Psychological problems

Psychological disturbances occur throughout Type1 diabetes, from diagnosis to the experience of late tissue complications. Serious life events may precipitate diabetes onset. All parents of newly diagnosed children report stress. Poor glycaemic control is associated with suboptimal school performance, but children do not consider their own quality of life to be poor. Depression during adolescence is no more common than in the background population. Single parenthood and minority ethnicity are associated with worse glycaemic outcomes. Poor glycaemia associated with poor family functioning can be helped by family-based interventions. Eating disorders are not more frequent in diabetes, but disordered eating and insulin omission are prevalent, the last associated with increased mortality. Depression is common, often severe, undiagnosed, and associated with maternal depression. Non-pharmacological treatment is more effective than antidepressants. Diabetic complications increase the risk of depression 2- to 3-fold, and all depressive disorders may increase mortality in people with foot ulceration.