] indexes, higher HbA1c, impaired satisfaction with care, worse health statuses and depressive symptoms,” the researchers wrote. “Interventions aimed at improving the quality of health care (eg, by improving the coordination of care and strengthening the self-care competencies) may reduce worries, concerns and fears related to living with type 1 diabetes and its treatment.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.