Klemenčič Simona, Lipovšek Jasna Klara, Turin Anja, Dovč Klemen, Bratina Nataša, Shmueli-Goetz Yael, Trebušak Podkrajšek Katarina, Repič Lampret Barbka, Jenko Bizjan Barbara, Karakatič Sašo, Battelino Tadej, Drobnič Radobuljac Maja
Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Bohoričeva Ulica 20, 1000, Ljubljana, Slovenia.
Centre for Mental Health, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia.
Child Adolesc Psychiatry Ment Health. 2023 Oct 17;17(1):121. doi: 10.1186/s13034-023-00672-1.
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).
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.
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).
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.
我们的目的是确定1型糖尿病（T1D）患儿对父母的依恋、父母的依恋风格以及早晨皮质醇水平是否与通过平均糖化血红蛋白（HbA1c）、4年内HbA1c的变异性以及血糖达标时间（TIR）衡量的糖尿病结局相关。
对101名T1D患儿及其一名父母在基线时进行儿童依恋（儿童依恋访谈；CAI）和父母依恋（关系结构问卷；ECR-RS）评估。在访谈前采集血清样本用于皮质醇测量。在4年的随访期内，每3个月定期测量HbA1c水平，并从血糖仪导出TIR数据。构建多变量线性回归模型以确定血糖结局的独立预测因素。
与男孩相比，更多女孩对母亲表现出安全型依恋。回归模型结果显示，安全型依恋的女孩（CAI）的平均HbA1c高于不安全型依恋的女孩（B = -0.64，p = 0.03）。在男孩中，父母的依恋风格越不安全，孩子的血糖结局越差：平均Hb1Ac越高（B = 0.51，p = 0.005），HbA1c变异性越高（B = 0.017，p = 0.011），TIR越低（B = -8.543，p = 0.002）。
亲密关系中的依恋与T1D患儿的血糖结局相关，且我们观察到了性别差异。对于血糖结局较差的患儿，建议采用针对性别和依恋类型的治疗方法。对于安全型依恋的女孩，在转移糖尿病护理责任时应给予特别关注和量身定制的支持，对于不安全型依恋父母的男孩至少也应如此，以防止血糖控制不佳。在更大样本和更多日常皮质醇测量的进一步研究可能有助于我们更好地理解应激反应、依恋与T1D之间的联系。
