Why peer support matters for adolescents with type 1 diabetes

A new study shows that peer relationships may play a key role in diabetes distress and improving quality of life among adolescents with type 1 diabetes

By Dr Edith Holloway

Type 1 diabetes is the most common type of diabetes affecting children and teenagers. The teenage years can be tricky for anyone. Teens need to find their own way through various changes, for example in their body, hormones, sleep, relationships with family and friends, school/work and social life. They also take on more responsibilities and become less dependent on their parents. At the same time, type 1 diabetes adds its own layer of challenges. It is very hard to predict, and often sets them apart from those around them. So, this makes type 1 diabetes both physically and emotionally demanding.

At this stage, relationships outside the family play an important role. Friends and peers become a big source of social and emotional support. Peers are people who are at a similar age or life stage or share similar experiences. This might include living with a condition such as type 1 diabetes or some challenges to emotional well-being or mental health.

Studies show that diabetes can cause negative emotions, e.g. frustrations, worries, sadness, anger. This is unsurprising because diabetes is demanding, relentless, and unpredictable. It is a job no-one asks for and no-one gets a break from. Around one third of teenagers experience diabetes distress. This can lead to a higher risk of developing mental health conditions, such as depression. Diabetes can also have a negative impact on quality of life. For teenagers with type 1 diabetes, guidelines recommend reducing diabetes distress and improving health-related quality of life.

In China, Dr Dan Luo and colleagues have done research into peer support among teenagers with type 1 diabetes. Their aim was to examine the effect of peer relationships and positive coping on diabetes distress and the impact of diabetes on quality of life. They also looked at the effects of having to manage diabetes in front of others. This might include checking glucose, injecting insulin or dealing with hypos (low glucose levels). This may include negative thoughts and reactions from friends or peers. They refer to this as diabetes-related peer stress.

Their study included 201 teenagers with type 1 diabetes from 20 cities across China. They were aged between 10 and 19 years old. On average, they had lived with diabetes for just over four years. Just over two thirds (68%) were using insulin pen injectors to manage their diabetes. Nearly half had an HbA1c above the recommended target range. Research shows that this is usually associated with diabetes distress.

The teenagers completed two surveys – one on entry to the study and a second one 18 months later. This is important because most surveys include only one point in time, making it difficult to know what causes what.

What did this study find?

1. 1. 1. Greater peer stress at baseline led to:
         1. 1. greater diabetes distress at 18 months, and
            2. greater negative impact of diabetes on quality of life at 18 months.

1. 1. 2. There was little direct benefit of peer support at baseline on diabetes distress or the impact of diabetes on quality of life at 18 months.

1. 1. 3. Having peer support at baseline led to more positive coping strategies. For example, improved problem solving. Together, these were associated with:
         1. 1. less diabetes distress at 18 months, and
            2. reduction in the negative impact of diabetes on quality of life at 18 months.

Overall, the findings from this study suggest that managing diabetes in front of others is stressful for teenagers. They experience negative reactions from friends or peers, which can lead to diabetes distress and reduce their quality of life. Peer support was not important for its own sake. The study shows that peer support was associated with improving coping skills. It was the positive coping skills that had a beneficial impact on the teenagers’ well-being and quality of life.

The authors recommend that teenagers with type 1 diabetes need peer support and training to develop positive coping skills. This will set them up well for living with the challenges of type 1 diabetes. This study provides support for diabetes camps, where teenagers can spend valuable time away from their family, among other teens with diabetes, and develop their coping skills.

You can read our other blogs about type 1 diabetes and peer support.

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Reference:

Luo D, Cai X, Wang H, Wang Y, Xu J. The role of peer social relationships in psychological distress and quality of life among adolescents with type 1 diabetes mellitus: a longitudinal study. BMC Psychiatry, 2024; 11;24(1):270.

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