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      Common Issues Seen in Paediatric Diabetes Clinics, Psychological Formulations, and Related Approaches to Management

      review-article
      1 , , 1 , 2 , 3
      Journal of Diabetes Research
      Hindawi

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          Abstract

          Diabetes is a chronic disease and its management is associated with multiple challenges. This is particularly the case in children and adolescents. Factors that contribute to difficulties in managing diabetes in youth include psychological characteristics, family dynamics, and social behavior. The purpose of this article is to highlight some psychological issues in children and adolescents with diabetes. We aim to present selected case scenarios encountered by health professionals and to provide tips on strategies for managing psychological aspect of diabetes. We tackle the psychological issues related to diabetes under four main categories: maladaptive disorders, eating disorders, family psychopathology, and family dysfunction. Psychotherapy and psychoanalysis are useful modalities in diabetes management. The psychological intervention is aimed at supporting patients and families to reach a balance between a normal family routine and a good glycemic control. We demonstrate unique requirements in coordinating care for children and adolescents with diabetes and highlight the importance of encouraging a positive behavior. Managing diabetes in children and adolescents needs to be in the form of a collaborative work between health care professionals, children and adolescents, and their families. Caring, supportive family backed up by experienced multidisciplinary team is the best approach to prevent psychological difficulties.

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          Most cited references27

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          Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study.

          To determine the prevalence of eating disorders in adolescent females with type 1 diabetes mellitus compared with that in their non-diabetic peers. Cross sectional case-control led study. Diabetes clinics and schools in three Canadian cities. 356 females aged 12-19 with type 1 diabetes and 1098 age matched non-diabetic controls. Eating disorders meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Eating disorders that met DSM-IV criteria were more prevalent in diabetic subjects (36, 10%) than in non-diabetic controls (49, 4%) (odds ratio 2.4, 95% confidence interval 1.5 to 3.7; P<0.001). Subthreshold eating disorders were also more common in those with diabetes (49, 14%) than in controls (84, 8%) (odds ratio 1.9, 95% confidence interval 1.3 to 2.8; P<0.001). Mean haemoglobin A(1c) concentration was higher in diabetic subjects with an eating disorder (9.4% (1.8)) than in those without (8.6% (1.6)), P=0.04). DSM-IV and subthreshold eating disorders are almost twice as common in adolescent females with type 1 diabetes as in their non-diabetic peers. In diabetic subjects, eating disorders are associated with insulin omission for weight loss and impaired metabolic control.
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            The relation between family factors and metabolic control: the role of diabetes adherence.

            To examine family factors as predictors of metabolic control in children with type 1 diabetes and determine whether adherence behaviors mediate this relationship. Participants were 109 children (ages 8-18) and a parent. Measures of diabetes-specific family functioning and an adherence interview were completed. Glycosylated hemoglobin (HbA1c) was the index of metabolic control. Family functioning and adherence were strongly associated with metabolic control. Combined with demographic information, these constructs accounted for 49% of the variance in metabolic control. Age moderated the relation between aspects of family functioning and HbA1c. Path analyses suggest that adherence mediates the relationship between family functioning and metabolic control. Family functioning and adherence behaviors are strongly related to a child's health status. Assessment of diabetes-specific family functioning, in addition to adherence, is an important factor in understanding metabolic control.
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              Psychosocial factors are associated with metabolic control in adolescents: research from the Hvidoere Study Group on Childhood Diabetes.

              , Hilary Hoey (2009)
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                Author and article information

                Contributors
                Journal
                J Diabetes Res
                J Diabetes Res
                JDR
                Journal of Diabetes Research
                Hindawi
                2314-6745
                2314-6753
                2018
                27 February 2018
                : 2018
                : 1684175
                Affiliations
                1Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
                2Medical & Surgical Psychiatry, Kuwait University, Kuwait City, Kuwait
                3Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, VIC, Australia
                Author notes

                Academic Editor: Eusebio Chiefari

                Author information
                http://orcid.org/0000-0003-4090-4672
                Article
                10.1155/2018/1684175
                5848057
                39dd2f39-6e34-4085-ac14-795110842d52
                Copyright © 2018 Asma Deeb et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 3 September 2017
                : 14 November 2017
                : 11 January 2018
                Funding
                Funded by: Ain Shams University
                Categories
                Review Article

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