Poor prognosis of young adults with type 1 diabetes: a longitudinal study.

Journal article

OBJECTIVE: To determine the role of early behavioral and psychological factors on later outcomes in young adults with childhood- or adolescent-onset type 1 diabetes. RESEARCH DESIGN AND METHODS: We conducted a longitudinal cohort study of patients recruited from the register of the young adult outpatient diabetes clinic, Oxford, U.K. A total of 113 individuals (51 male subjects) aged 17-25 years completed assessments, and 87 (77%) were reinterviewed as older adults (aged 28-37 years). Longitudinal assessments were made of glycemic control (HbA(1c)) and complications. Psychological state at baseline was assessed using the Present State Examination and self-report Symptom Checklist, with corresponding interview schedules administered at follow-up. RESULTS: There was no significant improvement between baseline and follow-up in mean HbA(1c) levels (8.5 vs. 8.6% in men, 9.3 vs. 8.7% in women). The proportion of individuals with serious complications (preproliferative or laser-treated retinopathy, proteinuria or more severe renal disease, peripheral neuropathy, and autonomic neuropathy) increased from 3-37% during the 11-year period. Women were more likely than men to have multiple complications (23 vs. 6%, difference 17%, 95% CI 4-29%, P = 0.02). Psychiatric disorders increased from 16 to 28% (20% in men, 36% in women at follow-up, difference NS), and 8% had psychiatric disorders at both assessments. Baseline psychiatric symptom scores predicted follow-up scores (beta = 0.32, SE [beta] 0.12, P = 0.008, 95% CI 0.09-0.56) and recurrent admissions with diabetic ketoacidosis (odds ratio 9.1, 95% CI 2.9-28.6, P < 0.0001). CONCLUSIONS: The clinical and psychiatric outcome in this cohort was poor. Psychiatric symptoms in later adolescence and young adulthood appeared to predict later psychiatric problems.

Authors: Bryden, K; Dunger, D; Mayou, R; Peveler, R; Neil, H

• Journal: Diabetes care
• Volume: 26
• Issue: 4
• Pages: 1052-1057
• Publication date: 2003-04-01
• DOI: 10.2337/diacare.26.4.1052
• EISSN: 1935-5548
• ISSN: 0149-5992
• Language: English
• Keywords: Adolescent; Follow-Up Studies; Registries; Humans; European Continental Ancestry Group; Diabetes Mellitus, Type 1; England; Longitudinal Studies; Hemoglobin A, Glycosylated; Prevalence; Diabetic Retinopathy; Treatment Outcome; Diabetic Neuropathies; Age Factors; Prognosis; Adult; Cohort Studies; Diabetic Nephropathies