Psychological care in children and adolescents with type 1 diabetes in a real-world setting and associations with metabolic control

Pediatr Diabetes. 2020 Sep;21(6):1050-1058. doi: 10.1111/pedi.13065. Epub 2020 Jul 8.


Background: International guidelines recommend psychosocial care for children and adolescents with type 1 diabetes.

Objective: To assess psychological care in children and adolescents with type 1 diabetes in a real-world setting and to evaluate associations with metabolic outcome.

Methods: Delivery of psychological care, HbA1c, and rates of severe hypoglycemia and diabetic ketoacidosis (DKA) in children and adolescents with type 1 diabetes from 199 diabetes care centers participating in the German diabetes survey (DPV) were analyzed.

Results: Overall, 12 326 out of 31 861 children with type 1 diabetes were supported by short-term or continued psychological care (CPC). Children with psychological care had higher HbA1c (8.0% vs 7.7%, P<.001) and higher rates of DKA (0.032 vs 0.021 per patient-year, P<.001) compared with children without psychological care. In age-, sex-, diabetes duration-, and migratory background-matched children, HbA1c stayed stable in children supported by CPC during follow-up (HbA1c 8.5% one year before psychological care started vs 8.4% after two years, P = 1.0), whereas HbA1c was lower but increased significantly by 0.3% in children without psychological care (HbA1c 7.5% vs 7.8% after two years, P <.001). Additional HbA1c-matching showed that the change in HbA1c during follow-up was not different between the groups, but the percentage of children with severe hypoglycemia decreased from 16.3% to 10.7% in children receiving CPC compared with children without psychological care (5.5% to 5.8%, P =.009).

Conclusions: In this real-world setting, psychological care was provided to children with higher HbA1c levels. CPC was associated with stable glycemic control and less frequent severe hypoglycemia during follow-up.

Keywords: HbA1c; adolescent; child; clinical; diabetes mellitus, type 1; psychology.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Blood Glucose / metabolism
  • Child
  • Delivery of Health Care / methods
  • Delivery of Health Care / standards
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 1 / therapy*
  • Female
  • Germany / epidemiology
  • Glycemic Control* / psychology
  • Glycemic Control* / statistics & numerical data
  • Humans
  • Male
  • Mental Disorders / blood
  • Mental Disorders / complications
  • Mental Disorders / epidemiology
  • Mental Disorders / therapy*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Psychological Distress
  • Psychology, Child / methods


  • Blood Glucose