Attachment in close relationships and glycemic outcomes in children with type 1 diabetes

Simona Klemenčič; Jasna Klara Lipovšek; Anja Turin; Klemen Dovč; Nataša Bratina; Yael Shmueli-Goetz; Katarina Trebušak Podkrajšek; Barbka Repič Lampret; Barbara Jenko Bizjan; Sašo Karakatič; Tadej Battelino; Maja Drobnič Radobuljac

doi:10.1186/s13034-023-00672-1

Attachment in close relationships and glycemic outcomes in children with type 1 diabetes

Child Adolesc Psychiatry Ment Health. 2023 Oct 17;17(1):121. doi: 10.1186/s13034-023-00672-1.

Authors

Simona Klemenčič¹, Jasna Klara Lipovšek², Anja Turin^{2

3}, Klemen Dovč^{4

3}, Nataša Bratina^{4

3}, Yael Shmueli-Goetz⁵, Katarina Trebušak Podkrajšek^{3

6}, Barbka Repič Lampret⁶, Barbara Jenko Bizjan^{3

6}, Sašo Karakatič⁷, Tadej Battelino^{4

3}, Maja Drobnič Radobuljac^{2

3}

Affiliations

¹ Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Bohoričeva Ulica 20, 1000, Ljubljana, Slovenia. simona.klemencic@kclj.si.
² Centre for Mental Health, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia.
³ Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
⁴ Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Bohoričeva Ulica 20, 1000, Ljubljana, Slovenia.
⁵ Anna Freud National Centre for Children and Families and Psychoanalysis Unit, University College London, London, UK.
⁶ Clinical Institute of Special Laboratory Diagnostics, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.
⁷ Institute of Informatics, Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia.

Abstract

Background: Our aim was to determine whether child attachment to parents, parent attachment style, and morning cortisol levels were related to diabetes outcomes measured by average glycated hemoglobin (HbA1c), HbA1c variability over 4 years and time in range (TIR) in children with type 1 diabetes (T1D).

Research design and methods: 101 children with T1D and one of their parents were assessed at baseline for child attachment (Child Attachment Interview; CAI) and parent attachment (Relationship Structures Questionnaire; ECR-RS). Serum samples were collected for cortisol measurements before the interviews. HbA1c levels were measured during a 4-year follow-up period at regular 3-monthly visits, and data for TIR were exported from blood glucose measuring devices. Multivariate linear regression models were constructed to identify independent predictors of glycemic outcomes.

Results: More girls than boys exhibited secure attachment to their mothers. The results of the regression models showed that securely attached girls (CAI) had higher average HbA1c than did insecurely attached girls (B = -0.64, p = 0.03). In boys, the more insecure the parent's attachment style, the worse the child's glycemic outcome: the higher the average Hb1Ac (B = 0.51, p = 0.005), the higher the HbA1c variability (B = 0.017, p = 0.011), and the lower the TIR (B = -8.543, p = 0.002).

Conclusions: Attachment in close relationships is associated with glycemic outcomes in children with T1D, and we observed significant differences between sexes. A sex- and attachment-specific approach is recommended when treating children with less favorable glycemic outcomes. Special attention and tailored support should be offered to securely attached girls in transferring responsibility for diabetes care and at least to male children of insecurely attached parents to prevent suboptimal glycemic control. Further studies in larger samples and more daily cortisol measurements may help us better understand the links between stress response, attachment and T1D.

Keywords: Attachment; Childhood and adolescence; Cortisol; Diabetes control; Time in range.

Grants and funding

P3-0343/Javna Agencija za Raziskovalno Dejavnost RS