The Influence of Psychobiological Adversity to Children and Adolescents With Type 1 Diabetes
Condition: Type 1 Diabetes; Stress
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 1
Study type: Observational

Summary: 
      The aims of this study are two fold: To show whether there is an increased environmental or
      genetic susceptibility to stress in patients with T1D and whether it influences diabetes
      management. And to develop a strategy for the assessment and treatment of patients with T1D
      and an increased risk for development of psychopathology under stress.
    

Detailed description: 
      Lately, a marked increase in the incidence and earlier age of onset of type 1 diabetes (T1D)
      has been noted. These observations could also be connected to an increased prevalence of
      stressful experiences and a lowered stress tolerance in some children.

      The way a person responds to stress is determined by the interplay of genetic and
      environmental factors. Environmental experiences at specific times of development have been
      shown to shape individual's hypothalamic-pituitary-adrenal axis (HPA axis) stress response.
      It is known, that early development of central nervous system is critically dependent on
      child's interaction with the environment (experience dependent maturation), especially to the
      attachment to caregivers (most often the mother). Appropriate caregiving is connected to
      lower basal cortisol levels in children and a more stable HPA axis response after the
      exposure to stress. Any circumstances that disturbed the formation of the attachment to the
      primary caregiver (e.g. complications at delivery, psychosocial stressors affecting the
      mother or mother's postpartum depression) resulted in higher HPA axis responsiveness to
      stress in the affected children.

      Changes in individual genes have also been shown to influence a person's susceptibility to
      stress and risk for the development of stress-induced psychopathology.
    

Intervention name(s): Psychological background determinations; Genetic susceptibility determination; Cortisol release test; Saliva cortisol measurement
Intervention type(s): Behavioral; Genetic; Procedure; Procedure
Intervention description(s): For the psychological background determinations a structured interview and questionnaires will be administered:
Child Attachment Interview (CAI)
General/sociodemographic questionnaire with the questions on diabetes management, current health status and the child's development in the infancy
"Parenting Stress Index" with the "19-item Life Stress Scale" (PSI)
Achenbach System of Empirically Based Assessment (CBCL, YSR)
Holmes and Rahe "Social readjustment rating scale"
Lifetime Incidence of Traumatic Events (LITE) - parent and child reports of child's trauma/loss history (LITE- S/ P)
Experiences in Close Relationships - Relationship Structures questionnaire (ECR-RS); DNA will be isolated from the patients' blood samples and form the control subjects buccal swabs. The genes with expected influence to stress reactivity and mental disorders will be tested.; Synacthen test - will be used with the group of patients with type 1 diabetes to measure HPA axis reactivity; Saliva cortisol measurement - will be used with the patients before and after the Synacthen test and with the Hashimoto thyroiditis and the healthy control group before and after the Child Attachment Interview
Intervention MeSH terms: Hydrocortisone; Hydrocortisone 17-butyrate 21-propionate; Hydrocortisone acetate; Hydrocortisone hemisuccinate
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Children of 8 to 15 years of age with type 1 diabetes with their parents; Healthy primary
        school pupils of 8 to 15 years of age with their parents
      
Biospecimen description: 
      The genes with expected influence to stress reactivity and mental disorders will be tested.
    
Keywords: Type 1 diabetes; Children and adolescents; Stress; Genetic factors; Psychological background