Teens who reported a lower quality of life were more likely to have
rising levels of hemoglobin 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.”
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 Center 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.”
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
U.S. have diabetes, according to the Centers 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
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.
They analyzed 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 childrens’ mental and physical health, looking for connections
between the two.
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Across the entire group, A1c levels rose by about 1.5 percent 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
The constant presence of health problems could isolate teens from
their peers and make them feel frustrated, said Ingrid Libman, a
pediatric 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 counseling.
“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.
Journal of Adolescent Health, online May 12, 2014.
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