Abstract
The COVID-19 pandemic has been a major stressor for adolescents. Given the unique implications of the pandemic for youth with type 1 diabetes (T1D), who already navigate multiple stressors as a function of their chronic condition, we aimed to describe the impact of the pandemic on adolescents with T1D and describe their coping strategies and resilience resources. In a 2-site (Seattle WA, Houston TX) clinical trial of a psychosocial intervention targeting stress/resilience, adolescents 13-18 years old with T1D ≥ 1 year and elevated diabetes distress were enrolled August 2020 - June 2021. Participants completed a baseline survey about the pandemic, including open-ended questions about the effects of the pandemic, what was helping them navigate, and how it impacted T1D management. Hemoglobin A1c (A1c) was extracted from clinical records. Free text responses were analyzed using an inductive content approach. Survey responses and A1c were summarized using descriptive statistics and associations were assessed by Chi-squared tests. Adolescents (n=122) were 56% female. 11% of adolescents reported diagnosis of COVID-19 and 12% had a family member/other important person die from COVID-19 complications. Adolescents described Social Relationships, Personal Health/Safety Practices, Mental Health, Family Relationships, and School to be primary areas affected by COVID-19. Helpful resources included: Learned Skills/Behaviors, Social Support/Community, and Meaning-Making/Faith. Among participants indicating that the pandemic had an impact on their T1D management (n=35), the most commonly described areas were: Food, Self-Care, Health/Safety, Diabetes Appointments, andExercise. Compared to adolescents who reported minimal difficulty managing T1D during the pandemic (71%), those reporting moderate to extreme difficulty (29%) were more likely to have A1C ≥ 8% (80% vs. 43%, p<.01). Results underscore the pervasive impact of COVID-19 on teens with T1D across multiple major life domains. Their coping strategies aligned with stress, coping, and resilience theories and suggest resilient responses in the face of stress. Despite experiencing pandemic-related stressors in many areas, diabetes-related functioning was relatively protected for most teens, highlighting their diabetes-specific resilience. Discussing the pandemic impact on T1D management may be an important focus for clinicians, especially for adolescents with diabetes distress and above-target A1C.
Highlights
IntroductionOver one-third report high stress about their diabetes [1], with serious implications for mental and physical heath
Adolescents with type 1 diabetes (T1D) are disproportionately affected by stress
The purpose of this study was to explore the effects of the COVID-19 pandemic, to understand what coping strategies were utilized, and to describe the impact of the pandemic on diabetes management for a diverse sample of teens with T1D and elevated diabetes distress participating in a clinical trial
Summary
Over one-third report high stress about their diabetes [1], with serious implications for mental and physical heath. High diabetes distress is associated with higher A1c and an increased risk of developing psychological disorders [2, 3]. The COVID-19 pandemic is widely recognized as a global and potentially traumatic stressor [4] and has been linked with high rates of stress, loneliness, and increased risk of depression for teens [5]. While there is no existing literature on the impact of the COVID-19 pandemic on the psychosocial well-being of adolescents with diabetes, research in adults with diabetes (both type 1 and type 2) suggests a significant impact on psychosocial health and diabetes management. Similar information has not been reported in teens, which represents a critical gap in the literature considering that prior to the pandemic over 80% of U.S adolescents with T1D were not meeting glycemic targets [13]
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