K Scholar’s Research on Mental Health and Pediatric Diabetes Highlighted by Cleveland Clinic

LEXINGTON, Ky. (Feb. 8, 2022) – Research led by Amy Meadows, MD, MHS, FAACP, recently received top billing in the Cleveland Clinic’s Endocrinology Daily Briefing, a digest of the field’s most important news selected from thousands of sources. Meadows, who trained as a pediatrician and child psychiatrist, spearheaded a multidisciplinary team to publish “Effects of Trauma and Anxiety on Adherence in Pediatric Type 1 Diabetes” in Diabetes Spectrum.

Rishi Raj, MD, (Meadows' former endocrinology fellow who now practices at Pikeville Medical Center), Mai Nguyen (University of Kentucky), Alba Morales Pozzo, MD, (UK), Meghan Marsac, PhD (UK), and Olga Vselvoshkaya, PhD (UK) were coauthors.

The research builds on Meadows’ expertise in treating children with co-occurring psychiatric and chronic health diagnoses. The research team enrolled 99 participants, aged seven to 21, who were being treated at UK’s Barnstable Brown diabetes clinic. Seeking to understand how trauma, PTSD, anxiety and depression affect ability young peoples’ ability to self-manage diabetes, the study team developed a psychiatric screening questionnaire to administer at patients’ regular clinic visits. While current standard of care is to screen pediatric type 1 diabetes patients for depression, the study’s questionnaire expanded to inquire about anxiety and trauma as well.

Of the participants, 38.4 percent had trauma symptoms and functional impairment related to PTSD, compared to estimates of 0.5 to 9.2 percent in the general pediatric/adolescent population and 14 percent in the general adult population.

While the study found that trauma was common among youth with type 1 diabetes—perhaps partly due to increased risk of medical trauma—neither trauma nor PTSD was associated with impairment to their diabetes self-management. Alternatively, certain forms of anxiety (especially school avoidance and generalized anxiety disorders) and suicidal ideation were associated with poor self-management and higher A1C, respectively.

The findings reaffirm that anxiety and suicidal ideation are particularly important factors in young people’s diabetes self-management. Understanding how psychiatric factors contribute to glycemic control and diabetes self-management, Meadows said, will allow more effective education, screening, and interventions, especially early in the course of pediatric diabetes.

“Even small differences in A1C, compounded over time, can make a difference in macro and micro implications of diabetes. So we really need to do more to integrate mental health care into diabetes care.”

This is particularly important in Kentucky, with the country’s eighth highest rate of diabetes.

Meadows’ research was supported by UK’s physician scientist career development program, a joint effort of the Center for Clinical and Translational Science KL2 Program and the College of Medicine.

“One of the game changers for this project was being able to have additional research personnel. It was originally just me and clip board in the diabetes clinic. But the funding from the K program allowed me to have a research assistance and statistical support,” Meadows said. “And the mentorship I received helped connect me to so many resources.”

Based on the findings of this study, Meadows and team have extended their scope and are now researching the implications of trauma exposure in adults with type 1, type 2, or prediabetes.

“So far,” she said, “we’re unfortunately seeing even greater effects of trauma on adults’ ability to control their diabetes.”

Media Contact: Mallory Profeta, mallory.profeta@uky.edu