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Poor prognosis of young adults with type 1 diabetes: a longitudinal study

Poor prognosis of young adults with type 1 diabetes: a longitudinal study
Poor prognosis of young adults with type 1 diabetes: a longitudinal study
OBJECTIVE—To determine the role of early behavioral and psychological factors on later outcomes in young adults with childhood- or adolescent-onset type 1 diabetes.
RESEARCH DESIGN AND METHODS—We conducted a longitudinal cohort study of patients recruited from the register of the young adult outpatient diabetes clinic, Oxford, U.K. A total of 113 individuals (51 male subjects) aged 17–25 years completed assessments, and 87 (77%) were reinterviewed as older adults (aged 28–37 years). Longitudinal assessments were made of glycemic control (HbA1c) and complications. Psychological state at baseline was assessed using the Present State Examination and self-report Symptom Checklist, with corresponding interview schedules administered at follow-up.
RESULTS—There was no significant improvement between baseline and follow-up in mean HbA1c levels (8.5 vs. 8.6% in men, 9.3 vs. 8.7% in women). The proportion of individuals with serious complications (preproliferative or laser-treated retinopathy, proteinuria or more severe renal disease, peripheral neuropathy, and autonomic neuropathy) increased from 3–37% during the 11-year period. Women were more likely than men to have multiple complications (23 vs. 6%, difference 17%, 95% CI 4–29%, P = 0.02). Psychiatric disorders increased from 16 to 28% (20% in men, 36% in women at follow-up, difference NS), and 8% had psychiatric disorders at both assessments. Baseline psychiatric symptom scores predicted follow-up scores (ß = 0.32, SE [ß] 0.12, P = 0.008, 95% CI 0.09–0.56) and recurrent admissions with diabetic ketoacidosis (odds ratio 9.1, 95% CI 2.9–28.6, P < 0.0001).
CONCLUSIONS—The clinical and psychiatric outcome in this cohort was poor. Psychiatric symptoms in later adolescence and young adulthood appeared to predict later psychiatric problems.
global severity index, urinary albumin-to-creatinine
1935-5548
1052-1057
Bryden, Kathryn
1c7ce647-adb7-4947-913e-10c9f40ff7b2
Dunger, David
0d5ac2b8-5ea9-47b7-8841-a8fba0ae678b
Mayou, Richard
7ca7f16b-746b-49ec-abf5-770a089f5fb3
Peveler, Robert
93198224-78d9-4c1f-9c07-fdecfa69cf96
Neil, H. Andrew W.
ded0352b-edc2-499f-a8b9-51f82489f985
Bryden, Kathryn
1c7ce647-adb7-4947-913e-10c9f40ff7b2
Dunger, David
0d5ac2b8-5ea9-47b7-8841-a8fba0ae678b
Mayou, Richard
7ca7f16b-746b-49ec-abf5-770a089f5fb3
Peveler, Robert
93198224-78d9-4c1f-9c07-fdecfa69cf96
Neil, H. Andrew W.
ded0352b-edc2-499f-a8b9-51f82489f985

Bryden, Kathryn, Dunger, David, Mayou, Richard, Peveler, Robert and Neil, H. Andrew W. (2003) Poor prognosis of young adults with type 1 diabetes: a longitudinal study. Diabetes Care, 26 (4), 1052-1057. (doi:10.2337/diacare.26.4.1052).

Record type: Article

Abstract

OBJECTIVE—To determine the role of early behavioral and psychological factors on later outcomes in young adults with childhood- or adolescent-onset type 1 diabetes.
RESEARCH DESIGN AND METHODS—We conducted a longitudinal cohort study of patients recruited from the register of the young adult outpatient diabetes clinic, Oxford, U.K. A total of 113 individuals (51 male subjects) aged 17–25 years completed assessments, and 87 (77%) were reinterviewed as older adults (aged 28–37 years). Longitudinal assessments were made of glycemic control (HbA1c) and complications. Psychological state at baseline was assessed using the Present State Examination and self-report Symptom Checklist, with corresponding interview schedules administered at follow-up.
RESULTS—There was no significant improvement between baseline and follow-up in mean HbA1c levels (8.5 vs. 8.6% in men, 9.3 vs. 8.7% in women). The proportion of individuals with serious complications (preproliferative or laser-treated retinopathy, proteinuria or more severe renal disease, peripheral neuropathy, and autonomic neuropathy) increased from 3–37% during the 11-year period. Women were more likely than men to have multiple complications (23 vs. 6%, difference 17%, 95% CI 4–29%, P = 0.02). Psychiatric disorders increased from 16 to 28% (20% in men, 36% in women at follow-up, difference NS), and 8% had psychiatric disorders at both assessments. Baseline psychiatric symptom scores predicted follow-up scores (ß = 0.32, SE [ß] 0.12, P = 0.008, 95% CI 0.09–0.56) and recurrent admissions with diabetic ketoacidosis (odds ratio 9.1, 95% CI 2.9–28.6, P < 0.0001).
CONCLUSIONS—The clinical and psychiatric outcome in this cohort was poor. Psychiatric symptoms in later adolescence and young adulthood appeared to predict later psychiatric problems.

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Published date: April 2003
Keywords: global severity index, urinary albumin-to-creatinine

Identifiers

Local EPrints ID: 27539
URI: https://eprints.soton.ac.uk/id/eprint/27539
ISSN: 1935-5548
PURE UUID: 436873a8-9fc2-4193-a2fa-2673c9abf325
ORCID for Robert Peveler: ORCID iD orcid.org/0000-0001-5596-9394

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Date deposited: 27 Apr 2006
Last modified: 27 Feb 2019 01:36

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