Endocrine Abstracts

Background: Pediatric patients with diabetes are required to adhere to strict regimens including blood glucose testing, insulin therapy, and dietary restrictions. Adequate glucose control is necessary to prevent acute and chronic complications. Testing Hemoglobin A1c (HgbA1c) provides a simple evaluation of diabetes control and compliance with therapy. Psychological factors (depression, anxiety) play a major role in pediatric diabetes compliance. Access to psychological support may not be always attainable. The effect of improved access can be evaluated by comparing HgbA1c values before and after psychological support.

Objective: Patients who visit with a psychologist during their routine clinic visits for diabetes have an improved HgbA1c in follow-up after this intervention.

Methods: A clinical psychologist was present in clinic for three months allowing immediate access to psychological intervention. Charts were retrospectively reviewed and non-identifying information was collected including age, time since diagnosis, race, gender, HgbA1c before and after the intervention, reason for referral, and topics of discussion as documented by the psychologist. The data was described using medians (with interquartile ranges) and frequencies (with percentages). Stratified and non-stratified univariable comparisons were made using the Friedman test. Multivariable regression comparisons utilized generalized linear mixed models. Statistical significance was assumed at a type I error rate of 5%.

Results: Data was collected on 41 patients. HgbA1c values were 9.9% (8.7–11.8) and 10.3% (8.7–12.7) before and after psychological intervention, respectively. Values were higher in African Americans than in non-Hispanic whites (P=0.005). There was no difference in HgbA1c values before and after psychological intervention with a median difference of 0.3 (−0.9–1).

Conclusions: There was no significant change in HgbA1c values after a one-time clinical psychological intervention. Some individual patients may have benefited, but a larger dataset is needed to assess this subgroup while considering the reason for the psychology consult.