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Psychosocial screening in children and adolescents with type 1 diabetes
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Date
2025
Authors
Hennessy, Elena
Journal Title
Journal ISSN
Volume Title
Publisher
University College Cork
Published Version
Abstract
Management of Type 1 Diabetes (T1D) in children and adolescents is challenging. Psychological and social factors may explain why many young people fail to adequately control their diabetes. Research examining the potential benefits of introducing psychosocial screening into routine clinical care is lacking.
This study aimed to evaluate the utility of psychosocial screening incorporated into routine clinical practice, and its association with glycaemic control, risk of emotional distress (ED), and quality of life in children and adolescents with T1D. It also aimed to evaluate the prevalence of high-risk patients for poor glycaemic control, for ED (depression and anxiety), and its association with quality of life (QoL).
Methods
Over 2 years, a cohort of 245 children and adolescents with T1D was assessed prospectively in six regional centres in Ireland. Two screening tools were used to identify psychosocial issues in children and adolescents with T1D. The Risk Index for Poor Glycaemic Control questionnaire (RIPGC) is the first validated screening tool that allows estimation of psychosocial risk for poor glycaemic control and diabetes ketoacidosis (DKA) in children and adolescents with T1D. RIPGC provides low, moderate, and high risk categories. The Paediatric Index for Emotional Distress questionnaire (PIED). This screening tool identifies children with T1D at high risk of ED. The Paediatrics Quality of Life Inventory (PaedsQoL) is a well-known validated tool that has been used to measure health-related quality of life in children and adolescents with T1D. There were two-time points of PIED and RIPGC screening: at baseline T0 and follow-up T1. Follow-up assessments (RIPGC and PIED) were conducted for approximately 30% of the cohort, during the 12-24 month post baseline measurements, and HbA1C levels were recorded for 200 from patient charts.
Results
Total data from 245 patients from six regional hospitals were analysed in this study. The mean age was 11.75±3.5SD years and the mean HbA1c was 65.8±12.8 mmol/l. There were 52.7% of males in the cohort. The median time to follow up was 14.5 months (Q1, Q3:12.9, 17), range 12-24 months. The internal reliability was adequate for the RIPGC tool (α=0.68) and very good level for the PIED tool (α=0.85) in our study cohort.
The percentage of patients at high and moderate RIPGC risk for poor glycaemic control was over 40% at the baseline (T0).
The regression model had an acceptable fit; but the overall performance of the RIPGC model in predicting poor glycaemic control was below the acceptable level (AUC=0.634, p=0.007 at T0, AUC=0.693, at T1). The best model predicting poor glycaemic control at one year (T1) was the combination of RIPGC, Age and HbA1c at baseline (T0). Therefore its clinical utility in predicting poor control in the following year was improved (AUC=0.892, p<0.001).
There was an upward trend in the mean HbA1c, increasing from low to high RIPGC risk (p=0.017). We confirmed that glycaemic control was higher in the high RIPGC risk children when compared to the low RIPGC risk group at T0 (70.2 vs 63.8 mmol/mol, p=0.020, Hedges’ g= 0.51) and at T1 (71.5±14.7 vs 63.1±10.9, 95% CI: 2.07, 14.7, p=0.007, Hedges g= 0.7).
Based on the PIED score, 7.9% of children were at high risk for ED (anxiety - 12.8% and depression - 16.7%) with significantly higher rates in female adolescents (anxiety – 22% and depression - 25%). The prevalence of high PIED risk was significantly higher in patients at high and moderate RIPGC risk when compared to the low RIPGC risk. No difference in glycaemic control was found between children with T1D at low and high PIED risk, anxiety risk, and depression risk at both T0 and T1. Reduced PaedsQoL scores were found in patients at high RIPGC risk (p<0.001) and high PIED risk (p<0.001). In our study lower PaedsQoL score was associated with poorer glycaemic control (p=0.01), female gender (p=0.014), and social factors such as parental unemployment (p=0.005).
Conclusion:
This study demonstrates how incorporating screening tools into the routine Paediatric Diabetes Clinic in order to identify children and adolescents with psychosocial issues is beneficial. The RIPGC, PIED and QOL questionnaires are useful, practical and reliable tools.
We found that the RIPGC score is associated with poor glycaemic control. The clinical utility of the RIPGC model in predicting poor glycaemic control in the following year was improved by adding the age and HbA1c.
We identified patients at high risk of ED using the PIED tool. Our study demonstrated that adolescent girls with T1D are more prone to develop symptoms of anxiety and depression. No association between glycaemic control and risk of ED was found in children with T1D. Significantly lower QoL was found in patients at high RIPGC risk and at high PIED risk.
With high numbers of children and adolescents with T1D in Ireland and the lack of Clinical Psychologists in Regional Centres; these results indicate the need for more Clinical Psychologists as a part multidisciplinary team approach for children with T1D and psychosocial risk. While this work will need to be expanded in a larger cohort, we recommend Psychosocial Risk screening for all children with T1D Nationally.
Description
Keywords
Type 1 diabetes , Emotional distress , Psychosocial screening , Quality of life
Citation
Hennessy, E. 2025. Psychosocial screening in children and adolescents with type 1 diabetes. MD Thesis, University College Cork.