What is the clinical significance of diabetes distress among adolescents with type 1 diabetes?

An ACBRD publication, from the Diabetes MILES Youth – Australia study, shows that HbA1c is more strongly related to diabetes distress than depressive symptoms

by Dr Virginia Hagger

Relatively little is known about diabetes distress among adolescents with type 1 diabetes, including seemingly basic details, which are well-established in adults with diabetes. For example, the extent to which diabetes distress is associated with HbA1c or depressive symptoms, i.e. its clinically significance.

Diabetes distress refers to the negative emotions associated with living with diabetes, for example, feeling alone, overwhelmed, guilty or anxious about diabetes management. Studies have shown elevated depressive symptoms among adolescents with type 1 diabetes. However, the association with elevated HbA1c (a measure of average blood glucose levels) is inconsistent, and the relationship between depressive symptoms and diabetes distress had not been examined among adolescents.

The aim of this study was to examine the interaction between depressive symptoms, diabetes distress and HbA1c among adolescents. Data were analysed from the Diabetes MILES Youth Study, a large national survey about emotional well-being and quality of life for Australian adolescents living with type 1 diabetes. For the current study, we analysed data from 450 participants aged 13 to 19 years. Diabetes distress was assessed using the age-specific Problem Areas in Diabetes – Teen version (PAID-T) questionnaire and validated cut-points for elevated distress.

In this cohort of young people (average age: 16 years), diabetes distress and depressive symptoms were common; 36% experienced high diabetes distress and 21% experienced moderate-to-severe depressive symptoms. Diabetes distress was independently associated with elevated HbA1c whereas depressive symptoms were no longer related to HbA1c when diabetes distress was included in the analysis. Further, the association between less frequent self-monitoring of blood glucose and elevated HbA1c was stronger with higher levels of diabetes distress.

These results are consistent with the findings of studies among adults with diabetes, and demonstrate the clinical importance of diabetes distress among adolescents with type 1 diabetes. This suggests that clinicians need to assess diabetes distress in routine diabetes care to identify those teens who would benefit from greater support with the emotional impact of their condition.

Hagger V, Hendrieckx C, Cameron F, Pouwer F, Skinner TC, Speight J. Diabetes distress is more strongly associated with HbA1c than depressive symptoms in adolescents with type 1 diabetes: Results from Diabetes MILES Youth-Australia. Pediatric Diabetes. 2018; 19(4): 840-847.

Check out our other blogs about diabetes distress and adolescents.

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