The importance of a psychosocial focus in the treatment and management of type 1 diabetes in children : A comparison between Norway and Australia

ABSTRACT Background Type 1 Diabetes (T1D) is a chronic autoimmune disease in which a selective destruction of the insulin-producing β-cells in the pancreas results in insulin deficiency and hyperglycaemia, thus a dependance on exogenous insulin for survival. It is one of the most common chronic diseases in childhood and adolescence, and the incidence is increasing worldwide. Children and adolescents with T1D are at increased risk of developing psychiatric disorders and many report reduced quality of life. This emphasizes the importance of diabetes care by a highly qualified multidiciplinary team which includes mental health workers. Aim The aim of this study was to illustrate current research on psychosocial care for children and adolescents with T1D around the world, and to compare the diabetes care in Norway and Australia, mainly focusing on the organisation of diabetes teams and their attention towards the patient’s mental health. Methods The thesis is divided in two parts. Part one is a literature review on T1D based on a non-systematic PubMed search, mainly focusing on mental health among children and adolescents with T1D. In part 2, the care for young patients with T1D at Oslo University Hospital (OUH) in Oslo, Norway, Royal Children´s Hospital (RCH) in Melbourne, Australia, Alice Springs Hospital (ASH) in Alice Springs, Australia and John Hunter Hospital (JHH) in Newcastle, Australia is presented. The discussed results are based on information gathered using a standardized electronic questionnaire on T1D, based on international guidelines for diabetes care, and personal experiences. Results At RCH and ASH, the most common treatment regime was twice-daily insulin injection unlike OUH and JHH where multi-injection therapy and insulin pump was most commonly used. Nevertheless, the average HbA1c was quite similar. All the presented hospitals used guidelines in their clinics. However, at ASH the recommended screening programs were not followed and no social worker nor psychologist was included in the diabetes care team. Even though the other three hospitals (OUH, RCH, JHH) had multidiciplinary diabetes care teams as advocated in The International Society for Paediatric and Adolescent Diabetes (ISPAD) guidelines, only one of these teams (OUH) include a psychologist. Comprehensive education and care was offered at all the hospitals, but the lack of organized reeducation and limited knowledge about their patients mental health was an important finding. Only OUH had organized reeducation for adolescents. Discussion At all the presented hospitals children and adolescents with T1D had access to recommended insulin preparations and treatment regimens, and the treatment and follow up was well organised. However, keeping in mind the high risk of developing mental health problems among these patients, an increased focus on psychosocial health should be implemented in the diabetes management. Furthermore, regular re-education might be helpful in understanding the disease and thus coping better. Coping is essential for good glycaemic control and for the patient’s quality of life. Conclusion Achieving both metabolic and psychological stability in children and adolescents with T1D requires a multidisciplinary diabetes team that is equipped to provide physical, social and psychological support. A psychologist should be a compulsory part of the diabetes team and psychological interventions, such as screening programs for psychological issues, should be a part of the of diabetes care for young people