From sph.unc.edu
People diagnosed with Type 1 diabetes (T1D), formerly called juvenile diabetes, learn many strategies for self-management that must evolve as they age. Despite advances in treatment, the burdensome nature of managing T1D – including non-stop glucose monitoring, dosing insulin, and responding to episodes of dangerous low blood– contributes to “diabetes distress,” a term for the expected burdens, concerns and fears related to living with and managing diabetes.
As treatments and technologies improve, the number of older adults living with T1D has grown. Studies have explored facets of T1D management that can be stressful for children and young adults as they learn to live with their condition, but little research has focused on the way those stressors can shift with age.
A new UNC-led study, published in the Journal of Diabetes and Its Complications, is the first to highlight diabetes distress that people over the age of 65 can encounter when managing T1D, including the unique stressors in this age group. While the researchers found that markedly elevated levels of diabetes distress were less prevalent among older adults than in younger age groups, understanding the sources of that distress – and the people most likely to experience it – will help health care and public health experts improve treatment strategies for this unique population.
Dr. Anna Kahkoska
“Screening for and addressing diabetes distress is now recognized as an important part of diabetes care,” said Anna R. Kahkoska, MD, PhD, senior author and Joan Heckler Gillings Assistant Professor of nutrition at the UNC Gillings School of Global Public Health. “Not only does diabetes distress worsen quality of life, but it can also directly interfere with self-management, resulting in worse health outcomes. Given that so much can change in older adulthood, we were interested in understanding how diabetes distress impacts older adults living with T1D.”
Around 36% of older adults surveyed in the study reported elevated levels of diabetes distress warranting further assessment and treatment. Older adults who identified as women, had higher haemoglobin A1C levels and had been to the emergency room in the past year were most likely to experience elevated levels of diabetes distress. The most common stressors included financial worries, T1D management difficulties and worries about complications. An unexpected finding was that people who had been diagnosed with T1D at earlier ages or had lived with the condition the longest had lower levels of diabetes distress.
“These data highlight new opportunities to improve diabetes care for older adults with T1D by providing more support for the stressors in this age group, as well as interventions focused on the specific subpopulations who may be at the highest risk of having elevated distress,” Kahkoska said. “For example, older adults may benefit from additional guidance to navigate age-related changes in their self-management routines, including changes in employment and insurance coverage that impact someone’s ability to obtain all the supplies they need.”
Adriana Wisniewski
“This work serves as a foundation for diabetes distress research focused on the experiences of older adults with T1D,” said lead author Adriana Wisniewski, a doctoral student in anthropology at the UNC College of Arts and Sciences. “Our group hopes to continue exploring the specific factors and experiences that contribute to diabetes distress in this population, and this study has highlighted areas for potential next steps. This work also closely aligns with ongoing projects our research team is conducting, including a clinical trial, ChargeUp.”
The ChargeUp study is a virtual clinical initiative focused on reducing diabetes distress among adults with T1D, including older adults. Wisniewski said the findings of this study have helped the research team better understand what specific factors may be important to emphasize, explore or be more sensitive to when working with older adult participants in ChargeUp.
Learn more about ChargeUp from the North Carolina Translational and Clinical Sciences Institute.
Researchers on the study include Wisniewski; Kahkoska; biostatistics doctoral student Justin DeMonte, alumna Angelica Cristello Sarteau, PhD, and senior project manager in nutrition Angela Fruik, MPH, from the Gillings School; and Ruth S. Weinstock, MD, PhD, from SUNY Upstate Medical University.
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