Adolescent Patients with Type 1 Diabetes Experience Extreme Stress

Young patients with type 1 diabetes mellitus (T1DM) experience extremely high levels of stress, which can be offset through education and psychological therapy.

T1DM has exhibited an increasing global incidence among adolescents and patients <20 years old. Given the lifelong dependency on insulin brought on by T1DM, as well as glucose monitoring and hypo- and hyperglycemia management, a significant lifestyle change is required for disease management. These processes can be a significant source of stress, particularly in younger patients.2

“The purpose of this study was to assess the level of knowledge, stress, and acceptance of the illness in young adults with T1DM and to present the impact of various sociodemographic and medical factors on the level of knowledge, stress, and acceptance of the illness in young adults with T1DM,” Anna Stefanowicz-Bielska, department of pediatrics, diabetology and endocrinology, University Clinical Center of Gdansk, and colleagues wrote.1

The study took the form of an interview, conducted between August 2023 and November 2024. Participants were young adults with T1DM who had had the disease for >1 year and were 18-35 years old. The survey included the Perceived Stress Scale (PSS-10) and the Acceptance of Illness Scale (AIS).1

Patients were invited to participate in the survey, which collected sociodemographic data such as gender, age, place of residence, education, professional/school activity, et cetera, medical data related to T1DM such as HbA1c level, illness duration, existence of long-term micro- and macrovascular complications, and T1DM self-monitoring and treatment methods, as well as a knowledge test.1

Knowledge was verified using 20 statements concerning T1DM self-monitoring and treatment, which were formatted as correct/incorrect questions. Respondents answered on the definition and treatment of T1DM, the effect of insulin and its administration, principles of glycemia and monitoring, risk factors, symptoms and prevention of hypo- and hyperglycemia, and types of macrovascular complications. Each question was assigned 1 point, with a maximum of 20 points.1

A total of 274 patients with T1DM participated in the survey. On average, the participants had T1DM for 13.4 +/- 7.1 years, were treated with a personal insulin pump, had secondary education, were professionally active, and did not smoke or consume alcohol. The average body mass index (BMI) and HbA1c concentration were 25 +/- 4.7 kg/m2 and 7.94 +/- 1.68%, respectively. Median time in range (TIR) was 70.1

Median test score was 18/20 – the following statements were the most difficult for respondents:

• Type 1 diabetes develops as a result of excessive sugar consumption, overweight, obesity, and lack of physical activity (75.2% correct)
• The level of glycemia (glucose concentration) in blood that is correct for an adult with type 1 diabetes is from 80 to 140 (78.1% correct)
• Hyperglycemia is diagnosed if the level of glycemia (glucose) in the blood is ≥160-180 mg/dL (79.2% correct), and
• Heavy hypoglycemia is a contraindication to physical activity for 24 hours (70.1% correct)1

In the stress measurement test, investigators found a positive relationship between the level of stress experienced and the patient’s BMI (raw score: n = 274, R = 0.18, P = .00275) and between illness duration and hyperglycemic incidents at night. No relationship was found between stress levels and knowledge levels.1

Illness acceptance also saw a negative relationship with HbA1c concentration, as well as with hyperglycemic incidents during the day. However, no relationship was found between the level of acceptance and the level of knowledge.1

Investigators went on to discuss alternative methods of relieving this stress and lack of acceptance, citing contemporary self-monitoring technologies. Additionally, Stefanowicz-Bielska and colleagues highlighted the value of educational programs to support patients with T1DM and to help them understand treatment principles.1

“Acceptance prevents a decrease in quality of life and reduces the risk of complications related to the illness,” Stefanowicz-Bielska and colleagues wrote. “It is very important during the development of a different way of life, including new rules and limitations.”1

References

1. Stefanowicz-Bielska A, Rąpała M, Mazuryk K, Dygaszewicz E. Level of knowledge, stress and acceptance of illness in young adults with type 1 diabetes mellitus. Frontiers in Endocrinology. 2025;16. doi:10.3389/fendo.2025.1648260

2. Wijk I, Amsberg S, Johansson UB, Livheim F, Toft E, Anderbro T. Impact of an Acceptance and Commitment Therapy programme on HbA1c, self-management and psychosocial factors in adults with type 1 diabetes and elevated HbA1c levels: a randomised controlled trial. BMJ Open. 2023;13(12):e072061. Published 2023 Dec 14. doi:10.1136/bmjopen-2023-072061