Fact Sheet: Type 1 Diabetes Mellitus in Children and Adolescents
Type 1 diabetes mellitus is a lifelong disorder of glucose metabolism due to autoimmune destruction of insulin-producing beta cells in the pancreas. Effective treatment requires insulin replacement via multiple daily injections or use of an insulin pump, blood glucose monitoring several times daily, regulated carbohydrate intake and exercise, and active prevention or correction of abnormally high or low blood glucose levels. Goals of treatment are normalization of blood sugar to within the 70-120 mg/dl range, minimization of both prolonged hyperglycemia and frequent episodes of hypoglycemia, maintenance of good quality of life and prevention of long-term complications (damage to heart, eyes, kidneys and nerves).
Prevalence and Course
Type 1 diabetes affects about one in 500 U.S. children. Adequate diabetes knowledge, skills and treatment adherence, a supportive and organized family environment, and effective diabetes-related communication and problem solving are key influences on diabetes outcomes. Greater proportion of time in the normal range of blood glucose substantially reduces both the onset and progression of major long-term complications.
Health and Psychosocial Consequences
Managing diabetes requires the child and parent(s)/caregivers to share responsibility for daily tasks, and collaborate effectively even into adolescence, Diabetes both affects, and is affected by, psychological adjustment of the child and family members. Youth with type 1 diabetes are at elevated risk of depression, anxiety disorders, eating disorders and diabetes-related distress, as well as possible effects on cognitive function. Transition from pediatric to adult care needs to be planned deliberately to avoid lapses in care.
Key domains of function that warrant ongoing assessment are youth-parent collaboration in diabetes care, family conflict/distress/burnout, treatment adherence, quality of life and psychological disorders. Many structured interview, questionnaire, observation and electronic monitoring methods (blood glucose meter and insulin pump downloads) have been validated. The American Diabetes Association and International Society for Pediatric and Adolescent Diabetes recommend regular psychosocial screening of patients and families.
Culture, Diversity, Demographic and Developmental Factors
Management of type 1 diabetes is more difficult among youth with these demographic characteristics: adolescents, racial/ethnic minorities, recent immigrants, economically disadvantaged families and single parent households. Health literacy and numeracy may mediate these associations.
There have been rigorous randomized controlled trials of psychological interventions targeting adolescents’ coping skills and family-focused interventions targeting parent-youth teamwork, diabetes-related communication, problem solving and conflict resolution. Most of these trials have yielded stronger treatment effects on behavioral outcomes than on objective measures of metabolic control of diabetes.
Anderson, B.J., Brackett, J., Ho, J., & Laffel, L. (1999). An office-based intervention to maintain parent-adolescent teamwork in diabetes management: impact on parent involvement, family conflict, and subsequent glycemic control. Diabetes Care, 22, 713-721.
Delamater, A.M., Davis, S., Bubb, J., Smith, J., Schmidt, L., White, N.H. & Santiago, J.V. (1990). Randomized prospective study of self management training with newly diagnosed diabetic children. Diabetes Care, 13, 241-253.
Ellis, D.A., Frey, M., Naar-King, S., Templin, T., Cunningham, P. & Cakan, N. (2005). Use of multisystemic therapy to improve regimen adherence among adolescents with type 1 diabetes in chronic poor metabolic control: A randomized controlled trial. Diabetes Care, 28(7), 1604-1610.
Grey, M., Boland, E.A., Davidson, M., Li, J., & Tamborlane, W.V. (2000). Coping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life. Journal of Pediatrics, 137, 107-114.
Wysocki, T., Harris, M.A.,Buckloh, L.M., Mertlich, D., Lochrie, A.S., Taylor, A., Sadler, M., Mauras, N., & White, N.H. (2006). Effects of behavioral family systems therapy for diabetes on adolescents' family relationships, treatment adherence and metabolic control. Journal of Pediatric Psychology, 31(9), 928-938.