Post-traumatic stress and psychological well-being in children with type 1 diabetes: An Indian perspective

The diagnosis of type 1 diabetes mellitus (T1D) is frequently recalled by families as one of the most frightening moments of their lives.What follows is not a single crisis but a chronic one: Relentless glucose monitoring, insulin dosing, and the ever-present fear of hypoglycemia and diabetic ketoacidosis.It is increasingly recognized that this burden can cross the threshold from ordinary adjustment stress into post-traumatic stress symptoms and, in a subset, frank posttraumatic stress disorder (PTSD) -affecting not only the child but the caregiver who carries the round-the-clock vigilance of disease management.In this issue, Shah et al. present findings from a study examining probable PTSD among children with T1D and their caregivers, reporting a prevalence of approximately 10%-a figure the authors note is nearly twice that reported in earlier United States cohorts.[1] What makes this striking is the context: 88% of participants were on insulin pumps, 97% had access to continuous glucose monitoring (CGM), mean hemoglobin A1c (HbA1c) was 7.5%, and nearly all had public or private insurance.The lesson is an important one-trauma related to a chronic, life-threatening childhood illness is not fully mitigated by technology, tight glycemic control, or financial access.The emotional weight of living with T1DM appears to persist independent of resource level.If probable PTSD persists at this rate even under near-optimal resource settings, the Indian scenario invites a different and arguably more layered set of stressors.Insulin pump and CGM penetration remain low, and most children are managed on multiple daily injections with selfmonitoring of blood glucose that is frequently curtailed by cost or by the pain of repeated fingerpricks.This directly translates into unpredictable hypoglycemia and glycemic swings-an Indian cohort using retrospective CGM found a mean HbA1c of 8.0%, yet time-in-range averaging only 41%, with none of the children meeting recommended glycemic targets.[2] Layered onto this is genuine financial insecurity: A North Indian survey found families spending roughly ₹55,000 a year on glucose monitoring, insulin, and investigations alone, with over 30% of families spending more than half their household income on diabetes care, more than a third borrowing money to sustain treatment, and fewer than 12% receiving any organized financial support-many families depend on out-of-pocket purchases or non-governmental organization-supplied strips and insulin.[3] For an Indian family, then, the traumatic burden of T1D is not only the fear of the disease itself but also the compounding weight of unaffordability, technology denied, and the visible dejection of an HbA1c far above target despite best efforts.This is consistent with Indian data specifically on caregivers.The IDREAM study found that high caregiving burden nearly doubled the probability of severe depression and low well-being https://ispae-jped.com/