Adolescents have more difficulty adjusting to life with insulin-dependent (type 1) diabetes when stressed over poorly controlled blood sugar levels or when apprehensive about giving themselves insulin shots, researchers have found.

“Diabetes-related stress plays a critical role in diabetes management and control,” Jamil Ahmad Malik, of VU University, Amsterdam, in the Netherlands, told Reuters Health.

Malik and co-investigator Hans M. Koot assessed diabetes-related quality of life, general well-being, and behavioral and emotional problems reported by 437 adolescents with type 1 diabetes and their family members, and whether these factors influenced diabetes control.

The young people were 11 to 19 years old at the time and had type 1 diabetes for more than 6 years on average, the researchers report in the journal Diabetes Care.

The investigators assessed hemoglobin A1C levels - a key gauge of long-term blood sugar control - in the adolescents to determine how well they had controlled their blood sugar over the previous 2 to 3 months.

Malik and Koot found that poorly controlled diabetes, as evidenced by higher A1C levels, associated with adjustment difficulties, and with lower diabetes-related quality of life and general well-being.

However, disease-related stress - fear of insulin shots, daily blood sugar testing, or blood sugar swings - played a greater role in the adolescents’ adjustment issues than did general stress such as tension with parents, teachers, siblings, and friends, or stress caused by self-esteem issues.

Moreover, tangible support from family and friends, such as helping the adolescents’ follow a meal plan or reminding them to test their blood sugar, did not minimize the impact diabetes-related stress played on the adolescents’ adjustment to having the disease.

These findings, noted Malik, highlight the need for strategies that specifically address diabetes-related stress. The researchers also call for further intervention studies that address diabetes-related stress among adolescents.

SOURCE: Diabetes Care, May 2009