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World J Diabetes. Sep 15, 2021; 12(9): 1518-1529
Published online Sep 15, 2021. doi: 10.4239/wjd.v12.i9.1518
Psychosocial factors affecting the etiology and management of type 1 diabetes mellitus: A narrative review
Anja Turin, Maja Drobnič Radobuljac
Anja Turin, Department for Child Psychiatry, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
Anja Turin, Maja Drobnič Radobuljac, Department of Psychiatry, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
Maja Drobnič Radobuljac, Unit for Intensive Child and Adolescent Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana 1000, Slovenia
Author contributions: Turin A and Radobuljac MD both made substantial contributions to conception and design of the article; Turin A drafted the article; Radobuljac MD made critical revisions related to important intellectual content of the manuscript; Turin A and Radobuljac MD approved the final version of the article to be published.
Supported by Slovenian Research Agency Grant, No. P3-0343.
Conflict-of-interest statement: The authors declare that the manuscript was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maja Drobnič Radobuljac, MD, PhD, Associate Professor, Chief Physician, Unit for Intensive Child and Adolescent Psychiatry, University Psychiatric Clinic Ljubljana, Grabloviceva 44a, Ljubljana 1000, Slovenia. maja.radobuljac@psih-klinika.si
Received: January 26, 2021
Peer-review started: January 26, 2021
First decision: May 3, 2021
Revised: May 26, 2021
Accepted: July 26, 2021
Article in press: July 26, 2021
Published online: September 15, 2021
Processing time: 223 Days and 18.1 Hours
Abstract

Type 1 diabetes (T1D) is one of the most common chronic diseases in children and adolescents worldwide. Its etiopathogenesis results from the interplay of genetic and environmental variables. Among the latter, psychological stress has been implicated in disease onset as well as disease management. Various studies, including large population-based studies, have highlighted the role of stressful life events in the etiopathogenesis of T1D. In this article, we also emphasize the importance of attachment in the early child-caregiver relationship, which can be seen as a measure of the quality of the relationship and is crucial for stress and emotional regulation. It serves as a model for all subsequent relationships in one’s life. We summarize some of the few studies performed in the field of attachment and T1D etiopathogenesis or management. T1D management demands a lifelong therapeutic regimen to prevent acute and chronic complications. In addition to psychological stress, psychological factors such as family functioning, developmental adjustment, autonomy, mental health problems and other factors have been found to relate to metabolic control. Psychological factors need to be understood not as a single directional causality-based principle but as a dynamic bi- or multidirectional system that is affected by the normal developmental transitions of childhood and adolescence.

Keywords: Type 1 diabetes; Psychosocial factors; Stressful life events; Etiology; Disease management; Attachment

Core Tip: The incidence of type 1 diabetes is increasing worldwide. Its diagnosis and management present a major burden for the child as well as the family. Different psychological factors affecting the development and course of type 1 diabetes need to be understood not as a single directional causality-based principle but as a dynamic bi- or multidirectional system that is affected by the normal developmental transitions of childhood and adolescence. The current article summarizes some of these factors, especially those related to stress and its regulation, both in an attachment context and in relation to family dynamics and psychopathology.