The Influence Of Continuous Subcutaneous Insulin Infusion On The Emotional Of Children And Adolescents With Type 1 Diabetes Mellitus And Psychology Of Their Parents

ObjectiveIn recent years,the risk of emotional problems in children and adolescents has been increasing.Children and adolescents with type 1 diabetes mellitus(T1DM),as a high-risk group of emotional problems,It is critical to reduce emotional problems in children and adolescents with T1 DM and to help them grow up healthy.This study was to investigate the effects of continuous subcutaneous insulin infusion(CSⅡ)on blood glucose levels,depression,anxiety of children and adolescents with T1 DM and psychology of their parents.MethodsSeventy-two children and adolescents aged 8-16 years who were under long-term follow-up at the Pediatric Endocrinology Gastroenterology of the Affiliated Hospital of Qingdao University and their parents formed the T1 DM group.They were divided into CSⅡ group(n=40)and multiple daily injection(MDI)group(n=32)based on the mode of intensive treatment.Fifty-eight children and adolescents from the Children’s Health Section of the Affiliated Hospital of Qingdao University and their parents were recruited as the control population during the same period.General information was collected on all children and adolescents including gender,age,primary caregivers and parental education level.The most recent glycated hemoglobin A1c(Hb A1c),duration of currrent treatment mode,frequency of hypoglycemia and diabetic ketoacidosis(DKA)were collected from children and adolescents in the T1 DM group.The emotional status of children and adolescents in T1 DM group and control group was evaluated using Depression Self-rating Scale for Children(DSRS)and the Screen for Child Anxiety Related Emotional Disorders(SCARED)respectively,and Symptom Checklist-90(SCL-90)was used for evaluating the mental health of all parents.Results1.There was no statistical difference between the T1 DM group and the control group in gender,age,primary caregivers and parental education level(P>0.05).2.The average Hb A1 c of T1 DM group was in the optimal level(7.406±1.294)%.The average Hb A1 c was(7.040±1.082)% in the CSⅡ group and(7.863±1.404)% in the MDI group.The level of Hb A1 c in CSⅡ group was significantly lower than that in MDI group(t=2.728,P=0.008).The frequency of hypoglycemia and DKA was significantly lower in the CSⅡ group than that in the MDI group,respectively.(Z=3.533,P<0.001;Z=2.046,P=0.041).3.The detection rate of depression of children and adolescents in T1 DM group was significant increased than that in the control group(31.9% vs 15.5%,χ~2 =4.671,P=0.031).4.The detection rate of depression of children and adolescents were statistically different among CSⅡ group,MDI group and control group(20.0% vs 46.9% vs 15.5%,χ~2=11.591,P=0.003).The depression rate of children and adolescents in MDI group was significantly increased than that in CSⅡ group and control group(all P<0.05).There was no significant difference between CSⅡ group and control group(P>0.05).5.The detection rate of anxiety of children and adolescents was no significant difference between T1 DM group and control group(19.4% vs 13.8%,χ~2=0.730,P=0.393).6.There was no significant difference among CSⅡ group,MDI group and control group(15.0% vs 25.0% vs 13.8%,χ~2=1.994,P=0.369)in the detection rate of anxiety in children and adolescents.7.The positive detection rate of SCL-90 in T1 DM group parents was significantly higher than that in control group parents(31.9% vs 5.2%,χ~2=52.927,P<0.001).The factor scores of obsessive-compulsive symptoms,interpersonal sensitivity,depression,anxiety,hostility,paranoia and psychotic symptoms in T1 DM group parents were very higher than that in control group parents(P<0.05).8.The positive detection rate of SCL-90 was statistically different among CSⅡ group,MDI group and control group(17.5% vs 50.0% vs 5.2%,χ~2=26.126,P<0.001).The positive detection rate of SCL-90 in MDI group parents was significantly higher than that in CSⅡ group parents and control group parents(all P<0.05).But there was no significant difference between CSⅡ group parents and control group parents(P>0.05).Conclusions1.Depression is the predominant emotional problem in 72 children and adolescents aged8-16 years who were under long-term follow-up in our department,and the detection rate of depression is higher than the detection rate of anxiety.The detection rate of depression in T1 DM children and adolescents is higher than that in T1 DM children and adolescents in global.but the detection rate of anxiety in T1 DM children and adolescents is lower than the detection rate reported in China.2.CSⅡ showed good clinical practice implications.The use of CSⅡ can significantly reduce the occurrence of depression in T1 DM children and adolescents,and also reduce the psychological problems of their parents.CSⅡ can improves the mental health of families suffering from T1 DM.3.The HBA1 c of 72 children and adolescents with T1 DM at a good level in this study.The rate of CSⅡ use among T1 DM children and adolescents in this study is 55.6%.The Hb A1 c of T1 DM children and adolescents treated with CSⅡ is significantly better than that with MDI.The frequency of hypoglycemia and DKA in CSⅡ group is also significantly lower than that in MDI group.