Early-Life Trauma and Diabetes Management: An Under-Recognized Phenomenon in Transition-Aged Youth.

Abstract

Robert is an 18-year-old young man with type 1 diabetes who was noted to have a pattern of increasing A1C at his most recent diabetes clinic visits. The certified diabetes educator reviewed his logs and recognized that he did not calibrate his continuous glucose monitoring system regularly. He denied having any management-related concerns, but when he met with the pediatric endocrinologist, he admitted to avoiding carbohydrate calculations and “winging it” for insulin dosing, which he attributed to “not wanting to deal with his diabetes right now.” As part of the clinic’s multidisciplinary evaluation, he met with a social worker. During this assessment, Robert disclosed that he was struggling with anxiety and intrusive thoughts resulting from witnessing domestic violence between his parents when he was 10 years old. He reported that these thoughts and increased anxiety were newly triggered by recent attempts by his estranged father to contact him. After meeting with the social worker and the clinic’s psychiatrist, he agreed to a referral for trauma therapy to discuss how his heightened hypervigilance and intrusive symptoms may be affecting his diabetes management and to strategize about how to address these symptoms to improve his overall health. Many adolescents and transition-aged young adults with type 1 diabetes do not meet glycemic control treatment targets (1). Depression, anxiety, disordered eating, and inadequate family support around diabetes are recognized as factors that …