Characteristics of adolescents with poorly controlled diabetes referred to a tertiary care center.

The medical and psychosocial findings concerning 15 adolescents with poorly controlled diabetes referred to a tertiary center are reviewed. While referring physicians usually attributed poor metabolic control to an unusual idiosyncratic pathophysiologic aspect of diabetes, all patients were managed by conventional treatment regimens. Psychosocial problems, including excessive school absence, depression, and social isolation were frequent in this population, and in eight families emotional factors appeared to contribute to the development and persistence of poor metabolic control. Eight patients accepted psychosocial intervention consisting of individual, family, and/or group counseling. Not one of the patients has been hospitalized for ketoacidosis in the subsequent 12-18-mo period, and their psychosocial functioning as adolescents is improved. Hemoglobin A1c levels remained elevated. Psychosocial factors in adolescents experiencing poor metabolic control should be addressed.