Diabetes Care, Vol 19, Issue 4 318-323, Copyright © 1996 by American Diabetes Association

ARTICLES

Psychiatric disorder and metabolic control among youths with IDDM. A longitudinal study

M Kovacs, P Mukerji, S Iyengar and A Drash
Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA.

OBJECTIVE: To investigate the longitudinal relationship between psychiatric diagnostic variables and metabolic control among youths with IDDM. RESEARCH DESIGN AND METHODS: A group of 88 youths, 8 to 13 years old at onset of IDDM, were evaluated repeatedly during a 9-year follow-up period, on average, using a standardized psychiatric protocol. Levels of HbA1 were also assessed repeatedly. Psychiatric diagnoses were derived independently of HbA1 values. RESULTS: In univariate longitudinal analyses, the psychiatric diagnosis of noncompliance with medical treatment was significantly related to HbA1 level. There was a trend of an association between any major psychiatric disorder, as well as nondepressive disorder, and HbA1. Interaction terms between IDDM duration (or age) and psychiatric variables were also significantly related to metabolic control. According to the final multivariate model of repeatedly assessed HbA1, noncompliance with medical treatment (irrespective of IDDM duration) and the interaction between nondepressive psychiatric disorder and IDDM duration contributed to worse metabolic control. CONCLUSIONS: We found some support for the hypothesis that psychiatric morbidity negatively affects blood glucose regulation and that its consequences are more marked the longer young patients have had IDDM. We did not confirm the hypothesis that depressive illness has particularly deleterious consequences on metabolic control. Noncompliance with medical treatment and having had nondepressive psychiatric illness in interaction with IDDM duration account for a statistically significant but clinically modest amount of variability in HbA1 over time. The weak relationship among these variables may explain the inconsistent findings in the literature regarding psychiatric morbidity and metabolic control.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				M. J. Naughton, A. M. Ruggiero, J. M. Lawrence, G. Imperatore, G. J. Klingensmith, B. Waitzfelder, R. E. McKeown, D. A. Standiford, A. D. Liese, B. Loots, et al. Health-Related Quality of Life of Children and Adolescents With Type 1 or Type 2 Diabetes Mellitus: SEARCH for Diabetes in Youth Study Arch Pediatr Adolesc Med, July 1, 2008; 162(7): 649 - 657. [Abstract] [Full Text] [PDF]

				Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders Focus, June 1, 2008; 6(3): 379 - 400. [Abstract] [Full Text] [PDF]

				H.-P. Lin, P.-F. Mu, and Y.-J. Lee Mothers' Experience Supporting Life Adjustment in Children With T1DM West J Nurs Res, February 1, 2008; 30(1): 96 - 110. [Abstract] [PDF]

				F. J. Cameron, E. A. Northam, G. R. Ambler, and D. Daneman Routine Psychological Screening in Youth With Type 1 Diabetes and Their Parents: A notion whose time has come? Diabetes Care, October 1, 2007; 30(10): 2716 - 2724. [Full Text] [PDF]

				C. M. McDonnell, E. A. Northam, S. M. Donath, G. A. Werther, and F. J. Cameron Hyperglycemia and Externalizing Behavior in Children With Type 1 Diabetes Diabetes Care, September 1, 2007; 30(9): 2211 - 2215. [Abstract] [Full Text] [PDF]

				P. J. Lustman, M. M. Williams, G. S. Sayuk, B. D. Nix, and R. E. Clouse Factors Influencing Glycemic Control in Type 2 Diabetes During Acute- and Maintenance-Phase Treatment of Major Depressive Disorder With Bupropion Diabetes Care, March 1, 2007; 30(3): 459 - 466. [Abstract] [Full Text] [PDF]

				T. Wysocki and L. Gavin Paternal Involvement in the Management of Pediatric Chronic Diseases: Associations with Adherence, Quality of Life, and Health Status J. Pediatr. Psychol., June 1, 2006; 31(5): 501 - 511. [Abstract] [Full Text] [PDF]

				M. M. Williams, R. E. Clouse, and P. J. Lustman Treating Depression to Prevent Diabetes and Its Complications: Understanding Depression as a Medical Risk Factor Clin. Diabetes, April 1, 2006; 24(2): 79 - 86. [Abstract] [Full Text] [PDF]

				S. B. Leichter Making Outpatient Care of Diabetes More Efficient: Analyzing Noncompliance Clin. Diabetes, October 1, 2005; 23(4): 187 - 190. [Full Text] [PDF]

				K. D. Hesketh, M. A. Wake, and F. J. Cameron Health-Related Quality of Life and Metabolic Control in Children With Type 1 Diabetes: A prospective cohort study Diabetes Care, February 1, 2004; 27(2): 415 - 420. [Abstract] [Full Text] [PDF]

				K. A. Edgar and T. C. Skinner Illness Representations and Coping as Predictors of Emotional Well-being in Adolescents with Type 1 Diabetes J. Pediatr. Psychol., October 1, 2003; 28(7): 485 - 493. [Abstract] [Full Text] [PDF]