Clinical and Psychological Course of Diabetes
Clinical and Psychological Course of Diabetes
Objective: To determine the clinical and psychological course of diabetes through adolescence and the relationship with glycemic control in young adulthood.
Research Design and Methods: A longitudinal cohort study of adolescents recruited from the register of the outpatient pediatric diabetes clinic. A total of 76 individuals (43 male patients, 33 female patients) aged 11-18 years completed baseline assessments, and 65 individuals (86%) were reinterviewed as young adults (20-28 years of age). Longitudinal assessments were made of glycemic control (HbA1c), weight gain (BMI), and development of complications. Adolescents completed self-report questionnaires to assess emotional and behavioral problems as well as self-esteem. As young adults, psychological state was assessed by the Revised Clinical Interview Schedule and the self-report Brief Symptom Inventory.
Results: Mean HbA1c levels peaked in late adolescence and were worse in female participants (average 11.1% at 18-19 years of age). The proportion of individuals who were overweight (BMI >25.0 kg/m) increased during the 8-year period from 21 to 54% in female patients and from 2 to 28% in male patients. Serious diabetes-related events included death in one patient and cognitive impairment in two patients. Individuals in whom diabetic complications developed (25% of male patients and 38% of female patients) had significantly higher mean HbA1c levels than those without complications (difference 1.9%, 95% CI 1.1-2.7, P < 0.0001). Behavioral problems at baseline were related to higher mean HbA1c during the subsequent 8 years (ß = 0.15, SEM (ß) 0.04, P < 0.001, 95% CI 0.07-0.24).
Conclusions: The outcome for this cohort was generally poor. Behavioral problems in adolescence seem to be important in influencing later glycemic control.
Adolescence is a difficult time for people with type 1 diabetes because glycemic control often deteriorates and the risk of developing long-term complications seems to accelerate. The role of hyperglycemia in the development of microvascular complications has been demonstrated conclusively by the results of the Diabetes Control and Complications Trial. It has been argued that poor control in adolescence relates to the physiological changes of puberty; however, problems of adherence to treatment regimens and attendance at outpatient visits suggest that psychological factors are also important.
Psychiatric disorders have been shown to be more common in both adolescents and young adults with type 1 diabetes than in nondiabetic populations. However, the influence of psychological state in adolescence on later diabetic outcomes has not been established; the three previous longitudinal cohort studies in adolescents were based on younger children and comprised small numbers of participants or selective samples.
We used a prospective longitudinal design in a representative population of teenagers to determine the clinical and psychological course of diabetes from adolescence to young adulthood and the relationship between psychological state in adolescence and later diabetes outcomes.
Objective: To determine the clinical and psychological course of diabetes through adolescence and the relationship with glycemic control in young adulthood.
Research Design and Methods: A longitudinal cohort study of adolescents recruited from the register of the outpatient pediatric diabetes clinic. A total of 76 individuals (43 male patients, 33 female patients) aged 11-18 years completed baseline assessments, and 65 individuals (86%) were reinterviewed as young adults (20-28 years of age). Longitudinal assessments were made of glycemic control (HbA1c), weight gain (BMI), and development of complications. Adolescents completed self-report questionnaires to assess emotional and behavioral problems as well as self-esteem. As young adults, psychological state was assessed by the Revised Clinical Interview Schedule and the self-report Brief Symptom Inventory.
Results: Mean HbA1c levels peaked in late adolescence and were worse in female participants (average 11.1% at 18-19 years of age). The proportion of individuals who were overweight (BMI >25.0 kg/m) increased during the 8-year period from 21 to 54% in female patients and from 2 to 28% in male patients. Serious diabetes-related events included death in one patient and cognitive impairment in two patients. Individuals in whom diabetic complications developed (25% of male patients and 38% of female patients) had significantly higher mean HbA1c levels than those without complications (difference 1.9%, 95% CI 1.1-2.7, P < 0.0001). Behavioral problems at baseline were related to higher mean HbA1c during the subsequent 8 years (ß = 0.15, SEM (ß) 0.04, P < 0.001, 95% CI 0.07-0.24).
Conclusions: The outcome for this cohort was generally poor. Behavioral problems in adolescence seem to be important in influencing later glycemic control.
Adolescence is a difficult time for people with type 1 diabetes because glycemic control often deteriorates and the risk of developing long-term complications seems to accelerate. The role of hyperglycemia in the development of microvascular complications has been demonstrated conclusively by the results of the Diabetes Control and Complications Trial. It has been argued that poor control in adolescence relates to the physiological changes of puberty; however, problems of adherence to treatment regimens and attendance at outpatient visits suggest that psychological factors are also important.
Psychiatric disorders have been shown to be more common in both adolescents and young adults with type 1 diabetes than in nondiabetic populations. However, the influence of psychological state in adolescence on later diabetic outcomes has not been established; the three previous longitudinal cohort studies in adolescents were based on younger children and comprised small numbers of participants or selective samples.
We used a prospective longitudinal design in a representative population of teenagers to determine the clinical and psychological course of diabetes from adolescence to young adulthood and the relationship between psychological state in adolescence and later diabetes outcomes.