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Routine Psychological Screening in Youth With Type 1 Diabetes and Their Parents

A notion whose time has come?

¹ Department of Endocrinology and Diabetes, Royal Children's Hospital, and Murdoch Children's Research Institute, Melbourne, Victoria, Australia
² Department of Psychology, Royal Children's Hospital and the University of Melbourne, Melbourne, Victoria, Australia
³ Department of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
⁴ Division of Endocrinology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada

Address correspondence and reprint requests to Fergus J. Cameron, Head of Diabetes Services, Royal Children's Hospital, Parkville, Melbourne, Victoria 3052, Australia. E-mail: fergus.cameron@rch.org.au

Abbreviations: BGM, blood glucose monitoring • CHQ, Child Health Questionnaire • DCCT, Diabetes Control and Complications Trial • DQOL, Diabetes Quality of Life • EDIC, Epidemiology of Diabetes Interventions and Complications • HRQOL, health-related quality of life • PedsQL, Pediatric Quality of Life Inventory

The first 300 words of the full text of this article appear below.

	INTRODUCTION

 
In the post-DCCT (Diabetes Control and Complications Trial) (1) and -EDIC (Epidemiology of Diabetes Interventions and Complications) (2) eras, considerable effort has been expended on early detection and treatment of diabetes-related microvascular complications in youth using screening programs. Numerous consensus statements have been generated relating to the timing, frequency, and content of such programs (3–7). Although each recommends a slightly different approach to screening, the same basic principles apply—achieve and maintain excellent glycemic control; reduce known and modifiable risk factors, such as smoking, obesity, hyperlipidemia, and hypertension; and screen for nephropathy and retinopathy on a regular basis following the inset of puberty.

To be considered successful, any screening program must satisfy several criteria (8):

• Is the prevalence of the condition being screened for high enough to warrant universal screening?
  
• Do the tests used by the screening program have sufficient specificity and sensitivity to allow for appropriate detection of true positive cases?
  
• Is there an adequate intervention strategy for those patients detected by the screening process?
  
• Is the screening process cost-effective?
  

Certainly, given what we know about microvascular complications and their progression and treatment, universal diabetes complication screening programs satisfy most of these prerequisites. Ten years after the DCCT, average levels of metabolic control have improved in most clinical reports of children and adolescents with type 1 diabetes, although population-based data remain scanty and perhaps less optimistic (9–14). Contemporary clinic-based reports of microvascular complication rates in adolescence have shown a concomitant improvement (15–18).

On the other hand, reports relating to health-related quality of life (HRQOL) and psychological outcomes have been distressingly suboptimal (19–24). Although not all studies report significant associations (25–27), there are a number . . . [Full Text of this Article]

	Is the prevalence of psychosocial distress in youth with type 1 diabetes sufficiently high enough to warrant universal screening?

 
Functional health (HRQOL).
Psychological outcomes.
Psychological adjustment and metabolic control.
Family dynamics.

	Do the tests used by the screening program have sufficient specificity and sensitivity to allow appropriated detection of true positive cases?

 

	Is there an adequate intervention strategy for those patients detected by the screening process?

 

	Is the screening process cost-effective?

 

	Conclusions

 

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				M. E. Hilliard, M. Goeke-Morey, F. R. Cogen, C. Henderson, and R. Streisand Predictors of Diabetes-related Quality of Life after Transitioning to the Insulin Pump J. Pediatr. Psychol., June 27, 2008; (2008) jsn062v2. [Abstract] [Full Text] [PDF]

				M. de Wit and F. J. Snoek Routine Psychological Screening in Youth With Type 1 Diabetes and Their Parents: a Notion Whose Time Has Come?: Response to Cameron et al. Diabetes Care, March 1, 2008; 31(3): e14 - e14. [Full Text] [PDF]

				F. Cameron, E. Northam, G. Ambler, and D. Daneman Routine Psychological Screening in Youth With Type 1 Diabetes and Their Parents: a Notion Whose Time Has Come?: Response to de Wit and Snoek Diabetes Care, March 1, 2008; 31(3): e15 - e15. [Full Text] [PDF]