Psychological Aspects in the Prevention of Type 1 Diabetes

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Summary, Zusammenfassung

Screening refers to assessments aimed at detecting illness at an asymptomatic stage of development so that its progression can be halted or delayed.

There are only few psychological data gained in diabetes screening or intervention studies, showing clinical high anxiety before blood sampling and after notification of high risk. After a few months anxiety in average uses to drop to normal levels, but family functioning, life style and health behaviour seem to be changed. Obtaining data regarding the psychological impact on family members and the individuals at risk and identifying variables related to continued study participation are needed for studies seeking to recruit and retain subjects in longitudinal protocols for prediction and prevention of type 1 diabetes. For individuals with decreased quality of life psychological support should be provided.

Key words: : type 1 diabetes, genetic screening, antibody screening, psychological impact, risk notification

Psychologische Aspekte in der Pravention des Typ-1-Diabetes

Das Ziel von Screening Untersuchungen zum Typ-1-Diabetes ist es, Personen mit erhbhtem Diabetesrisiko zu identifizieren and die Manifestation des Typ-1-Diabetes zu verzogern oder zu verbindern. Es gibt nur wenige Untersuchungen, die psychologische Aspekte in Screening- oder Interventions-Studien erfassen. In allen Studien zeigt sich klinisch relevance Angst bei den Betroffenen direkt vor der Blutabnahme and nach der Risikomitteilung, vor allem wenn das Risiko hoch ist. Nach einigen Monaten sinks die Angst wieder auf normale Werte, abet im Familienleben, im Lebensstil and im Gesundheitsverhalten werden Anderungen sichtbar. Die Erfassung psychologischer Aspekte in Interventionsstudien zur Pradiktion and Pravention des Typ-1-Diabetes ist wichtig sowohl zur Gewinnung von ProbandInnen als auch zur Sicherung der langfristigen Teilnahme in Praventionsstudien. Fur Personen reit stark verminderter Lebensqualitat sollte psychologische Unterstutzung zur Verfigung stehen.

Schlisselwbrter: Typ-1-Diabetes, genetisches Screening, Antikdrper Screening, psychologische Belastung

Introduction

Prevention of type 1 diabetes is important because the disease most often affects young children and threatens not only the physical development but also the psychological and social development of the child and carries threat of severe complications in the most active period of life, that is in the fourth or fifth decade. The life of the whole family is affected (Dahlquist, 1999). The care of childhood diabetes during the last decades has significantly improved all aspects of living with the disease, but an effective prevention must still remain a goal, especially since in many countries the incidence of type 1 diabetes is rapidly increasing (Onkamo et al., 1999). Over the past 25 years it has become recognised that type 1 diabetes is an auto-immune disease with aberrant immune responses to specific beta-cell auto-antigens. Both environmental and genetic factors play etiological roles. Advances in the understanding of the natural history of pre-diabetes, using a combination of immune, genetic and metabolic markets, have led to the ability to predict the disease in both high-risk relatives and lowerrisk general population. World wide efforts have therefore been launched within the past few years in attempts to delay the onset or prevent the disease in higher risk relatives of type 1 probands. Primary and secondary prevention in the case of pre-type 1 diabetes could be divided into two levels: (1) to try to arrest an already ongoing destruction of the beta-cells, in animal studies and pilot human studies, insulin (DPT-1) and nicotinamide (DENIS, ENDIT) have been shown to be safe, leading to their application in human trials (Schatz & Bingley, 2001), and (2) to try to intervene with exposures that may initiate this process, this strategy aiming at eradicating environmental initiators of the beta-cell destruction will approach a total population at risk. …