Psychological care lowers severe hypoglycemia rate for children with type 1 diabetes
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Children with type 1 diabetes who received continued psychological care had a decrease in severe hypoglycemic episodes and stable glycemic control during 2 years of follow up, according to a study published in Pediatric Diabetes.
“International consensus guidelines recommend easy accessibility of psychosocial care for children and adolescents with type 1 diabetes and their families,” Angela Galler, MD, PhD, in the department of pediatric endocrinology and diabetology at Charité – Universitätsmedizin, in Berlin, Germany, and colleagues wrote. “Considering the inconclusive data about psycho-educational interventions and the presumed positive effect of psychological care on glycemic control, rate of DKA and hospital admissions, we see a need to examine the outcome of psychological care in a real-world-setting.”
Galler and colleagues analyzed real-world data on 31,861 children and adolescents with type 1 diabetes living in Germany who participated in a prospective diabetes survey that provided information about psychological care from 2009 to 2017. Among the cohort, 12,326 received psychological care and 19,535 did not. For 3,260 participants who received psychological care, details on duration of care during 1 year were available: 65% received short-term care, 11% had continued care and 24% had both short-term and continued care. Rates of severe hypoglycemia were similar between the groups. A psychiatric diagnosis was available for 2,125 of those in the psychological care group: 40% had attention deficit hyperactivity disorder, 30% had depression, 16% had anxiety disorders and 10% had an eating disorder.
Researchers used case control propensity-score matching to compare participants with similar baseline characteristics. Data points included age, sex, migratory background, diabetes duration, BMI, treatment strategy, insulin dose, HbA1, and severe hypoglycemia, DKA, microalbuminuria, retinopathy and hospital admission rates.
During the year prior to beginning psychological care, participants in the psychological care group had higher HbA1c (8% vs. 7.7%, P < .001) and more episodes of DKA (.032 per patient-year) vs. than those without psychological care (.021, P < .001).
The researchers further matched participants with similar baseline HbA1c levels to compensate for the higher median HbA1c among those with continued psychological care. When HbA1c was included in the matching, researchers found participants receiving continued psychological care (n = 270) and those not receiving psychological care (n = 1,350) both had a 0.1% increase in HbA1c levels (P = .49) at 2 years. However, participants receiving continued psychological care had a 5.6% decrease in severe hypoglycemia, whereas those without psychological care had a 0.3% increase (P = .009).
“In our opinion, overall outcome improved because continued psychological care was associated with stable glycemic control and decreased frequency of severe hypoglycemia,” researchers wrote. “A probable explanation for the decreased rate of severe hypoglycemia is that in a real-world setting psychological care is often combined with educational interventions. In Germany, diabetes education programs comprise educational as well as psychosocial contents. Therefore, non-psychological interventions, for instance educational interventions and knowledge-based teachings, might had an additional positive effect on outcome parameters.”
Researchers wrote that further analysis examining parameters such as quality of life and subgroups featuring children with different psychiatric disorders can enhance the findings in the future.
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