Disconnect between advanced diabetes technology and psychological well-being among young people: a cross-sectional analysis

Introduction

Diabetes technologies may improve glycemic control and psychological well-being among adolescents and young adults (AYA) with type 1 diabetes. This cross-sectional study examines perceptions of automated insulin dosing (AID) systems and their association with glycemic and psychological outcomes compared with multiple daily insulin injections (MDI) and continuous subcutaneous insulin infusion (CSII).

Research design and methods

Participants were recruited from the largest diabetes camp for AYA in Germany. A total of 151 participants (70% female, mean age 20.7±2.9 years, 33% AID users) completed a questionnaire that included self-reported glycated hemoglobin A1c (HbA1c), global health status, emotional well-being (WHO-5), Generalized anxiety (GAD-7) and diabetes distress (PAID-5). AID users also rated their experiences with the system.

Results

AID users reported significantly lower HbA1c levels (7.3±1.0%) than CSII users (7.5±1.1%) and MDI users (8.4±2.0%, p=0.003). Approximately 75% of AID users viewed their current system as an improvement over previous therapy, reporting greater ease (84%), comfort (82%) and safety (80%). They reported higher treatment satisfaction than CSII users (p=0.044) and lower diabetes burden than MDI users (p=0.044) after controlling for age and gender. Treatment groups did not differ in well-being or anxiety. Better global health status was associated with the absence of other chronic health conditions (p=0.024), greater well-being (WHO-5; p<0.001), lower HbA1c (p=0.038) and fewer anxiety symptoms (GAD-7, p=0.007). Despite these positive indicators, a substantial proportion of participants reported symptoms of depression (18%), anxiety (30%), and diabetes distress (39%).

Conclusions

AID systems were associated with improved glycemic control and high satisfaction among AYA. However, psychological distress remained prevalent across all treatment modalities, underscoring a discrepancy between metabolic benefits and persistent mental health challenges. These findings highlight the need to integrate psychological support alongside technological advances in the care of AYA living with diabetes.