Psychological care lowers hypos for type 1 kids

Monday, 17 August 2020

Children and teens with type 1 diabetes who received continued psychological care had a decrease in severe hypoglycaemia and experienced stable glycaemic control according to a study published in Paediatric Diabetes.

Having easy access to psychosocial care for children and adolescents with type 1 diabetes and their families will help with the short and long term management of their condition,” said Dr Angela Galler, MD, PhD, paediatric endocrinology and diabetology at Charité – Universitätsmedizin, Berlin.

About the study

Dr Galler and her colleagues analysed data on 31,861 children and teens with type 1 diabetes living in Germany who participated in a survey that provided information about the psychological care they received from 2009 to 2017.

Among those who participated in the survey 12,326 received psychological care and 19,535 did not.

For 3,260 participants who received psychological care, details on duration of care during 1 year were available:

  • 65% received short-term care,
  • 11% had continued care and
  • 24% had both short-term and continued care.

Rates of severe hypoglycaemia were similar between the groups.

A psychiatric diagnosis was available for 2,125 of those in the psychological care group:

  • 40% had attention deficit hyperactivity disorder,
  • 30% had depression,
  • 16% had anxiety disorders and
  • 10% had an eating disorder.

Researchers used case control propensity-score matching to compare participants with similar baseline characteristics. Data points included age, sex, migratory background, diabetes duration, BMI, treatment strategy, insulin dose, HbA1C, and severe hypoglycaemia, Diabetic Ketoacidosis (DKA), microalbuminuria,  retinopathy and hospital admission rates.

Delving into the data

During the year prior to beginning psychological care, participants in the psychological care group had higher HbA1C (8% vs. 7.7%, P < .001) and more episodes of DKA (.032 per patient-year) vs. than those without psychological care (.021, P < .001).

The researchers further matched participants with similar baseline HbA1C levels to compensate for the higher median HbA1c among those with continued psychological care.

When HbA1C was included in the matching, researchers found participants receiving continued psychological care (n = 270) and those not receiving psychological care (n = 1,350) both had a 0.1% increase in HbA1C levels (P = .49) at 2 years.

However, participants receiving continued psychological care had a 5.6% decrease in severe hypoglycaemia, whereas those without psychological care had a 0.3% increase (P = .009).

“In our opinion, overall outcome improved because continued psychological care was associated with stable glycaemic control and decreased frequency of severe hypoglycaemia,” researchers wrote.

“A probable explanation for the decreased rate of severe hypoglycaemia is that in a real-world setting psychological care is often combined with educational interventions.

In Germany, diabetes education programs comprise educational as well as psychosocial contents. Therefore, non-psychological interventions, for instance educational interventions and knowledge-based teachings, might had an additional positive effect on outcome parameters.”

Researchers wrote that further analysis examining parameters such as quality of life and subgroups featuring children with different psychiatric disorders can enhance the findings in the future.

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