Psychological care in children and adolescents with type 1 diabetes in a real-world setting and associations with metabolic control.

BACKGROUND International guidelines recommend psychosocial care for children and adolescents with type 1 diabetes. OBJECTIVE To assess psychological care in children and adolescents with type 1 diabetes in a real-world-setting and to evaluate associations with metabolic outcome. METHODS Delivery of psychological care, HbA1c, and rates of severe hypoglycaemia and diabetic ketoacidosis (DKA) in children and adolescents with type 1 diabetes from 199 diabetes-care-centres participating in the German diabetes survey DPV were analysed. RESULTS Overall, 12 326 out of 31 861 children with type 1 diabetes were supported by short-term or continued psychological care. Children with psychological care had higher HbA1c (8.0% vs 7.7%, p = <0.001) and higher rates of DKA (0.032 vs 0.021 per patient-year, p = <0.001) compared to children without psychological care. In age-, sex-, diabetes-duration-, and migratory background-matched children HbA1c stayed stable in children supported by continued psychological care during follow-up (HbA1c 8.5% one year before psychological care started vs 8.4% after two years, P = 1.0), whereas HbA1c was lower but increased significantly by 0.3% in children without psychological care (HbA1c 7.5% vs 7.8% after two years, P < 0.001). Additional HbA1c-matching showed that the change in HbA1c during follow-up was not different between the groups but the percentage of children with severe hypoglycaemia decreased from 16.3% to 10.7% in children receiving continued psychological care compared to children without psychological care (5.5% to 5.8% P = 0.009). CONCLUSIONS In this real-world-setting, psychological care was provided to children with higher HbA1c levels. Continued psychological care was associated with stable glycaemic control and less frequent severe hypoglycaemias during follow-up. This article is protected by copyright. All rights reserved.