Abstract Details

Session title: Childhood and adolescence

Session type: Oral Poster

Track: Epidemiology and Public Health

Presentation number: OP-0123

Abstract title:

Anxiety, depression, glycemic control and wellbeing in poverty associated type 1 diabetes mellitus adolescents in India

Presenting Author: Priya M

Background

Managing a chronic illness can be challenging, and developing effective coping strategies to overcome difficulties is essential for maintaining health, balance and happiness. Type 1 diabetes is one of the most common chronic illnesses of childhood and requires a complex and demanding treatment regimen. General association of psychological disorders with childhood type 1 diabetes is well known. However, while anxiety and depression appear to play an important and complex role in determining adaptation to the disease, their relationship to metabolic control does not yet appear very clear.

Aim

To analyse the potential psychosocial determinants of glycemic control in economically underprivileged type 1 diabetic mellitus adolescents in India.

Method

DISHA: Beginning 1987, 3000 children provided free insulin, syringes, health counseling, 24 h helplines. Since 2006, BG meters and 5-10 strips/month added. Basal bolus insulin [meal time regular + bedtime NPH] 100%.

DISHA + CDiC/LFAC: 2011-ongoing: [Changing Diabetes in Children and Life for a Child with Diabetes] 342 children receiving enhanced support -100 BG strips/ month, limited biochemical evaluations [TSH, quarterly HbA1c, annual urine albumin: creatinine ratio] [Bangalore, India].

Psychosocial evaluation: 84 adolescents (age range 10 - 18 y; mean age 15.4 y ; age of diabetes onset 9.83 y; duration of diabetes mellitus 5.5 y; 37% boys; 52% urban and semi-urban) attending the DISHA Free Diabetes Clinic for the Poor.

Tools:

HADS(1983); Self Care Inventory-R SCI-R(2001);
PAID(2006); KIDSCREEN-27(2004);
Multidimensional Scale of Perceived Social Support(1991);
Self-Esteem(1965);
Emotional Regulation(2003);
General Health Questionnaire-28;
ACOPE(2001); 
FAD(1983)].

Results

Glycemic Control HbAlc % Range N HbAlc % Mean Anxiety Score Depression Score

Better glycemic control (HbAlc <9.1) was associated with lower anxiety, lower hypochondriasis, higher adherence, and lower family dysfunctional behavior. Poor glycemic control (HbA1c > 11) was associated higher anxiety, higher hypochondriasis, lower adherence, and higher family dysfunctional behavior.
Depression scores were highest in the 'Better" control group, compared with 'Poor" control group.

In subgroup analysis, adolescents with 'Good" control (HbA1c <8.1) had lowest anxiety scores (5.56); whereas those with 'Worst" control (HbA1c > 12) had lowest depression scores (5.05) -perhaps reflecting a 'careless, carefree and happy-go-lucky" attitude.

In the 'Better" glycemic control group, there was relatively more preponderance of girls and urban / semi urban adolescents.

Discussion

Optimal psychosocial environment and support are important determinants of better glycemic control and overall health and well-being of adolescents with type 1 diabetes mellitus, even in resource limited settings. Additional studies [models of chronic disease] are necessary to more fully understand the etiology and impact of these disorders in the adolescent population.