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