RELATIONSHIP BETWEEN PHYSICAL ACTIVITY LEVEL AND DEPRESSION, ANXIETY, QUALITY OF LIFE, SELFESTEEM, AND HBA1C IN ADOLESCENTS WITH TYPE 1 DIABETES MELLITUS

Abstract

Purpose: The aim of this study was to assess the relationship between physical activity (PA) level and depression, anxiety, quality of life, self-esteem and HbA1c in adolescents with type 1 diabetes mellitus (T1DM).
Methods: A cross-sectional study design, including 41 adolescents with T1DM and 38 healthy controls aged 13-17 years, were included in this study. The PA level was assessed using the Physical Activity Questionnaire for Older Children. Anxiety was screened using the Screen for Anxiety Related Emotional Disorders questionnaire. Depressive symptoms were evaluated using the Children’s Depression Inventory. The Pediatric Quality of Life Inventory 4.0 was used for evaluating the quality of life. Self-esteem was assessed using the Rosenberg Self-Esteem Scale.
Results: Emotional functioning of parent proxy-report was significantly lower in the T1DM group (p=0.01) compared with the control group. The PA level was positively low correlated with the Pediatric Quality of Life Inventory 4.0-child self-report (r=0.48, p=0.03 for total scale score; r=0.49, p=0.001 for the physical health summary score). There was a low negative correlation between the PA level and HbA1c (r=-0.40, p=0.01).
Conclusion: The present study suggested similar PA levels, depression and anxiety scores, selfesteem, and quality of life (except lower emotional score in parents’ proxy reports) between adolescents with T1DM and healthy controls. The PA was associated with quality of life-adolescent self-report and HbA1c in patients. Despite similar PA levels, these patients should be encouraged to adherence to PA in the early period to improve the quality of life and metabolic control.

Keywords

• Adolescent
• Physical Activity
• Quality of Life

TİP 1 DİYABETİ OLAN ERGENLERDE FİZİKSEL AKTİVİTE SEVİYESİ İLE DEPRESYON, ANKSİYETE, YAŞAM KALİTESİ VE BENLİK SAYGISI ARASINDAKİ İLİŞKİ

Öz

Amaç: Bu çalışmanın amacı, Tip 1 diabeti (T1DM) olan ergenlerde fiziksel aktivite (FA) seviyesi ile depresyon, anksiyete, yaşam kalitesi, benlik saygısı ve HbA1c arasındaki ilişkiyi değerlendirmekti.
Yöntem: Yaşları 13-17 yıl olan 41 T1DM ve 38 sağlıklı ergeni kapsayan kesitsel bir çalışma tasarımı kullanıldı. FA seviyesi, Ergenler İçin Fiziksel Aktivite Anketi ile değerlendirildi. Anksiyete, Anksiyete İle İlişkili Duygusal Bozuklukları Tarama Anketi ile tarandı. Depresif belirtiler, Çocuk Depresyon Ölçeği kullanılarak değerlendirildi. Yaşam kalitesini değerlendirmek için, Çocuk Yaşam Kalitesi 4.0 Envanteri kullanıldı. Benlik saygısı, Rosenberg Benlik Saygısı Ölçeği kullanılarak değerlendirildi.
Sonuçlar: Kontrol gruba göre, T1DM grubunda ebeveynin bildirdiği emosyonel işlevsellik daha düşüktü (p=0,01). FA ile Çocuk Yaşam Kalitesi 4.0 Envanteri-çocuk öz bildirimi arasında, düşük derecede pozitif korelasyon bulundu (Total envanter skoru için r=0,48, p=0,03; fiziksel sağlık özet skoru için r=0,49, p=0,001). FA ile HbA1c arasında düşük derecede negatif korelasyon saptandı (r=-0,40, p=0,01).
Tartışma: Bu çalışma T1DM olan ergenler ve sağlıklı kontroller arasında benzer FA seviyesi, depresyon ve anksiyete skorları, benlik saygısı ve yaşam kalitesine (ebeveynin çocuk için bildirdiği daha düşük emosyonel skor dışında) işaret etti. FA,  hastalarda yaşam kalitesi-ergen özbildirimi ve HbA1c ile ilişkili idi. Benzer FA seviyelerine rağmen, bu hastalar yaşam kalitesi ve metabolik kontrolü artırmak için erken dönemde FA katılım konusunda cesaretlendirilmelidir.

Anahtar Kelimeler

• Ergen
• Fiziksel Aktivite
• Yaşam Kalitesi

Kaynakça

1. REFERENCES 1. Soedamah-Muthu SS, Fuller JH, Mulnier HE, Raleigh VS, Lawrenson RA, Colhoun HM. High risk of cardiovascular disease in patients with type 1 diabetes in the UK: a cohort study using the general practice research database. Diabetes Care. 2006;29(4):798–804.
2. 2. Babar GS, Zidan H, Widlansky ME, Das E, Hoffmann RG, Daoud M, et al. Impaired endothelial function in preadolescent children with type 1 diabetes. Diabetes Care. 2011;34(3):681–5.
3. 3. Quirk H, Blake H, Tennyson R, Randell TL, Glazebrook C. Physical activity interventions in children and young people with Type 1 diabetes mellitus: a systematic review with meta-analysis. Diabet Med. 2014;31(10):1163–73.
4. 4. Zduńczyk B, Sendela J, Szypowska A. High prevalence of depressive symptoms in well-controlled adolescents with type 1 diabetes treated with continuous subcutaneous insulin infusion. Diabetes Metab Res Rev. 2014;30(4):333-8.
5. 5. Naughton MJ, Yi-Frazier JP, Morgan TM, Seid M, Lawrence JM, Klingensmith GJ, et al. Longitudinal associations between sex, diabetes self-care, and health-related quality of life among youth with type 1 or type 2 diabetes mellitus. J Pediatr. 2014;164(6):1376-83.
6. 6. Mohammed J, Deda L, Clarson CL, Stein RI, Cuerden MS, Mahmud FH. Assessment of habitual physical activity in adolescents with type 1 diabetes. Can J Diabetes. 2014;38(4):250-5.
7. 7. Roberts AJ, Taplin CE. Exercise in youth with type 1 diabetes. Curr Pediatr Rev. 2015;11(2):120-5.
8. 8. Aman J, Skinner TC, de Beaufort CE, Swift PG, Aanstoot HJ, Cameron F, et al. Associations between physical activity, sedentary behavior, and glycemic control in a large cohort of adolescents with type 1 diabetes: the Hvidoere Study Group on Childhood Diabetes. Pediatr Diabetes. 2009;10(4):234–9.

9. 9. Edmunds S, Roche D, Stratton G, Wallymahmed K, Glenn SM. Physical activity and psychological well-being in children with Type 1 diabetes. Psychol Health Med. 2007;12(3):353-63.
10. 10. Edmunds S, Roche D, Stratton G. Levels and patterns of physical activity in children and adolescents with type 1 diabetes and associated metabolic and physiologic health outcomes. J Phys Act Health. 2010;7(1):68-77.
11. 11. Nguyen T, Obeid J, Walker RG, Krause MP, Hawke TJ, McAssey K, et al. Fitness and physical activity in youth with type 1 diabetes mellitus in good or poor glycemic control. Pediatr Diabetes. 2015;16(1):48-57.
12. 12. Caspersen CJ, Pereira MA, Curran KM. Changes in physical activity patterns in the United States, by sex and by crosssectional age. Med Sci Sports Exerc. 2000;32(9):1601-9.
13. 13. Lukács A, Mayer K, Juhász E, Varga B, Fodor B, Barakai L. Reduced physical fitness in children and adolescents with type 1 diabetes. Pediatr Diabetes. 2012;13(5):432-7.
14. 14. Trigona B, Aggoun Y, Maggio A, Martin XE, Marchand LM, Beghetti M, et al. Preclinical non-invasive markers of atherosclerosis in children and adolescents with type 1 diabetes are influenced by physical activity. J Pediatr. 2010;157(4):533–9.
15. 15. Zenlea IS, Mednick L, Rein J, Quinn M, Wolfsdorf J, Rhodes ET. Routine behavioral and mental health screening in young children with type 1 diabetes mellitus. Pediatr Diabetes. 2014;15(5):384–8.
16. 16. Sinnamon GC, Caltabiano M, Baune BT. Differentiating disordered affect in children and adolescents with type 1 diabetes. J Affect Disord. 2013;147(1-3):51–8.
17. 17. Abolfotouh MA, Kamal MM, El-Bourgy MD, Mohamed SG. Quality of life and glycemic control in adolescents with type 1 diabetes and the impact of an education intervention. Int J Gen Med. 2011;4:141–52.
18. 18. O’Neill JR, Liese AD, McKeown RE, Cai B, Cuffe SP, Mayer-Davis EJ, et al. Physical activity and self-concept: the for diabetes in youth case control study. Pediatr Exerc Sci. 2012;24(4):577-88.
19. 19. Kaminsky LA, Dewey D. The association between body mass index and physical activity, and body image, self esteem and social support in adolescents with type 1 diabetes. Can J Diabetes. 2014;38(4):244-9.
20. 20. Vlachioti E1, Petsios K, Boutopoulou B, Chrisostomou A, Galanis P, Matziou V. Assessment of self-reported self-esteem in healthy and diabetic children and adolescents in Greece. J Diabetes. 2010;2(2):104-11.
21. 21. Kongkaew C, Jampachaisri K, Chaturongkul CA, Scholfield CN. Depression and adherence to treatment in diabetic children and adolescents: a systematic review and meta-analysis of observational studies. Eur J Pediatr. 2014;173 (2):203–12.
22. 22. Frøisland DH, Graue M, Markestad T, Skrivarhaug T,Wentzel- Larsen T, Dahl-Jørgensen K. Health-related quality of life among Norwegian children and adolescents with type 1 diabetes on intensive insulin treatment: a population-based study. Acta Paediatr. 2013;102(9):889–95.
23. 23. Saka HN. Diabetes mellitus. In: Günöz H, Öcal G, Yordam N, Kurtoğlu S, eds. Pediatrik endokrinoloji. 1. Baskı. Ankara: Pediatrik Endokrinoloji ve Oksoloji Derneği Yayınları, Kalkan Matbaacılık; 2003: p. 415-55.
24. 24. Kowalski KC, Crocker PR, Faulkner RA. Validation of the physical activity questionnaire for older children. Pediatr Exerc Sci. 1997;9(2):174–86.
25. 25. Sert ZE, Temel AB. İlköğretim öğrencileri için fiziksel aktivite soru formunun Türk toplumuna uyarlanması: geçerlilik ve güvenilirlik çalışması. DEUHYO ED. 2014;7(2):109–14.
26. 26. Kovacs M. The Children’s Depression, Inventory (CDI). Psychopharmacol Bull. 1985;21(4):995–8.
27. 27. Oy B. Children’s Depression Inventory: depression scale for children: study of validity and reliability. J Turk Psychiatry. 1991;2(2):132–7.
28. 28. Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, et al. The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry. 1997;36(4):545–53.
29. 29. Karaceylan Cakmakci F, Agaoglu B, Karakaya I, Coskun A. Screening instrument for children anxiety disorders: study of validity and reliability. 15th National Congress of Child and Adolescent Mental Health and Disorders, Istanbul, 2005.
30. 30. Varni JW, Seid M, Kurtin PS. The PedsQLTM 4.0: reliability and validity of the pediatric quality of life inventory TM version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39(8):800–12.
31. 31. Cakin Memik N, Ağaoğlu B, Coşkun A, Uneri OS, Karakaya I. The validity and reliability of the Turkish Pediatric Quality of Life Inventory for children 13-18 years old. J Turk Psychiatry. 2007;18(4):353-63.
32. 32. Rosenberg, M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press;1965.
33. 33. Pallant J. SPSS survival manual. 4th ed. New York: McGraw-Hill Education (UK); 2013.
34. 34. Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B, et al. Evidence based physical activity for schoolage youth. J Pediatr. 2005;146(6):732–7.
35. 35. Sundberg F, Forsander G, Fasth A, Ekelund U. Children younger than 7 years with type 1 diabetes are less physically active than healthy controls. Acta Paediatr. 2012;101(11):1164–9.
36. 36. Mutlu EK, Mutlu C, Taskiran H, Ozgen IT. Association of physical activity level with depression, anxiety, and quality of life in children with type 1 diabetes mellitus. J Pediatr Endocrinol Metab. 2015;28(11-12):1273-8.
37. 37. Beraki Å, Magnuson A, Särnblad S, Åman J, Samuelsson U. Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes: results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS). Diabetes Res Clin Pract. 2014;105(1):119–25.
38. 38. Bar-Or O, Rowland TW. Pediatric exercise medicine: from physiologic principles to health care application. 1st ed. Champaign, IL: Human Kinetics; 2004.
39. 39. Whittemore R, Jas er S, Chao A, Jang M, Grey M. Psychological experience of parents of children with type 1 diabetes: a systematic mixed-studies review. Diabetes Educ. 2012;38(4):562-79.
40. 40. Bernstein CM, Stockwell MS, Gallagher MP, Rosenthal SL, Soren K. Mental health issues in adolescents and young adults with type 1 diabetes: prevalence and impact on glycemic control. Clin Pediatr (Phila). 2013;52(1):10-5.
41. 41. Herzer M, Hood KK. Anxiety symptoms in adolescents with type 1 diabetes: association with blood glucose monitoring and glycemic control. J Pediatr Psychol. 2010;35(4):415-25.
42. 42. Helgeson VS, Snyder PR, Escobar O, Siminerio L, Becker D. Comparison of adolescents with and without diabetes on indices of psychosocial functioning for three years. J Pediatr Psychol. 2007;32(7):794-806.
43. 43. Abdul-Rasoul M, AlOtaibi F, Abdulla A, Rahme Z, AlShawaf F. Quality of life of children and adolescents with type 1 diabetes in Kuwait. Med Princ Pract. 2013;22(4):379–84.
44. 44. Guo J, Whittemore R, Grey M, Wang J, Zhou ZG, He GP. Diabetes self-management, depressive symptoms, quality of life and metabolic control in youth with type 1 diabetes in China. J Clin Nurs. 2013;22(1-2):69–79.
45. 45. Newton KH, Wiltshire EJ, Elley CR. Pedometers and Text Messaging to Increase Physical Activity Randomized controlled trial of adolescents with type 1 diabetes. Diabetes Care. 2009;32(5):813–5.
46. 46. Nieuwesteeg A, Pouwer F, van der Kamp R, van Bakel H, Aanstoot HJ, Hartman E. Quality of life of children with type 1 diabetes: a systematic review. Curr Diabetes Rev. 2012;8(6):434–43.
47. 47. Nardi L, Zucchini S, D’Alberton F, Salardi S, Maltoni G, Bisacchi N, et al. Quality of life, psychological adjustment and metabolic control in youths with type 1 diabetes: a study with self- and parent-report questionnaires. Pediatr Diabetes. 2008;9(5):496–503.
48. 48. Kummer S, Stahl-Pehe A, Castillo K, Bächle C, Graf C, Straßburger K, et al. Health behaviour in children and adolescents with type 1 diabetes compared to a representative reference population. PLoS One. 2014;9(11):e112083.
49. 49. Chimen M, Kennedy A, Nirantharakumar K, Pang TT, Andrews R, Narendran P. What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia.2012;55(3):542–51.
50. 50. Lawrence JM, Yi-Frazier JP, Black MH, Anderson A, Hood K, Imperatore G, et al. Demographic and clinical correlates of diabetes-related quality of life among youth with type 1 diabetes. J Pediatr. 2012;161(2):201-7.