Clinical and psychological course of diabetes from adolescence to young adulthood - A longitudinal cohort study

被引:292
|
作者
Bryden, KS
Peveler, RC
Stein, A
Neil, A
Mayou, RA
Dunger, DB
机构
[1] Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford, England
[2] Univ Oxford, Dept Publ Hlth & Primary Care, Oxford OX3 7LF, England
[3] Tavistock Clin, London NW3 5BA, England
[4] Royal Free & Univ Coll, Sch Med, UCL, Leopold Muller Ctr Child & Family Mental Hlth, London, England
[5] Mental Hlth Grp, Southampton, Hants, England
[6] Univ Oxford, John Radcliffe Hosp, Dept Paediat, Oxford OX3 9DU, England
关键词
D O I
10.2337/diacare.24.9.1536
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE - To determine the clinical and psychological course of diabetes through adolescence and the relationship with glycemic control in young adulthood. RESEARCH DESIGN AND METHODS - A longitudinal cohort study of adolescents recruited from the register of the outpatient pediatric diabetes clinic. A total of 76 individuals (43 mate patients, 33 female patients) aged 11-18 years completed baseline assessments, and 65 individuals (86%) were reinter-dewed as young adults (20-28 years of age). Longitudinal assessments were made of glycemic control (HbA(1c)), weight gain (BMI), and development of complications. Adolescents completed sell-report questionnaires to assess emotional and behavioral problems as well as self-esteem. As young adults, psychological state was assessed by the Revised Clinical Interview Schedule and the self-report Brief Symptom Inventory. RESULTS - Mean HbA(1c) levels peaked in late adolescence and were worse in female participants (average 11.1% at 18-19 years of age). The proportion of individuals who were over",eight (BMI > 25.0 kg/m(2)) increased during the 8-year period from 21 to 54% in female patients and from 2 to 28% in male patients. Serious diabetes-related events included death in one patient and cognitive impairment in two patients. Individuals in whom diabetic complications developed (25% of male patients and 38% of female patients) had significantly higher mean HbA(1c) levels than those without complications (difference 1.9%, 95% CI 1.1-2.7, P < 0.0001). Behavioral problems at baseline were related to higher mean HbA(1c) during the subsequent 8 years (beta = 0.15, SEM (beta) 0.04, P < 0.001, 95% Cl 0.07-0.24). CONCLUSIONS - The outcome for this cohort was generally poor. Behavioral problems in adolescence seem to be important in influencing later glycemic control.
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页码:1536 / 1540
页数:5
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