title: Psychosocial burden and glycemic control during the first 6 years of diabetes: results from the SEARCH for Diabetes in Youth study.
abstract: OBJECTIVE
  To evaluate the psychosocial burden of adolescents with diabetes, determine the trajectory of psychosocial burden, and examine the interdependent relationships between psychosocial burden and glycemic control across the first 6 years of diabetes.
  
  
  METHODS
  Data from SEARCH for Diabetes in Youth, an observational study of U.S. children diagnosed with diabetes before the age of 20, were collected during study visits conducted at baseline and then at 12, 24, and 60 months after baseline. Blood was drawn, clinical and demographic information was collected, and psychosocial burden was evaluated using standardized depression and generic and diabetes-specific health-related quality of life (QOL) surveys.
  
  
  RESULTS
  Among the 1,307 adolescents (mean age, 14.1±2.5 years) with baseline data, 1,026 had type 1 diabetes and 281 had type 2 diabetes. For those with a 60-month follow-up visit, glycated hemoglobin (A1c) values rose 1.5% from baseline (type 1, 7.7%-9.3% and type 2, 7.3%-8.8%). Adolescents with type 2 diabetes reported more depression and poorer QOL than adolescents with type 1 diabetes. For each diabetes type, there were similar baseline risk factors for higher A1c values: longer diabetes duration, ethnic minority status, and declining diabetes QOL (p < .05). However, youth with type 2 diabetes had higher A1c values with increasing generic QOL, an unexpected finding. Younger adolescents with type 1 diabetes had higher A1c values at the end of the study.
  
  
  CONCLUSIONS
  Significant deterioration in glycemic control marks the first 6 years of diabetes for adolescents. Psychosocial burden, particularly poor diabetes-specific QOL, is a contributor to suboptimal glycemic outcomes.
authors.affiliation: Department of Pediatrics, University of California, San Francisco, San Francisco, California. Electronic address: hoodk@peds.ucsf.edu.
authors.forename: Korey K
authors.initials: KK
authors.lastname: Hood
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Beavers
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington.
authors.forename: Joyce
authors.initials: J
authors.lastname: Yi-Frazier
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Ronny
authors.initials: R
authors.lastname: Bell
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, Colorado.
authors.forename: Dana
authors.initials: D
authors.lastname: Dabelea
authors.affiliation: Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Mckeown
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Lawrence
mesh_terms: D000293:Adolescent; D001786:Blood Glucose; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000208:ethnology / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000208:ethnology / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008913:Minority Groups; D011788:Quality of Life
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Adolescent; Depression; Glycemic control; Pediatric diabetes; Psychosocial burden; Quality of life; Type 1 diabetes; Type 2 diabetes