In the years after being diagnosed with diabetes, adolescents struggling with social and psychological burdens of managing the disease are likely to do a worse job of controlling it, according to a new US study.
Teens who reported a lower quality of life were more likely to have rising levels of haemoglobin A1c, a marker of elevated blood sugar over time and a sign of poor diabetes control.
"We need to intervene from a prevention standpoint," said Korey Hood, a psychologist at the University of California, San Francisco and lead author of the study. "We need to do systematic screening of these psychosocial issues."
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Teens who are psychologically stressed are less likely to take care of themselves, which could explain the rise in A1c levels, added Michael Scharf, a psychiatrist at the University of Rochester Medical Centre who was not involved in the study.
By catching the problem early, it might be possible to keep the disease from getting worse, he told Reuters Health.
"When I see them, people are stressed out by how sick they are," Scharf said. "The sad part is that if we could have intervened earlier we may have been able to help prevent the negative medical consequences of poorly controlled diabetes."
Damage throughout the body
The new study followed youth with either type 1 or type 2 diabetes for about six years from the time they were diagnosed. Type 1 diabetes, formerly known as juvenile diabetes, typically appears in childhood or adolescence and results from a failure to make insulin, a hormone that helps the body use blood sugar for energy.
Type 2 diabetes, more commonly seen in adults and often linked to obesity, happens when the body makes insulin but is unable to use it. Over time, too much sugar in the blood can cause damage to the eyes, kidneys and to nerves throughout the body. Too little blood sugar can lead to coma.
Altogether, about 151 000 people younger than 20 years old in the US have diabetes, according to the Centres for Disease Control and Prevention. Out of the general population in 2009, 19 kids per 10 000 had type 1 diabetes and 3 per 10 000 had type 2 diabetes.
Managing the disease is similar for kids with type 1 and type 2, and particularly in type 1 it involves taking insulin daily to keep blood sugar levels steady. For kids with type 2 disease, there's more focus on diet, exercise and medications, according to Hood and his co-authors.
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Past research has shown that young people with diabetes are more prone than their peers without the disease to experience psychosocial difficulties in general and depression in particular. Hood and his colleagues wanted to find out if those problems affected the teens' ability to manage their blood sugar.
Poor quality of life
They analysed medical records and interviews for 1 307 kids who were over age 10 at the beginning of the study period and had been diagnosed within the previous year. The researchers then followed the children's mental and physical health, looking for connections between the two.
Across the entire group, A1c levels rose by about 1.5% over the study period.
Among the teens who reported poor quality of life related to their disease – such as diabetes causing difficulties with their social life or school performance – A1c levels tended to run higher than in kids without quality of life issues.
A1c was also higher among kids whose quality of life worsened from the start of the study period to the end, according to the findings published in the Journal of Adolescent Health.
Teens with type 2 diabetes tended to be worse off in general, reporting more mental health issues, including depression, and a lower quality of life than the kids with type 1 disease, the researchers note.
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The constant presence of health problems could isolate teens from their peers and make them feel frustrated, said Ingrid Libman, a paediatric endocrinologist at the Children's Hospital of Pittsburgh.
However, the mental health differences could also be caused by outside stress. Adolescents with type 2 diabetes are often born into families who are poor and don't have insurance. Either way, Hood said, teens and their relatives could benefit from counselling.
"I hope that a study like this can help raise awareness that monitoring a patient and a family's stress level should really be part of care before it becomes a problem," Scharf said.
Hood and his team say doctors should talk to teens about their quality of life and mental health issues at every check up.
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