Monitoring the emotional well-being of teenagers with type 1 diabetes at clinic visits

A recent study published in Pediatric Diabetes shows how and why to implement psychosocial screening for young people with diabetes.

by Dr Shikha Gray ^[1]

Teenage years are stormy enough. For young people with type 1 diabetes, the pressures of daily life are even greater. Emotional setbacks can reduce quality of life and make it difficult to manage diabetes.

International guidelines (ISPAD ^[2]) recommend routine screening for emotional well-being. This includes depression, anxiety, disordered eating, diabetes distress, family conflict, motivation for diabetes management, and quality of life.

Researchers in the US have explored how a comprehensive screening program could be implemented. A total of 232 teenagers with type 1 diabetes took part. Just over half (56%) were female, and the average age was 15 years. They were from diverse ethnic backgrounds. Participants were invited to complete a screening survey on iPads in the waiting room before their clinic visit.

Here is what the researchers found:

• 83% of teenagers completed the questionnaires in the waiting room. It took them less than 12 minutes.

• Psychological and social concerns were common:
  • • • Over half showed low motivation for diabetes management
      • One-fifth showed signs of depression, anxiety and/or diabetes distress
      • 7% showed signs of disordered eating
      • 7% showed signs of suicidality

• It is not enough to screen for depression alone. Of those who showed signs of a psychological or social problem, only 27% also showed signs of mild depression.

• Physical and emotional well-being are interlinked:
  • • • Those with high HbA1c and/or who avoided taking insulin were more likely to have symptoms of depression, anxiety, disordered eating, diabetes distress, as well as glucose monitoring stress, family conflict, low motivation. They were also more likely to be at risk of suicide.
      • Those with low motivation and high family conflict were more likely to avoid taking insulin.

• Following screening, there was a 25% increase in referrals to the team psychologist.

Conclusions:

This study highlights two key points.

First, an emotional well-being screening program can be implemented well. Young people are generally willing to complete the questions in the waiting room.

Second, screening for emotional well-being provides valuable information to enhance clinic visits. Health professionals can then take suitable action to meet teenagers’ support needs.

Reference: Brodar K, et al. Comprehensive psychosocial screening in pediatric diabetes clinic. Pediatric Diabetes, 2021; 22: 656-666.