Assessment of Psychopathology, Quality of Life, and Parental Attitudes in Adolescents with Type 1 Diabetes Mellitus

Evaluation of Quality of Life and Psychosocial Problems in Children with Type 1 Diabetes Mellitus

Objectives

To evaluate the frequency of psychosocial problems and the factors affecting the quality of life in children and adolescents aged between 8 and 18 years with type 1 diabetes mellitus (T1DM).

Methods

In the study, children and adolescents aged between 8 and 18 years who had been followed for at least 6 months for T1DM were evaluated (T1DM group), and compared with healthy children and adolescents who applied to the general pediatric outpatient clinic and did not have any chronic disease (control group). Data on disease follow-up of children and adolescents with T1DM were obtained from medical records. Sociodemographic characteristics of both groups were recorded in the study form. In addition, the Children's Depression Inventory (CDI), Screen for Child Anxiety Related Disorders (SCARED) and Children Quality of Life Questionnaire (KINDL: KINDerLebensqualitätsfragebogen) were applied to both groups. The scale scores of the T1DM group and the control group were compared. Factors affecting the scale scores of the T1DM group were evaluated.

Results

A total of 181 children or adolescents, 81 of whom were in the T1DM group and 100 in the control group, were evaluated for this study. The mean age was 13.1±2.4 years in the T1DM group and 12.4±2.1 years in the control group. The mean CDI, SCARED, and KINDL scores, respectively; it was 15.3±7.2, 23.6±11.9, and 53.5±13.7 in the T1DM group and 7.9±6.8, 14.7±13, 60±11.6 in the control group. There was a statistically significant difference between the two groups in terms of mean CDI, SCARED, and KINDL scores (all p values <0.001). As compliance with the diabetic diet decreased at home, there was a significant increase in the mean CDI score (p=0.005) and a significant decrease in the KINDL score (p=0.002). It was observed that KINDL score decreased significantly as compliance with the diabetic diet decreased outside the home (p=0.001).

Conclusion

Quality of life is lower, and levels of depression and anxiety are higher in children with T1DM compared to healthy children. Psychosocial support should be provided from the moment of diagnosis in order to improve the psychosocial problems and quality of life of children with T1DM.

Type 1 Diabetes Mellitus, Psychopathology, Uncertainty and Alexithymia: A Clinical and Differential Exploratory Study

Type 1 diabetes mellitus (T1DM) represents a complex pathology affecting a large number of people. Research suggests that psychological factors influence coping with T1DM. This study aimed to investigate the presence and role of psychopathology, alexithymia and uncertainty in people affected by T1DM. The sample consisted of 137 patients (88 females, 49 males) affected by T1DM aged from 11 to 19 years old (Mean: 13.87; SD: 2.40). The diagnostic protocol consisted of a sociodemographic questionnaire, Self-administration Psychiatric Scales for Children and Adolescents (SAFA), Toronto Alexithymia Scale-20 (TAS-20) and Intolerance to Uncertainty Scale-12 (IUS-12). Descriptive, differential, correlational and regression analyses were performed in order to examine the relationships between these variables. The results suggested the sample had high levels of psychopathological indexes, alexithymia and intolerance of uncertainty. Also, there were significant differences between TAS-20 and IUS-12 distributions with respect to psychopathology. Correlations and multivariate linear regressions indicated age, gender and education significantly predicted alexithymia and intolerance of uncertainty. This data suggest the presence of elevated psychopathology, alexithymia and uncertainty in people with diabetes.

Psychometric properties of the Turkish version of the Diabetes Family Impact Scale

PURPOSE

The objective of this study was to examine the psychometric properties of the Turkish version of the Diabetes Family Impact Scale (DFIS).

METHODS AND DESIGN

The study was carried out methodologically with 121 parents who have 6-18 year-old children with type 1 diabetes (n = 121). The collected data were analyzed by conducting confirmatory factor analysis, t test, and Pearson's correlation analysis and by computing Cronbach's α and intraclass correlation coefficients (ICCs).

RESULTS

The linguistic validity of the scale was ensured by undertaking translation and back-translation. Expert opinions were analyzed and all the content validity indices were found to be ≥0.80. The factor loadings of all the items ranged from 0.47 to 0.89, and the model fit indices were as follows: χ²/df = 1.21 and RMSEA = 0.04. Scores that were obtained across two temporally separated administrations were not significantly different (p > .05), and there was a strong correlation between the two sets of scores (ICC = 0.892; p < .001). The Cronbach's α of the scale was .881. The item-total correlation coefficients of the scale items ranged from .34 to .72.

CONCLUSIONS

Similar to the original assessment, the Turkish version of the DFIS consists of 14 items and 4 subscales. It is a valid and reliable measure that is suitable for use with Turkish samples. Researchers can use this scale to assess the effect of type 1 diabetes mellitus on the family of an affected child.

Possible Associations of Disturbed Neurometals and Ammonia with Glycaemic Control in Type 1 Diabetic Children with Attention Deficit Hyperactivity Disorder

The chronicity of type 1 diabetes mellitus (T1DM) is reported to be associated with various psychological disorders. The current study aimed to evaluate the levels of serum ammonia and various neurometals (zinc, copper, and magnesium) in patients with T1DM with and without ADHD and to correlate their levels with glycaemic status. A prospective case-control study was conducted with 60 diabetic children with T1DM (allocated into a group of 20 patients with a diagnosis of ADHD and a group of 40 patients without ADHD) who were comparable to 60 matched controls. Assays of glucose, glycated haemoglobin (HbA1c), ammonia, zinc, copper, and magnesium were performed. Overall, ammonia and copper levels were significantly higher in the diabetic patients especially those with ADHD than in the control group (p ˂ 0.05 for all). The calculated copper/zinc ratio was significantly higher in the diabetic patient group than in the control group and higher in diabetic children with ADHD than in diabetic children without ADHD (p ˂ 0.05 for all). Diabetic children had significantly lower magnesium levels than the controls (p ˂ 0.05), but no significant difference between the diabetic subgroups was detected. A positive correlation between glycaemic control (HbA1c %) and ammonia level was found in the diabetic group and subgroups, and a positive correlation was found between HbA1c % and the Cu/Zn ratio in diabetic children with ADHD (p ˂ 0.05 for all). The current study confirms an association of elevated ammonia and copper/zinc ratio with poor glycaemic control and ADHD development among children with T1DM.

The effect of attention deficit/hyperactivity disorder and other psychiatric disorders on the treatment of pediatric diabetes mellitus

OBJECTIVE

Psychiatric diagnoses of patients with type 1 diabetes mellitus (T1DM), the severity of attention deficit/hyperactivity disorder (ADHD) symptoms of the patients and their primary caregivers, and the effects of these factors on treatment were investigated.

METHODS

Sixty-one patients with T1DM were included in the study along with their parents. Psychiatric diagnoses of the patients were determined using a semistructured psychiatric interview, and their depression and ADHD symptom severities were evaluated with self-report scales. The ADHD symptom severities of the parents were evaluated using self-report scales. The relationships among the psychiatric symptoms and the hemoglobin A1c (HbA1c), fasting blood glucose (FBG), and postprandial blood glucose (PBG) levels of the patients were investigated.

RESULTS

HbA1c levels were found to correlate with the hyperactivity levels of children and the number of diagnoses they had. FBG and PBG values of patients diagnosed with ADHD were found to be higher than in those who did not have ADHD. HbA1c, FBG, and PBG values of the patients who had any disruptive behavior disorder were found to be higher than in those who did not. ADHD total scores, gender (being female), having diagnoses of ADHD or depression were found to be predictive of HbA1c levels according to the regression analyses. No relationship between the clinical findings of the children and their parents' ADHD levels was found.

CONCLUSIONS

The findings of this study implicate that children with T1DM should be evaluated in terms of ADHD which could have negative effects on the treatment.