56-LB: Trauma and Anxiety Effects on Adherence in Pediatric Type 1 Diabetes Mellitus

• Published in: Diabetes (New York, N.Y.) Vol. 69; no. Supplement_1
• Main Authors: RAJ, RISHI, NGUYEN, MAI, MORALES, ALBA, MEADOWS, AMY L.
• Format: Journal Article
• Language: English
• Published: New York American Diabetes Association 01-06-2020
• Subjects: Aggression; Anxiety; Diabetes; Diabetes mellitus (insulin dependent); Glucose monitoring; Patient compliance; Patients; Pediatrics; Post traumatic stress disorder; Suicidal behavior; Trauma
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/db20-56-LB

Background: Psychiatric factors, such as depression, anxiety, and life stressors, have been shown to negatively affect diabetes adherence and glycemic control in children and adolescents. However, less is known about how trauma exposure and symptoms of post-traumatic stress disorder (PTSD) may impact adherence and glycemic control.
Objectives: Determine the rates of trauma exposure and PTSD symptoms in patients ages 7-21 with type 1 diabetes (T1DM). Examine the relationship between trauma exposure, PTSD, Anxiety, behavioral adherence and glycemic control.
Methods: We enrolled 99 patients (mean age 13.8 ± 3.5 years, 51.5% female) who had been diagnosed with T1DM for at least 6 months and underwent standardized psychiatric screening questionnaires during their clinic visits. HbA1c at goal was defined by HbA1c < 7.5% and behavioral adherence were defined by self-monitoring of blood glucose (SMBG) ≥ 4/day or continuous glucose monitoring (CGM) calibration ≥ 2/day and/or CGM use ≥ 75%. All participants and/or their guardians provided assent and consent. Chi-square tests were used to assess the relationships between trauma, PTSD, anxiety and behavioral adherence. One-way ANOVA was conducted to examine group differences between HbA1c scores and the presence of suicidal ideation.
Results: 38.4% of participants had trauma symptoms and functional impairment. Rates of trauma secondary to accidental injury, medical traumatic stress, natural disaster and witness to family violence were 28.3%, 22.2%, 10.1%, and 6.1%, respectively. Neither trauma exposure nor PTSD predicted diabetes adherence. Anxiety was significantly associated with diabetes nonadherence (p=0.006). The group with suicidal ideation had higher HbA1c compared to the group without suicidal ideation (8.92 ± 1.40 vs. 8.30 ± 1.35, p=0.047).
Conclusions: Although trauma was common among young patients with T1DM, other factors, such as anxiety and suicidal ideation, maybe more important indicators of adherence and glycemic control.