Addressing mental health concerns in type 1 diabetes patients in a pandemic

The COVID-19 pandemic brought with it a variety of mental health issues ranging from economic concerns for parents, lack of time with peers, and worries about getting sick with the disease. There were particular concerns for children and families managing type 1 diabetes. During a session titled “Behavioral Interventions for Pediatric Diabetes During COVID-19” at the 81st Virtual Science Sessions for the American Diabetes Association, Carrie Tully, a child psychologist at Children’s National Hospital in Washington, DC, discussed how her program changed to provide care. grant during the pandemic and presented results of a study examining the effects of the pandemic.

For children with type 1 diabetes, the pandemic led to an increase in sedentary behavior and a decrease in access to diabetes-specific support due to social distancing guidelines. Children and families were concerned about whether children were vulnerable to the disease and whether they would have access to both medical teams and medical supplies when needed due to supply chain issues. There have been many changes to the Children’s National Hospital program, which treats >2,000 children and adolescents with diabetes in the greater Washington DC metro area, at various levels. At the institutional level, the hospital quickly switched to telemedicine options that comply with the Health Insurance Portability and Accountability Act. Although the department had been using telemedicine to treat patients who lived far away since 2017, the shift had to adapt. It was more difficult for dieticians, practice nurses and other clinicians to engage behavioral health care because they were no longer just in the hallway. Within the behavioral practice level, practitioners were required to know where the child was physically during each session, along with the nearest emergency department in case an emergency occurred during the session. Practitioners also had to provide technical support in case the telemedicine platform would stop working. Interpretation services were provided where necessary and patients were advised to ensure sessions were private, including finding quiet corners in the home and using headphones. Tully noted that telemedicine allowed practitioners to use tools that would not have been possible in normal sessions, including sharing memes and watching YouTube videos.

Tully concluded the session with results from a study of parents of early school-age children with type 1 diabetes comparing prepandemic and pandemic mental health problems. About 84% of parents reported experiencing at least 1 COVID-19 disruption, including job changes, relocation, insurance changes, childcare changes, and school changes. Ten percent of parents reported having severe COVID-19 outcomes in immediate or non-immediate family, and nearly 60% of families said they adhered to strict social distancing guidelines. The number reporting elevated depression scores, either prepandemic or during the pandemic, was approximately equal to 22%, but 10% of parents reported elevated depression at both time points.


1. Tully C. Behavioral interventions for pediatric diabetes during COVID-19. American Diabetes Association Scientific Sessions 2021; June 25, 2021; virtual. Access until June 25, 2021.

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