P-185: Clinical diabetes distress risk zones identify psychosocial vulnerability in children with type 1 diabetes (T1D)
S Patton, B Lockee, J Pierce, N Kahhan, M ClementsAbstract
Introduction
ISPAD guidelines recommend routine screening for diabetes distress (DD) in youth with T1D, yet guidance on how to interpret screening results or use them to initiate a referral to behavioral services remains limited.
Objectives
To define child DD risk zones grounded in routine clinical screening data and to examine how these risk zones relate to subsequent DD trajectories, HbA1c, and child resilience in an independent longitudinal research cohort.
Methods
We defined DD risk zones (low [<25th percentile], moderate [25-75% percentile], high [>75th percentile]) using child PAID-C scores obtained during routine clinic-based screening. Next, we applied the risk zones to a separate longitudinal cohort (n=133 children; mean age= 10.2±1.5 years; mean T1D duration= 3.8±2.4 years; 50% girls) with no targeted DD intervention. We examined changes (0 to 6 months) in child DD, HbA1c, and resilience based on baseline DD risk zones to support interpretation.
Results
Clinic-derived risk zones showed clear separation in child DD trajectories when applied to the research cohort. Over 6 months, youth in the low-risk zone maintained low and stable PAID-C scores, youth in the high-risk zone maintained high and stable PAID-C scores, and youth in the moderate-risk zone exhibited increasing PAID-C scores. Change in DD differed significantly by risk zone (p<.001). In contrast, change in HbA1c did not differ by risk zone (p=.38), despite modest baseline differences. Resilience differed significantly across risk zones at baseline (p<.01) and 6 months (p<.01), with lower resilience observed for youth in the highest risk zone.
Conclusions
DD risk zones derived from clinic screening meaningfully characterized psychosocial vulnerability in an independent cohort of youth with T1D. Results suggest moderate DD levels may be an early risk marker for worsening DD over time, despite stable HbA1c.