57. Psychosocial Distress And Resilience Among College Students With Type 1 Diabetes

Abstract

Purpose: Young adults (YA) with Type 1 Diabetes (T1D) struggle to achieve glycemic control and the increased stress/distress during college may complicate disease control while resilience may be important for promoting disease management. We sought to quantify psychosocial distress and resilience among college students with T1D, and estimate the impact on self-management behaviors and glycemic control. Methods: Data are from 138 respondents to a multi-national, web-based study of college students (ages 17-25 years) with T1D, recruited via a variety of social media platforms (e.g., College Diabetes Network Facebook, Twitter) and direct outreach (e.g., organization newsletter). Participants were enrolled in a comparative effectiveness trial of web-based delivery of health promotion messaging and asked to complete validated measures of psychosocial distress and resilience, diabetes self-management and burden, most recent hemoglobin A1c (HbA1c), and sociodemographics at baseline. Multivariable regression was used to model baseline reports of HbA1c, frequency of daily blood glucose testing, and receipt of diabetes care, as a function of burden and resilience while adjusting for confounders. Results: Participants were from 85 universities across 30 US states and Canada. Participants were 20.5 years old on average (SD=1.5), 80.4% female, 82.6% white non-Hispanic, an average of 10.9 years old at diagnosis (SD=5.2), 84.1% were pump users and 60.1% used continuous glucose monitors (CGM). 16.7% of YA screened positive for depressive symptoms and 31.9% screened positive for generalized anxiety; participants reported high levels of grit (3.9±0.6, max of 5) and self-efficacy (7.7±1.7, max of 10), and moderate diabetes acceptance (58.4±10.0, max of 72) on average. Per ADA recommendations, 44.2% tested their blood sugar ≥5 times per day, 65.9% had ≥3 HbA1c tests in the past year, with an average last HbA1c of 7.6 (SD=1.3), and 29.7% received all five other recommended annual screening and preventive services. Multivariable analyses revealed that diabetes self-efficacy was the most important predictor, demonstrating associations with receiving the recommended number of HbA1c tests per year (OR: 1.27, 95%CI: 1.02-1.59 per 1-unit increase in self-efficacy) and other key diabetes screening tests (OR: 1.36, 95%CI: 1.06-1.74), greater frequency of daily blood glucose testing (OR: 1.27, 95%CI: 1.05-1.54), and better/lower HbA1c (-0.27 units, p<0.001). Greater diabetes burden was associated with lower odds of receiving key diabetes screening tests (OR: 0.51, 95%CI: 0.32-0.82 per 1-SD increase in burden) and worse/higher HbA1c (+0.31 units, p<0.01). Depressive symptoms were associated with lower odds of receiving the recommended number of HbA1c tests (OR: 0.78, 95%CI: 0.60-0.99 per 1-unit increase on the PHQ-2). Conclusions: University students with T1D reported high psychosocial distress and mental health concerns and did not meet many professional standards for recommended care and management. Those with high distress or low resilience experience higher HbA1c and are less likely to receive recommended diabetes care. In order to improve the management of YA with T1D, particularly during college, providers should seek to discuss psychosocial concerns and apply interventions aimed at strengthening resilience. Sources of Support: Boston Children’s Hospital Awards Committee Pilot #20140273, Mentored Career Development Award AHRQ K12HS022986