Addressing mental health concerns in type 1 diabetes patients in a pandemic


Although the mental toll of the pandemic has been high for everyone, it’s been especially difficult for children with chronic diseases such as type 1 diabetes. A session at the virtual Scientific Sessions for the American Diabetes Association addressed how one program tackled these concerns.

The COVID-19 pandemic raised a variety of mental health concerns ranging from economic concerns for parents, lack of time with peers, and worries about becoming ill with the disease. For children and families managing type 1 diabetes, there were particular concerns. At a session titled “Behavioral interventions for pediatric diabetes during COVID-19” at the 81st virtual Scientific Sessions for the American Diabetes Association, Carrie Tully, a pediatric psychologist at Children’s National Hospital in Washington, DC, discussed how her program changed to provide care during the pandemic as well as presented results from a study that examined the effects of the pandemic.

For children with type 1 diabetes the pandemic led to an increase in sedentary behavior and a decrease in access to diabetes-specific support due to social distancing guidelines. Children and families were worried about whether children were vulnerable to the disease as well as being able to access both medical teams and medical supplies when needed because of supply chain issues. There were many changes to the Children’s National Hospital program, which treats >2000 children and adolescents with diabetes in the greater Washington DC metro area, on a variety of levels. On the institutional level, the hospital quickly transitioned to Health Insurance Portability and Accountability Act-compliant telemedicine options. Although the department had been using telemedicine to treat patients who lived far away since 2017, the shift required adjustment. It was more difficult for dietitians, nurse practitioners, and other clinicians to bring in behavioral care because they were no longer just down the hall. Within the behavioral practice level, practitioners had to know where the child physically was during each session along with the nearest emergency department in case of an emergency occurring during the session. Practitioners also had to offer technical support in case the telemedicine platform stopped working. Language interpretation services were offered when needed and patients were given advice on ensuring that the sessions were private, including finding quiet corners of the house and using headphones. Tully noted that telemedicine allowed practitioners to use tools that wouldn’t have been possible in normal sessions, including sharing memes and watching YouTube videos.

Tully concluded the session with results from a study of parents of early-school age children who had type 1 diabetes and comparing prepandemic and pandemic mental health concerns. Roughly 84% of the parents reported having at least 1 COVID-19 disruption, which included job changes, moving home, changes in insurance, child care changes, and changes in school. Ten percent of the parents indicated having severe COVID-19 outcomes in either immediate or non-immediate family and nearly 60% of the families said that they were adhering to strict social distancing guidelines. The number who reported elevated depression scores either prepandemic or during the pandemic was roughly equal at 22%, but 10% of the parents indicated elevated depression at both time points.


1. Tully C. Behavioral interventions for pediatric diabetes during COVID-19. American Diabetes Association Scientific Sessions 2021; June 25, 2021; virtual. Accessed June 25, 2021.

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