Disclosures: The authors report no relevant financial disclosures.
December 10, 2021
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High exposure to trauma, anxiety seen in children with type 1 diabetes

Disclosures: The authors report no relevant financial disclosures.
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Psychiatric conditions such as exposure to trauma, PTSD, depression, anxiety disorders and suicidal ideation are frequent among children with type 1 diabetes and may influence disease self-management, data show.

Rishi Raj

“Our study found alarming rates of traumatic exposure (66%) and posttraumatic stress disorder symptoms (38%) among children with type 1 diabetes,” Rishi Raj, MD, FACP, director of the division of endocrinology, diabetes and metabolism and an adjunct faculty member at the University of Pikeville – Kentucky College of Osteopathic Medicine, told Healio. “The most common trauma exposure was accidental injury (28%) and traumatic medical stress (22.2%). About one-fourth of children reported suicidal ideations, 30% reported anxiety symptoms and 7% had depression.”

Traumas experience by children with type 1 diabetes
Accidental injury, medical traumatic stress and natural disaster were three of the most common traumas experienced by children with type 1 diabetes. Data were derived from Raj R, et al. Diabetes Spectr. 2021;doi:10.2337/ds21-0024.

Data have shown that psychiatric factors can negatively affect diabetes self-management and HbA1c among children and adolescents, Raj and colleagues wrote in Diabetes Spectrum. However, less is known about how trauma exposure and symptoms of PTSD may affect type 1 diabetes.

In a single-center, cross-sectional study, Raj and colleagues analyzed data from 99 children and adolescents with type 1 diabetes who underwent standardized psychiatric screening questionnaires during clinic visits (mean age, 14 years; 51.5% girls). HbA1c goal was defined as less than 7%; frequency of blood glucose monitoring was also assessed. Researchers used Fisher exact tests to assess the relationships among trauma, PTSD, anxiety and blood glucose monitoring frequency and analysis of variance to examine group differences between HbA1c and the presence of suicidal ideation.

Within the cohort, questionnaire data showed 38.4% had trauma symptoms and functional impairment concerning for PTSD. Rates of trauma secondary to accidental injury, medical traumatic stress, natural disaster and witness to family violence were 28.3%, 22.2%, 10.1% and 6.1%, respectively.

Neither PTSD (P = .546), anxiety (P = .337) nor depression symptoms (P = .697) were associated with frequency of blood glucose monitoring. However, subscales for significant school avoidance (P = .023) and generalized anxiety disorders (P = .032) were associated with frequency of blood glucose monitoring.

Children who reported suicidal ideation had a higher mean HbA1c compared with those who did not report suicidal ideation (mean HbA1c, 8.9% vs. 8.3%; P = .047).

Amy Meadows

“Our study provides additional support for pediatric diabetes management to include a multidisciplinary team of social workers, psychologists or psychiatrists for routine screening, managing underlying psychiatric conditions and coordinating care with endocrinologists and other diabetes specialists,” Amy Lynn Meadows, MD, MHS, the Dr. Laurie L. Humphries Endowed Chair in child psychiatry at the University of Kentucky College of Medicine, told Healio. “When compared with the treatment goals as defined by American Diabetes Association guidelines, only 11% of children with type 1 diabetes achieved glycemic targets and only 40% of participants were checking blood glucose four times a day.”

The researchers wrote that health care providers working with children, adolescents and young adults with type 1 diabetes should ask about stressful life experiences and psychiatric symptoms and refer youths for appropriate interventions to optimize diabetes care.

For more information:

Rishi Raj, MD, FACP, can be reached at rishi.raj@pikevillehospital.org.