Poor prognosis of young adults with type 1 diabetes: a longitudinal study.
OBJECTIVE
To determine the role of early behavioral and psychological factors on later outcomes in young adults with childhood- or adolescent-onset type 1 diabetes.


METHODS
We conducted a longitudinal cohort study of patients recruited from the register of the young adult outpatient diabetes clinic, Oxford, U.K. A total of 113 individuals (51 male subjects) aged 17-25 years completed assessments, and 87 (77%) were reinterviewed as older adults (aged 28-37 years). Longitudinal assessments were made of glycemic control (HbA(1c)) and complications. Psychological state at baseline was assessed using the Present State Examination and self-report Symptom Checklist, with corresponding interview schedules administered at follow-up.


RESULTS
There was no significant improvement between baseline and follow-up in mean HbA(1c) levels (8.5 vs. 8.6% in men, 9.3 vs. 8.7% in women). The proportion of individuals with serious complications (preproliferative or laser-treated retinopathy, proteinuria or more severe renal disease, peripheral neuropathy, and autonomic neuropathy) increased from 3-37% during the 11-year period. Women were more likely than men to have multiple complications (23 vs. 6%, difference 17%, 95% CI 4-29%, P = 0.02). Psychiatric disorders increased from 16 to 28% (20% in men, 36% in women at follow-up, difference NS), and 8% had psychiatric disorders at both assessments. Baseline psychiatric symptom scores predicted follow-up scores (beta = 0.32, SE [beta] 0.12, P = 0.008, 95% CI 0.09-0.56) and recurrent admissions with diabetic ketoacidosis (odds ratio 9.1, 95% CI 2.9-28.6, P < 0.0001).


CONCLUSIONS
The clinical and psychiatric outcome in this cohort was poor. Psychiatric symptoms in later adolescence and young adulthood appeared to predict later psychiatric problems.
Bryden
Kathryn S
KS
Division of Public Health and Primary Health Care, University of Oxford, Oxford, UK.
Dunger
David B
DB
Mayou
Richard A
RA
Peveler
Robert C
RC
Neil
H Andrew W
HA
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000453:epidemiology; D003929:Diabetic Neuropathies / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008137:Longitudinal Studies; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D016896:Treatment Outcome; D044465:White People
D006442:Glycated Hemoglobin