Abstract
ObjectiveTo assess personality factors, coping, developmental conditions and quality of life in female adolescents and young adults with type 1 diabetes (T1D) and high vs.low HbA1c.MethodsPatients were approached at the Department for Pediatrics, Medical University of Vienna; n = 129 female adolescents (10 to 23 years, mean age 15.21 ± 2.91) with type 1 diabetes were included. HIGH-A1c was defined as HbA1c > 7.5%, LOW-A1c as HbA1c ≤ 7.5% and compared to a sample of 56 age-matched female healthy controls. Self-rating questionnaires were used to assess psychosocial factors: Children's Depression Inventory (CDI); Junior Temperament and Character Inventory (J-TCI); Eating Disorders Inventory-2 (EDI-2); KIDCOPE; Subjective Family Image Test (SFIT) and Inventory of Life Quality in Children and Adolescents(ILC).ResultsT1D patients with HIGH-A1c were younger at the age of diabetes onset, had a longer diabetes duration, a higher maximum BMI, higher depression score, and higher frequency of diabetic ketoacidosis in the last year. They showed significantly higher levels of fatigue, lower levels of taking responsibility, lower ability to set goals and lower self-acceptance, as well as higher levels of ineffectiveness, lower levels of emotional attachment within the family, in particular with the fathers, and used negative coping strategies more often compared to patients with LOW-A1c. Furthermore, they reported significantly higher burden of illness and lower quality of life.ConclusionsDisadvantageous personality and coping styles as well as developmental conditions should be addressed in the treatment of female adolescents with T1D with management problems.
Highlights
Over the past two decades, the use of more intensive therapy regimes such as basal-bolus or continuous subcutaneous insulin infusion (CSII) has increased [1]
Patients were approached at the Department for Pediatrics, Medical University of Vienna; n = 129 female adolescents (10 to 23 years, mean age 15.21 ± 2.91) with type 1 diabetes were included
type 1 diabetes (T1D) patients with HIGH-A1c were younger at the age of diabetes onset, had a longer diabetes duration, a higher maximum Body Mass Index (BMI), higher depression score, and higher frequency of diabetic ketoacidosis in the last year
Summary
Over the past two decades, the use of more intensive therapy regimes such as basal-bolus or continuous subcutaneous insulin infusion (CSII) has increased [1]. Improvement in metabolic control over time was observed in several diabetes cohort registries [1–6], but the targeted HbA1c levels were not achieved in the majority of studies, with mean HbA1c levels ranging from 7.6 to 8.9% [6, 7], and a deterioration of HbA1c in adolescent patients [7] was described in all surveys mentioned above. Adolescence and young adulthood is recognized as a time period with high risk of deterioration of metabolic control [10, 11]. Children and adolescents with chronic poor metabolic control are more likely to have psychosocial problems compared to those with good metabolic control [17]. The diabetes regimen seems to be only as good as the ability and motivation of the child and family to manage it, reflecting the role of selfmanagement abilities and family factors for metabolic control [18]. To date there are no studies on the impact of general familial developmental conditions and family relations
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