title: Psychosocial predictors of acute complications of diabetes in youth.
abstract: In this paper we determine whether individual and family psychosocial functioning predicts the risk for recurrent acute diabetic complications. An onset-cohort of 61 children and adolescents with Type 1 diabetes received conventional diabetes care. Episodes of ketoacidosis and of severe hypoglycemia were recorded for 8 years, and glycaemic control was measured by glycohaemoglobin. Measures of psychosocial functioning of the patient and parents were obtained during the first year. Over 8 years, 28% of subjects had at least one episode of ketoacidosis, and 21% had at least one episode of hypoglycaemia. The odds of observing recurrent hypoglycaemia versus recurrent ketoacidosis was 14 times greater in boys than in girls (Fisher's exact test p < 0.05). Girls with recurrent ketoacidosis had more behaviour problems and lower social competence, they reported higher levels of family conflict, and their parents reported lower levels of family cohesion, expressiveness and organization in year one. These relationships were independent of any association with poor glycaemic control. Recurrent hypoglycaemia in boys was generally unrelated to individual and family functioning or glycohaemoglobin. Despite our small sample size, our findings are suggestive of relationships that may lead to early identification of patients who are prone to recurrent ketoacidosis, and to the development of early intervention strategies.
authors.affiliation: Department of Pediatrics, Joslin Diabetes Center, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Dumont
authors.forename: A M
authors.initials: AM
authors.lastname: Jacobson
authors.forename: C
authors.initials: C
authors.lastname: Cole
authors.forename: S T
authors.initials: ST
authors.lastname: Hauser
authors.forename: J I
authors.initials: JI
authors.lastname: Wolfsdorf
authors.forename: J B
authors.initials: JB
authors.lastname: Willett
authors.forename: J E
authors.initials: JE
authors.lastname: Milley
authors.forename: D
authors.initials: D
authors.lastname: Wertlieb
mesh_terms: D000293:Adolescent; D015415:Biomarkers; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000523:psychology*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology* / Q000523:psychology; D005190:Family; D005220:Fathers; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology*; D007398:Interpersonal Relations; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D009035:Mothers; D012008:Recurrence; D012307:Risk Factors; D012649:Self Concept; D012727:Sex Characteristics; D012917:Social Adjustment; D012919:Social Behavior; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin