Research Supports Multidisciplinary Approach for Pediatric Diabetes Management

Recently published research from the University of Kentucky College of Medicine and UK HealthCare Barnstable Brown Diabetes Center found high rates of traumatic exposure and post-traumatic stress disorder (PTSD) symptoms in a group of pediatric patients living with Type 1 diabetes. Psychiatric factors are known to negatively affect glycemic control and self-management of diabetes in children and adolescents. However, not much is known about how trauma exposure and PTSD may impact Type 1 diabetes.

With the goal of learning more about those factors, researchers focused on the relationship between trauma exposure, PTSD, anxiety, depression and diabetes self-management. The study published in Diabetes Spectrum looked at 99 participants between the ages of 7 and 21. The participating patients all have Type 1 diabetes and were seen at the endocrinology clinic at the Barnstable Brown Diabetes Center. In addition to assessing each patient’s hemoglobin A1C and diabetes self-management, each patient also underwent standardized psychiatric screening questionnaires during their clinic visits.

The study found that 66% of participants had traumatic exposure, 39% of those also had PTSD symptoms. Researchers found the most common trauma exposure was accidental injury and traumatic medical stress. They also found that when comparing to the goal of treatment as defined by American Diabetes Association guidelines, only 11% of children with Type 1 diabetes achieved glycemic targets and only 40% of participants were checking blood glucose four times a day.

The study ultimately concluded that while trauma was common among youth with Type 1 diabetes, neither trauma nor PTSD was associated with changes to self-management. However, they do believe certain forms of anxiety and suicidal ideation were associated with poor self-management and higher HbA1c.

Rishi Raj, M.D., who is currently the director of Division of Endocrinology, Diabetes and Metabolism at Pikeville Medical Center, helped lead the study during his fellowship at the University of Kentucky.

"Psychiatric conditions such as exposure to trauma, PTSD, depression, anxiety disorders and suicidal ideation are frequent among children with Type 1 diabetes," he said. "Our study provides additional support for pediatric diabetes management to include a multidisciplinary team of social workers, psychologists, or psychiatrists for routine screening, managing underlying psychiatric conditions, and coordinating care with endocrinologists and other diabetes specialists.”

Raj says psychiatric disorders are often underdiagnosed and even less frequently addressed. He says certain psychiatric symptoms, including some symptoms of anxiety, were found to be associated with less frequent blood glucose checking.

“Careful screening and management of underlying psychiatric disorders may help in improving diabetes-related outcomes in pediatric patients with Type 1 diabetes,” he said.

Rishi was joined by several others at UK for this study including Mai Nguyen; Alba Morales Pozzo, M.D.; Meghan Marsac, Ph.D.; Olga Vselvoshakaya, Ph.D.; and lead-author Amy Lynn Meadows, M.D.

This project was supported by a Research Starter Grant from the Kentucky Children’s Hospital – Children’s Miracle Network Research Fund. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.