title: Adolescent life with diabetes-Gender matters for level of distress. Experiences from the national TODS study.
abstract: OBJECTIVE
  To examine the relationship between diabetes distress and gender, and the association with glycemic control, social support, health behaviors, and socio-economic status.
  
  
  METHODS
  All adolescents, aged 15 to 18 years, in the national, pediatric diabetes registry SWEDIABKIDS with type 1 diabetes were invited to complete an online questionnaire. A total of 2112 teenagers were identified.
  
  
  RESULTS
  453 complete responses were valid for analyses. Young women scored significantly higher on the distress-screening instrument DDS-2. Almost half of the female respondents exhibited moderate to severe diabetes distress-more than twice the proportion than among male respondents (44% vs 19%). Females reported twice as high scores on the fear of hypoglycemia scale (P < 0.0001) and had a higher HbA1c value than males (P < 0.0001). Gender was highly correlated with distress level even when controlling for multiple factors that may affect distress (parameterfemale= 0.4, P = 0.0003). Particular social problems were highly significant, that is, those who trust that their parents can handle their diabetes when necessary were significantly less distressed than others (P = 0.018). Higher HbA1c levels were associated with higher distress scores (P = 0.0005 [female], P = 0.0487 [male]).
  
  
  CONCLUSIONS
  Diabetes-related distress is a great burden for adolescents living with diabetes. Actively involved family and friends may reduce diabetes distress, but female adolescents appear to be particularly vulnerable and may need extra focus and support. Our findings indicate that pediatric diabetes teams working with teenagers must intensify the care during this vulnerable period of life in order to reduce the risk of both psychological and vascular complications in young adults.
authors.affiliation: Department of Pediatrics, Institute of Clin Sciences, Sahlgrenska Academy, University of Gothenburg and The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, S-416 85 Gothenburg, Sweden.
authors.forename: Gun
authors.initials: G
authors.lastname: Forsander
authors.affiliation: Incentive, Holte Stationsvej, 14, 1., 2840 Holte, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Bøgelund
authors.affiliation: Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden.
authors.forename: Josephine
authors.initials: J
authors.lastname: Haas
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Pediatrics, Linköping University, Linköping, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Samuelsson
mesh_terms: D000293:Adolescent; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000523:psychology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D005260:Female; D017144:Focus Groups; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D020407:Internet; D008297:Male; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D000072858:Psychosocial Support Systems; D011788:Quality of Life; D012042:Registries; D012306:Risk; D057566:Self Report; D012720:Severity of Illness Index; D012737:Sex Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D013548:Sweden / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: adolescent; diabetes; distress; female; gender