IMPE Abstracts

Introduction: Type 2 diabetes (T2D) is increasing among adolescents and is associated with suboptimal mental health. Diabetes-specific distress (DD) is common in adolescents with Type 1 diabetes but there is limited data in adolescents with T2D. Additionally, data in relation to how clinicians can better support the emotional wellbeing and engage adolescents with T2D is limited to Indigenous adolescents.

Aims: To evaluate DD and emotional wellbeing; and to examine the lived experiences and barriers to healthcare engagement in adolescents with T2D.

Methods: Cross-sectional and mixed methods study including adolescents with T2D recruited from two tertiary hospitals in Australia. Study measures included three questionnaires (Diabetes Distress Scale (DDS), World Health Organisation-5 Wellbeing Index (WHO-5) and Patient Health Questionnaire-2 [PHQ-2]); and two open-ended questions related to their experience living with T2D. Adolescents were subsequently invited to participate in a semi-structured focus group to explore the factors contributing to DD and identify the barriers to healthcare engagement and optimal T2D management. Clinical data was also collected from adolescents participating in both studies.

Results: Twenty-six adolescents completed the study (11 males, 23 from non-indigenous backgrounds, age (mean ± standard deviation) 16.1±1.8 years, diabetes duration (median [Interquartile range (IQR)]) of 1.95 [1-3.3] years, BMI Z-score (median [IQR]) of 1.8[1.3-2.6], and Hba1c (median [IQR]) of 7.05 [5.9-10.8] %. The mean DD score was 2.2±1.1, with the highest domain of distress being regimen-related 2.8±1.5 (DDS ≥2 indicates moderate to severe DD). 14 had moderate to severe DD, 10 experienced suboptimal emotional wellbeing (WHO-5 score <50) and 14 had a PHQ-2 ≥2, indicating an increased risk of depression. Seven adolescents experienced an overlap of abnormal results in all three questionnaires tested, that is, experienced significant DD, suboptimal emotional wellbeing, and depressive symptoms, while eight adolescents did not meet the positive threshold for any of the three questionnaires. Thematic analysis of qualitative data revealed that burden of managing diabetes, social isolation, stigma, and mental health impact were common experiences among adolescents with T2D. Whilst some adolescents were satisfied with their diabetes care, others desired more frequent appointments with their endocrinologist, access to T2D-specific support groups, and more open discussions about the link between T2D and mental health during their appointments.

Conclusions: Adolescents with T2D of non-indigenous background experience significant diabetes-specific distress, poor emotional wellbeing, and depressive symptoms. They also have unmet needs in relation to their diabetes care and perceived lack of emotional wellbeing support.