A.

PSYCHOLOGIC CONDITION AND QUALITY OF LIFE IN DIABETIC PATIENT

Young people with diabetes appear to have a greater incidence of depression, anxiety,
psychological distress, and eating disorders compared to their healthy peers. Research findings
indicate that children with type 1 diabetes are at risk for adjustment problems during the initial period
of adaptation after diagnosis. When adjustment problems exist, children are at higher risk for
continued adjustment difficulties. In a 10-yr prospective study from the diagnosis of type 1 diabetes,
adolescents were at high risk for various psychiatric diagnoses; females were more likely than males
to receive a diagnosis, and half of those with a history of poor glycemic control had a psychiatric
diagnosis. Depression and anxiety are related with less frequent glucose monitoring and poorer
glycemic control. Children with recurrent DKA are more likely to have psychiatric disorders than
children in good glycemic control. Poor glycemic control has also been associated with a number of
other psychosocial problems including anxiety, poor self-esteem, and diabetes-distress (Hilliard et
al, 2013).
Social support from parents and other family members is especially important for children
and adolescents with type 1 diabetes. Family members who provide high levels of support for
diabetes care have youngsters who adhere better to their diabetes regimen. It was also noted that
levels of diabetes-specific family support were inversely related to youngsters’ age, with older
children and adolescents reporting significantly less family support for diabetes. Youths may receive
instrumental support from their families and also considerable emotional support from their friends.
When youth attribute negative peer reactions to their self-care, they are more likely to have
adherence difficulties and increased diabetes stress, which in turn worsens glycemic control. Fear
of stigmatization and sense of autonomy appeared to be major barriers withholding adolescents to
solicit required support from peers. Poor peer relations has been associated with decreased regimen
adherence and worse glycemic control over time, while more family support predicted better
glycemic control (Peters et al, 2014).
In this case, patient has average PedsQL score 86, which means his quality of life within
normal limit. The average PedsQL score of the parents 84, which means their son’s quality of life
within normal limit. Generally, children with diabetes rate their own quality of life as similar to their
healthy peers. However, parents tend to rate their child’s quality of life somewhat lower. Boys report
better quality of life as well as youth with longer diabetes duration and those from a better
socioeconomic background. Lower quality of life seems associated with depression and a negative
family environment, especially diabetes conflicts. Less favorable quality of life also appears to be
related with youths’ perceptions that diabetes is upsetting, difficult to manage, and stressful, as well
as fear of hypoglycemia. There is some evidence that better quality of life is associated with better
glycemic control, but the relationship between glycemic control and quality of life appears
modest.Poorer quality of life predicted subsequent poor glycemic control via less frequent blood
glucose monitoring. Quality of life does not appear to be adversely affected by use of the insulin
pump and may be associated with improved quality of life. In addition, use of continuous glucose
monitoring does not seem to adversely affect quality of life (Nieuwesteeg et al, 2012).
The Diabetes Social Support Questionnaire-Family a measure of percieved family support
for aldolescent diabetes care. Items were generated primarily from aldolescent report of supportive
family behaviors and reflect five key areas of diabetes management: insulin administration, blood
glucose testing, meals, exercise, and emotional support. Calculated for the total DSSQ-Family item
such as insulin adminstration, blood glucose testing, and meals has range 15 (very supportive and
frequent). Item exercise and emotional support has range 5 (not supportive but very frequent). The
DSSQ-Family is useful chlinical and research tool for measuring aldolescent perceptions of diabtes-
specific family support. Future interventions should stress family support for management task,
taking into account the aldolescent’s perceptions of supportive behaviors. Scores from the DSSQ-
Family had high internal consistency. Higher frequency and individualized ratings were related to
younger aldolescent age and to more family emotional support and cohesion, but not to friend
support or family conflict (in general). The most supportive family behaviors reflected emotional
support for diabetes (Annette & Karen, 2013).
The Blood Glucose Monitoring Communication (BMCG) questionnaires were disignt to
evaluate affective responses to BMG result by youths and their parents. The BGMC questionnaire
score was 10, with higer scores reflecting the experience of more negative affect. The parent BGMC
questionnaire score was 22. The parent BGMC questionnaire scores was higher than youth scores,
indicating that parents perceived a slightly higher level of negative BGM affect than did children
(Korey et al., 2004).
Children with high life stress tend to have worse glycemic control. Daily stressors faced by
younger children are usually related to friends/peers and siblings, and their coping behaviors include
choosing an alternate activity and taking personal responsibility. Diabetes-specific stress has also
been linked to poor glycemic control. Youths in poor metabolic control are more likely to use the
learned helplessness style and engage in avoidance and wishful thinking in response to stress, while
youths in good glycemic control have high levels of self-efficacy and engage in active coping. Youth
underestimate their own risks while acknowledging greater risks of diabetes attributed to other
youths. Identification and improvements in primary caregivers (mothers’) coping may have the
potential to improve both maternal and adolescent outcomes (Yi-Frazier, 2014).

B. PROGNOSIS OF TYPE 1 DIABETES

Type 1 diabetes (T1DM) is one of the most common endocrine diseases in children. T1DM
is an autoimmune disease deriving from the interaction of genetic, environmental and immunological
factors. The traditional concept is that certain environmental factors could trigger an immune
response against pancreatic B-cells in genetically predisposed individual Glycemic control during
the long-term course of T1DM is known to be prone to the influence of emotional, psychological,
behavioral and socio-economic factors that affect the patient’s adherence to therapy. It is known that
age, the degree of glycemic deterioration and the immune status at the time of the onset of T1DM
are objective factors that can predict the residual B-cell function and the glycemic control 1 year after
diagnosis (Elsamahy et al.,2017).
The present large population-based study shows that in spite of a well-developed health
care system, Sweden, like many other developed mortality in type 1 diabetic pateints before the
development of late complications. There wes young males have higher death rate than female in
general population. In a population study, the analyzed the causes of death where clearly diabetic
ketoacidosis is the most common diabetes-related cause. The majority of onset deaths were
associated with signs of cerebral edema, as was two of the four ketoacidosis death treated in hospital
several years after the of onset of the disease. These were young adults with duration of diabetes
of many year and with access to moern home blood glucose testing. There is still a significant excess
mortality in young type 1 diabetic patients with a short duration, where onset deaths due to
ketoacidosis, especially in young children, are important to prevent (Dahlquist and Kallen, 2005).

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