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Low self-rated health tied to high stress, poor glycemic control in teens with diabetes
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Adolescents with type 1 diabetes who self-reported their health as “fair” or “poor” were more likely to have poor diabetes control and high diabetes-related stress and to use insulin injection or pen therapy than adolescents who rated their health as “very good” or “excellent,” according to an analysis of data from the T1D Exchange.
“One in 10 adolescents with type 1 diabetes report that their health is fair or poor rather than good, very good or excellent,” Nada A. Abualula, PhD, MSN, RN, vice dean of the College of Nursing at Taibah University in Medina, Saudi Arabia, told Endocrine Today. “The teens who rate their own health as fair or poor often report having frequent diabetes-related stress, and they are more likely than their peers to have uncontrolled blood glucose levels. Asking teen patients this one simple question — How would you rate your health? — can reveal a lot about their physical and mental wellbeing.”
Abualula and colleagues analyzed data from 5,799 adolescents aged 13 to 18 years at baseline (2010-2012) with type 1 diabetes for at least 1 year, enrolled in the T1D Exchange Clinic Registry (49% girls; 77.5% white; 46.3% aged 16 to 18 years; 64.3% with private or military insurance). At enrollment into the registry, all included participants answered the question, “In general, how would you rate your health?” Responses ranged from “poor” to “excellent” and had a five-point ordinal scale. For regression models, researchers categorized responses into “very good” or “excellent” vs. “poor” or “fair,” with the middle “good” response group excluded so the more extreme answers could be compared. Participants were also stratified by age as early or late adolescents. Based on American Diabetes Association criteria, HbA1c level of 7.6% or greater was classified as poor control.
Within the cohort, 78.8% had poor diabetes control, 92.3% reported low diabetes-related stress and 53.6% used insulin pump therapy.
Most patients reported their health as “very good” (37.6%), “good” (30.4%) or “excellent” (21.7%), whereas 8.9% rated their health as “fair” and 1.4% rated their health as “poor.”
Researchers found that patients who rated their health as fair or poor (n = 600) were more likely to be girls (adjusted OR = 1.7; 95% CI, 1.4-2.1), be aged 16 to 18 years (aOR = 2.1; 95% CI, 1.7-2.5) and be non-white (aOR = 2.7; 95% CI, 2.2-3.4) vs. those who rated their health as very good or excellent (n = 3,439). Additionally, patients who considered themselves in fair or poor health were more likely to have poor diabetes control (aOR = 3.3; 95% CI, 2.4-4.7), report diabetes-related stress as “often” or “very often” (aOR = 6.1; 95% CI, 5.1-7.2) and use injection or pen therapy vs. pump therapy (aOR = 2.1; 95% CI, 1.6-2.4)
“Several recommendations may be suggested by the results of this analysis,” the researchers wrote. “Routine evaluation of adolescents’ self-rated health may reveal important information about health-related stress and about the ability to effectively self-manage diabetes in order to prevent future complications of [type 1 diabetes]. This information can then be used by health care providers to modify patient care plans to reduce stress, increase quality of life and improve glycemic control.”
The researchers noted that certified diabetes educators can also offer strategies for stress management, including coping skills and problem-solving skills, which may also help to improve health-related quality of life for patients.
“When adolescent patients tell their clinical care providers that they feel their health is not good, there are several simple interventions that can help, like switching teens to insulin pumps (if that is clinically appropriate) and helping them implement stress-reduction techniques,” Abualula said. “These changes can improve diabetes management and increase quality of life.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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