Routine Psychological Screening in Youth With Type 1 Diabetes and Their Parents
A notion whose time has come?
- Fergus J. Cameron, MD1,
- Elisabeth A. Northam, PHD2,
- Geoffery R. Ambler, MD3 and
- Denis Daneman, MD4
- 1Department of Endocrinology and Diabetes, Royal Children's Hospital, and Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- 2Department of Psychology, Royal Children's Hospital and the University of Melbourne, Melbourne, Victoria, Australia
- 3Department of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
- 4Division 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{at}rch.org.au
- 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
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):
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Is the prevalence of the condition being screened for high enough to warrant universal screening?
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Do the tests used by the screening program have sufficient specificity and sensitivity to allow for appropriate detection of true positive cases?
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Is there an adequate intervention strategy for those patients detected by the screening process?
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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 of reports showing that psychosocial dysfunction and family conflict are close correlates of poor health …
