The Role of Psychological Care in Children and Adolescents with Type-1 Diabetes
Garofalo Alice Maria Valentina*, Cucugliato Maria Cristina, Scelfo Sabrina, Lupo Loredana and La Loggia Alfonso
U.O.D. di Diabetologia e Obesità in Età Evolutiva, Centro di riferimento regionale, ASP Caltanissetta, Caltanissetta, Italy
Submission: July 10, 2019; Published: August 06, 2019
*Corresponding author: Garofalo Alice Maria Valentina, U.O.D. di Diabetologia e Obesità in Età Evolutiva, Centro di riferimento regionale, ASP Caltanissetta, Caltanissetta, Via Malta 71, Caltanissetta, Italy.
How to cite this article: Garofalo A M V, Cucugliato M C, Scelfo S, Lupo L, La Loggia A. The Role of Psychological Care in Children and Adolescents with Type-1 Diabetes. Curr Res Diabetes Obes J. 2019; 11(4): 555816. DOI: 10.19080/CRDOJ.2019.11.555816
Keywords: Psychological care; Children; Adolescent; Diabetes; T1D; Diabetes health care; Pediatric endocrinologist; Psychologist; Glycemic control; Metabolic control; Psychosocial problems
Opinion
Diabetes is a major health-care problem all over the world with a high prevalence and incidence [1,2]. The approach and the management of the disease are challenging, especially in the early stages after diagnosis and in children.
For this reason, a multidisciplinary diabetes team for the management of the disease is recommended [3]. This should include several professional figures, among which the pediatric endocrinologist, the psychologist the dietician and a specialized nurse.
Psychological care for youth diabetic patients is of primary importance and recommended by guidelines [3]. As a matter of fact, children and adolescent with diabetes have a higher incidence of depression, anxiety, psychological distress, and eating disorders than patients without diabetes. These conditions should be early recognized by the psychologist, referred to the team, and treated.
In this regard, international guidelines, suggest that “the diabetes care team should receive training in the recognition, identification, and provision of information and counseling on psychosocial problems related to diabetes” and that “overt psychological problems in young persons or family members should receive support from the diabetes care team and expert attention from mental health professionals”.
Psychological assessment and counseling are also useful in patients without overt psychological problems since they are able to affect the quality of life and disease control [4-6]. A multicenter randomized controlled trial performed on a cohort of 66 teenagers with type 1 diabetes, randomly assigned to motivational interviewing or support visits, found that mean glycated hemoglobin (HbA1c) in the motivational interviewing group was significantly lower than in the control group (p=0.04), showing as this technique is effective method of inducing behavioral changes in teenagers with T1D and the improvement of their glycemic control.
Moreover, a meta-analysis of 21 randomized controlled trials (RCTs) assessing the effect of a psychological therapy on control of diabetes, 10 of them performed on children and adolescents, showed that psychological distress was significantly lower (estimates -0.46, 95% CI -0.83 to -0.10) and the percentage of HbA1c was significantly reduced (estimates -0.35; 95% CI 0.66 to -0.04) in patients receiving a psychological intervention compared to controls [7].
Psychological assessment and intervention should not be directed only to the patient but ideally to the whole family. Family therapy is focused to obtain an improvement of relatives’ interactions and changing problematic familial patterns and relationship hierarchies.
Evidence from literature clearly shows as the health of family relationships and the absence of family conflicts, as well as the cohesion and the collaboration of the family in the management of the disease, positively affect the glycemic control [8-12]. The effectiveness of family therapy for youth with type 1 diabetes (T1D) is confirmed by a systematic review of 25 RCTs showing that family-based interventions appear effective at improving diabetes and family-centered outcomes [13].
In addition, a study performed on 25 children with poorly controlled diabetes, showed that patients receiving family therapy improved their metabolic control and that family-based interventions enhance the health, quality of life, and family functioning of youth with T1D [14].
These evidence from literature, clearly support the importance of psychological care in children and adolescent with T1D and show as the regular intervention directed to the patients and his family positively affect, not only the distress and quality of life but, above all, the glycemic control. For these reasons, a multidisciplinary approach is recommended for children and adolescent with T1D and a regular phycological approach with family-based interventions during outpatient clinic visits is especially in patients with difficulty in adherence to therapy and glycemic control [3].
References
- (2006) Incidence and trends of childhood type 1 diabetes worldwide 1990-1999. Diabet Med 23(8): 857-866.
- Patterson CC, Dahlquist GG, Gyürüs E, Green A, Soltész G (2009) Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study. Lancet 373(9680): 2027-2033.
- Delamater AM, de Wit M, McDarby V, Malik JA, Hilliard ME, et al. (2018) ISPAD Clinical Practice Consensus Guidelines 2018: Psychological care of children and adolescents with type 1 diabetes. Pediatr Diabetes 19(Suppl 27): 237-249.
- Hampson SE, Skinner TC, Hart J, Storey L, Gage H, et al. (2000) Behavioral interventions for adolescents with type 1 diabetes: how effective are they? Diabetes Care 23(9): 1416-1422.
- Laron Z, Galatzer A, Karger S (1982) Psychological aspects of diabetes in children and adolescents. Pediatr Adolescent Endocrinol 10(1): 1-247.
- Delamater AM (2009) Psychological care of children and adolescents with diabetes. Pediatr Diabetes 10(12): 175-184.
- Winkley K, Landau S, Eisler I, Ismail K (2006) Psychological interventions to improve glycaemic control in patients with type 1 diabetes: systematic review and meta-analysis of randomised controlled trials. BMJ 333(7558): 65.
- Hilliard ME, Holmes CS, Chen R, Maher K, Robinson E, et al. (2013) Disentangling the roles of parental monitoring and family conflict in adolescents' management of type 1 diabetes. Health Psychol 32(4): 388-396.
- Sood ED, Pendley JS, Delamater AM, Rohan JM, Pulgaron ER, et al. (2012) Mother-father informant discrepancies regarding diabetes management: associations with diabetes-specific family conflict and glycemic control. Health Psychol 31(5): 571-579.
- Robinson EM, Weaver P, Chen R, Streisand R, Holmes CS (2016) A model of parental distress and factors that mediate its link with parental monitoring of youth diabetes care, adherence, and glycemic control. Health Psychol 35(12): 1373-1382.
- Cameron FJ, Skinner TC, de Beaufort CE, Hoey H, Swift PG, et al. (2008) Are family factors universally related to metabolic outcomes in adolescents with type 1 diabetes? Diabet Med 25(4): 463-468.
- Rohan JM, Rausch JR, Pendley JS, Delamater AM, Dolan L, et al. (2014) Identification and prediction of group-based glycemic control trajectories during the transition to adolescence. Health Psychol 33(10): 1143-1152.
- Feldman MA, Anderson LM, Shapiro JB, Jedraszko AM, Evans M, et al. (2018) Family-Based Interventions Targeting Improvements in Health and Family Outcomes of Children and Adolescents with Type 1 Diabetes: a Systematic Review. Curr Diab Rep 18(3): 15.
- Rydén O, Nevander L, Johnsson P, Hansson K, Kronvall P, et al. (1994) Family therapy in poorly controlled juvenile IDDM: effects on diabetic control, self-evaluation and behavioural symptoms. Acta Paediatr 83(3): 285-291.