1. In this prospective cohort study, adolescents with type 1 diabetes (T1D) were noted to be more likely to have persistently elevated distress levels if they were female, had elevated initial hemoglobin A1c (HbA1c) levels, reported the low self-care behaviors, higher levels of depression and anxiety, and increased disease-related family conflict, and demonstrated the low problem solving ability.
2. Conversely, participants in the stable, low distress group were more likely to be male, have a lower HbA1c, reported low levels of depression and anxiety as well as low levels of diabetes-related family conflict, and demonstrated higher levels of self-care and problem solving abilities.
Evidence Rating Level: 1 (Excellent)
Study Rundown: As a chronic disease, T1D can have a significant psychosocial impact on adolescents, making optimal disease management challenging. Prior research on T1D-associated distress has focused on distress levels at discrete points in time among a cross-section of patients. In this study, researchers completed a longitudinal assessment of disease-related distress among adolescents with T1D. Researchers looked at trends in distress levels over time and evaluated for factors associated with these trends. Participants with higher levels of distress were more likely to be female, have elevated initial HbA1c levels, and report lower rates of self-care behaviors. They were also more likely to report higher levels of depression, anxiety and disease-related family conflict and to demonstrate lower problem-solving ability. Conversely, participants with lower levels of distress were more likely to be male, have a lower initial HbA1c, report lower levels of depression, anxiety, and disease-related family conflict while also demonstrating high levels of self-care and problem-solving abilities. Though the study population was largely female, the study results reveal that many adolescents with T1DM struggle with disease-related distress and may benefit from targeted intervention soon after their diagnosis.
In-Depth [prospective cohort]: Researchers analyzed data from 244 adolescents (mean age 15.7 years, 59.8% female, mean disease duration 6.9 years) with T1DM who were also participating in a depression prevention study at 2 different urban sites in the United States. Participants were stratified into 4 different groups based on their starting distress level point and changes in their distress levels over time. Distress levels were determined based on the previously validated 26-item survey, Problem Areas in Diabetes-Teen Version. The 4 distress groups were labeled as “stable high”(n =19), “stable moderate” (n = 74), “low” (n = 82), and “improving” (n = 89). Girls were significantly more likely to be in the stable high group and significantly less likely than boys to be in the low distress group (p <.001). Participants in either the stable high or stable moderate groups were more likely than the other groups to have elevated HbA1c at the start of the study (p <.001), reported fewer self-care practices (p <.001), had higher rates of depressive and anxious symptoms (p <.001), reported more diabetes-related family conflict (p <.001), and demonstrated inferior problem solving abilities (p <.001).
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