By Lisa Rapaport

(Reuters Health) – Teens with type 1 diabetes may have more emotional distress from managing their condition when their blood sugar is high or they suffer from symptoms of depression, suggests a small study that advocates screening kids at risk for distress.

Researchers examined data on 264 adolescents with type 1 diabetes, the less common form of the disease that typically develops in childhood or young adulthood when the pancreas can’t produce insulin. Teens reported their diabetes-related emotional difficulties at five assessments over 16 months.

Overall, 7.2 percent of the youth reported consistently high levels of diabetes-related distress, which the study team describes as, “the frustration, helplessness, and other negative emotional experiences of managing diabetes.” Another 28 percent reported chronic moderate distress related to managing their disease.

Girls were almost three times more likely than boys to report high or moderate levels of chronic diabetes-related distress, the study found. Teens with depression had twice the risk of chronic distress, and youth with poorly controlled blood sugar had 30 percent greater odds of chronic distress.

“We know that just being diagnosed with diabetes raises a person’s risk for emotional distress,” said lead study author Esti Iturralde, a researcher at Kaiser Permanente Northern California in Oakland.

“This could be related to the physical burdens of caring for diabetes (e.g., frequent blood sugar checks, medications, and constantly monitoring one’s eating and physical activity) and the emotional burdens of having a serious lifelong medical condition,” Iturralde said by email. “It is also possible that the ups and downs of blood glucose from diabetes itself causes wear-and-tear on body systems, making people more vulnerable to depression and other emotional difficulties.”

Less than one-quarter of teens with type 1 diabetes manage to keep their blood sugar within a healthy range, the researchers note in Pediatrics. Left unchecked, dangerously high blood sugar puts these youth at risk for kidney damage, heart disease and other serious complications.

Diabetes can also contribute to conflicts within families, particularly when parents struggle to afford medication or take time off work to get kids to doctor appointments, the study team writes. This, in turn, can make teens feel helpless and frustrated, and contribute to depression and anxiety.

“We believe that the emotional distress that results from all of these diabetes factors makes it more difficult for many people to perform all their diabetes care tasks, and therefore can lead to worsened diabetes health,” Iturralde said.

“Positive coping with diabetes and other positive activities with family and peers can help teens feel better but also help them take better care of their diabetes,” Iturralde added.

About one-third of the teens in the study had consistently low levels of disease-related distress, and another one-third experienced declining distress levels during the study. Participants tended to be less distressed when they had lower blood sugar levels and came from higher-income households.

One drawback of the study is that it included only 19 teens with the most severe levels of chronic diabetes-related distress, which is too small a group to draw broad conclusions about all adolescents with type 1 diabetes, the study authors note. Researchers also lacked data to explore whether any interventions might help ease diabetes-related distress.

Even so, the results should serve as a reminder to parents that managing their own stress, as well as stress levels for their children, is crucial for helping young people live well with type 1 diabetes, said Dr. Jannet Svensson of the Copenhagen University Hospital in Herlev, Denmark.

“There is probably a high correlation between parental stress and the children’s stress,” Svensson, who wasn’t involved in the study, said by email.

Parents can also reassure teens that some fluctuation in blood sugar is normal, Svensson said.

“Help the children to learn to live with some unexplained variation – but just use close monitoring of blood (sugar) to follow up,” Svensson advised. “And learn to build healthy habits – not based on the diabetes diagnosis – but based in healthy living, so all diets and activities are not ‘because you have diabetes’ but because we want you to have a healthy life.”

SOURCE: Pediatrics, online May 1, 2019.