Abstract:
Background: Type 1 diabetes (T1D) is a lifelong condition requiring frequent attention every day. Adolescence is an unavoidable transitional phase when many developmental processes take place and can be fraught with challenges. The COVID-19 pandemic is a catastrophic global event that has reconstructed 'normal life' into a new, unpredictable world. We aimed to assess the impact of T1D on the quality of life (QoL) and psychological well-being of adolescents in Auckland during New Zealand‘s lockdown.
Methods: Adolescents aged 11 – 18 years with T1D were recruited from Auckland‘s paediatric diabetes service and an advertisement in Diabetes Youth Auckland‘s newsletter. Adolescents without diabetes (controls) were family and friends of adolescents with T1D. Participants completed an online questionnaire during lockdown which contained validated questions about QoL (Pediatric Quality of Life Inventory; PedsQL V.4.0TM) and psychological well-being (Youth Self-Report; YSR); those with T1D also completed diabetes-specific questions about disordered eating behaviours (DEB) (Diabetes Eating Problems Survey-Revised; DEPS-R). Parents completed questions about their child‘s QoL (PedsQL parent report).
Results: 33 adolescents withT1D (58% female, mean age 14.1 years, mean T1D duration 6.2 years) and 34 controls (74% female, mean age 14.6 years) completed questionnaires. There was no difference between T1D and control groups with regards to QoL (PedsQL mean total scale score 79.1 vs 79.0, p 0.960 [self-report]; 80.3 vs 80.8, p 0.871 [parent report]) or psychological well-being as per YSR. Within the T1D group, 31% had significant DEB (DEPS-R score ≥ 20). This was associated with higher mean BMI (SDS 1.70 vs 1.07, p 0.029), HbA1c (84.9 vs 66.3 mmol/mol, p 0.030) and TDD of insulin (1.2 vs 1.0 units/kg/day, p 0.023); as well as lower physical QoL (79.4 vs 88.2, p 0.025) and psychological distress, particularly anxiety (44% in clinical/borderline range vs 4%, p 0.017).
Discussion: QoL and psychological well-being were similar among adolescents with and without T1D, and both measures were reasonably high despite being in lockdown. As COVID-19 continues however, problems may emerge and should be watched for. DEB in T1D adolescents is common and screening is recommended in all, particularly those with higher HbA1c, higher BMI and more anxiety.