Anxiety and Self-Care in Adolescents with Type 1 Diabetes

PURPOSE: We aimed to explore the interrelationships among demographic characteristics, sleep quality, diabetes self-care behaviors, and diabetes-specific quality of life among adolescents with type 1 diabetes and anxiety symptoms. STUDY DESIGN AND METHODS: We conducted a cross-sectional study in 2024 among adolescents aged 12 to 19 years who had type 1 diabetes for > 6 months, were able to read and speak English, had access to a mobile phone, and had at least mild anxiety symptoms. After informed assent and consent, participants were screened for general anxiety symptoms. If participants had at least mild anxiety symptoms, they completed a demographic survey and measures of sleep quality, diabetes-specific anxiety symptoms, diabetes self-care behaviors, and diabetes-specific quality of life. We calculated descriptive statistics and correlations among continuous measures using Spearman's rho coefficients. RESULTS: Forty adolescents were included in our analysis. They were mostly White (74.36%), non-Hispanic (90%), and female (69.23%). Higher hemoglobin A1c values were significantly associated with lower diabetes self-care scores (p < .001), and lower self-care scores were associated with worse sleep quality (p = .006). Generalized anxiety symptoms were associated with poor sleep (p = 0.012) and diabetes-specific anxiety symptoms were associated with worse diabetes-specific quality of life (p < .001) and worse diabetes self-care (p = .004). Poor sleep quality was associated with worse diabetes-specific quality of life (p < .001). CLINICAL IMPLICATIONS: There is a complex interrelationship between psychosocial outcomes and A1c in adolescents with type 1 diabetes and co-occurring anxiety symptoms. Early interventions that address the multi-directional relationship among psychosocial outcomes and A1c among adolescents experiencing type 1 diabetes and anxiety symptoms are critically important to improving self-care behaviors and glycemic control.