Symptoms of Emotional, Behavioral, and Social Difficulties in the Danish Population of Children and Adolescents with Type 1 Diabetes -Results of a National Survey

Abstract Objective: To assess the prevalence of psychological difficulties in Danish children and adolescents with type 1 diabetes using both child/adolescent and caregiver reports, and to investigate associations between these symptoms and metabolic control, adherence, and quality of life. Results: Children with diabetes generally reported a lower level of symptoms of depression and anxiety, while older adolescents in most cases were comparable to the normative samples. However, the numbers of patients with elevated scores were similar to normative groups, especially regarding the proportion of participants with 'Extremely elevated' scores. Caregivers of children and adolescents with diabetes generally reported the prevalence of elevated scores on the SDQ to exceed the prevalence observed in the norm sample -particularly with regard to older boys. Both BYI-Y and SDQ responses were significantly correlated with HbA 1c , adherence, and quality of life. Research Design and Conclusions: This study finds Danish children and adolescents with diabetes to report lower or comparable levels of emotional difficulties compared to norms, while caregiver reports are less positive. The results therefore support the value of a multi-informant approach to the assessment of symptoms of psychological difficulty in girls and boys with diabetes

Percentage of participants with elevated scores compared with normative sample.

<p>Significance level; <i>p</i> = 0.05. In the parentheses the upper and lower 95% confidence interval of the proportions are provided.</p

Correlations between outcome variable, socio-demographic, and treatment-related variables and BDI-Y, BAI-Y, and SDQ scores.

<p>* = <i>p</i><0.05.</p><p>** = <i>p</i><0.01.</p

Residual β-Cell Function and the Insulin-Like Growth Factor System in Danish Children and Adolescents With Type 1 Diabetes

Context: C-peptide-positive adults with type 1 diabetes (T1D) have higher circulating total and free IGF-1 and lower IGF binding protein 1 (IGFBP-1) than C-peptide-negative patients. Whether this is also the case in children remains unknown. Objective: The objective of the study was to examine the IGF system in children/adolescents with and without residual β-cell function (RBF). Design and Patients: This was a cross-sectional study containing 136 prepubertal (hereof 15 RBF positive) and 206 pubertal (hereof 42 RBF positive) children/adolescents with T1D for 3–6 years as well as 40 prepubertal and 30 pubertal healthy controls. RBF was evaluated by meal-stimulated C-peptide. Main Outcome Measures: Fasting serum levels of bioactive IGF (ie, the ability of serum to activate the IGF-1 receptor in vitro), total IGF-1, total IGF-2, and IGFBP-1 and -3. Results: Irrespective of pubertal status, patients with T1D showed lower bioactive IGF and total IGF-1, but higher IGFBP-1 as compared with controls (P &amp;lt; .05). When stratified according to RBF status, a positive RBF was associated with normalization of all IGF-related peptides but IGFBP-1 in prepubertal children (P &amp;lt; .05), whereas none of the IGF components were normalized in prepubertal, RBF-negative children. In pubertal children, total IGF-1 and bioactive IGF remained subnormal and IGFBP-1 supranormal, irrespective of RBF status (P &amp;lt; .05). Conclusion: Independent of pubertal status, T1D was associated with an abnormal IGF system. However, a positive RBF status appeared important but only in prepubertal children, in whom all IGF components but IGFBP-1 were normalized. We speculate that the pubertal GH surge induces insulin resistance, which overrides the stimulatory effect that an RBF may exert on the liver-derived IGF system. </jats:sec