PSYCHOSOCIAL ISSUES
Denis Daneman,
Professor of Pediatrics, Chief, Division
of Endocrinology,
The Hospital for Sick Children and
University of Toronto, Toronto, Canada
Type 1 diabetes poses a complex therapeutic challenge to
children or adolescents with this disorder and their families. Both
longitudinal and cross-sectional studies provide evidence of a significant
psychosocial upheaval in the first year after diagnosis of diabetes with
return to prediagnosis status. Factors which contribute to adjustment to
and coping with the diabetes include individual and family variables.
Metabolic control is consistently better in children from intact,
economically stable families with high levels of cohesion and organization
and low levels of conflict. In toddlers and preschoolers, psychosocial
stress often is heightened by the inability of the child to articulate
their symptoms and the subsequent fear of hypoglycemia. During adolescence,
noncompliance with aspects of the therapeutic regimen (insulin injections,
blood glucose testing and meal planning) becomes relatively commonplace. In
teenage girls with type 1 diabetes, disturbed eating attitudes and
behaviors occur twice as frequent as in their nondiabetic peers.
Significant psychosocial problems during adolescence may be strongly
predict the expression of depressive symptoms in young adulthood. This presentation will focus on an
analysis of the psychosocial impact of type 1 diabetes from a developmental
viewpoint and will stress the need for excellent diabetes education and
care as essential first steps in preventing or ameliorating problems. All
diabetes health care professionals must be sensitive to the psychosocial
impact of this disorder and be able to detect as early as possible when
further intervention is required.