Vloga navezanosti pri telesnem odzivu na stres in presnovni urejenosti sladkorne bolezni pri otrocih in mladostnikih s sladkorno boleznijo tipa 1 : doktorska disertacija

Lipovšek, Jasna Klara (author), Drobnič Radobuljac, Maja (mentor), Gostečnik, Christian (comentor)

SBT1 je ena od najbolj razširjenih kroničnih bolezni v otroštvu, pri čemer njena incidenca narašča. Presnovno neurejena SBT1 lahko privede do številnih akutnih in kroničnih zapletov, ti pa pomembno zmanjšajo kakovost življenja posameznika s to boleznijo. Cilj obravnave SBT1 je dobra presnovna urejenost, katere kazalnik je raven HbA1c v krvi. Nanjo vplivajo številni biopsihosocialni dejavniki. Raziskave kažejo, da oblika navezanost pri posamezniku vpliva na to, kako se vede v času bolezni. Poleg tega se oblika navezanosti povezuje s telesnim odzivom na stres. Mehanizem delovanja stresne osi (HPA os) je pomemben v patogenezi številnih bolezni in predstavlja bistvo biopsihosocialnega modela nastanka bolezni. Predpostavili smo, da bi lahko oblika navezanost imela vlogo pri presnovni urejenosti ter telesnemu odzivu na stres pri otrocih in mladostnikih s SBT1. V raziskavo je bilo vključenih 101 otrok in mladostnikov s SBT1 ter njihovih staršev. Za oceno navezanosti je bil uporabljen intervju navezanosti otroka (CAI), za oceno presnovne urejenosti vrednost HbA1c v krvi, medtem ko je bila stresna odzivnost ocenjena s sinaktenskim testom. Starši so izpolnili vprašalnik demografskih podatkov. Rezultati niso pokazali statistično pomembnih razlik v povprečnem HbA1c ter stresni odzivnosti glede na posamezne oblike navezanosti. Kljub temu so že manjše razlike v HbA1c lahko klinično pomembne. Opažene majhne razlike v HbA1c bi lahko bile posledica obravnave na ravni zdravstvenega sistema ter dejstva, da navezanost otroka najverjetneje ne odraža presnovne urejenosti otroka v opisani starostni skupini (11,7 let). V tem obdobju imajo največjo odgovornost za obvladovanje bolezni njihovi starši, zaradi česar bi bilo smiselno ocenjevati tudi navezanost staršev. Nizka stresna odzivnost pri dezorganizirano navezanih posameznikih bi lahko bila posledica zmanjšanja aktivnosti HPA osi, oziroma sprememb navezanosti zaradi same SBT1. Predstavljene so posebnosti obravnave na Pediatrični kliniki Ljubljana in možne smeri za nadaljnje raziskave.

• Language: Slovenian
• Keywords: SBT1, presnovna urejenost, navezanost, stresna odzivnost, kortizol, HPA os, HbA1c, klinična obravnava otrok
• Work type: Doctoral dissertation
• Typology: 2.08 - Doctoral Dissertation
• Organization: TEOF - Theological Faculty
• Place of publishing: Ljubljana
• Publisher: [J. K. Lipovšek]
• Year: 2023
• Number of pages: XIII, 296 str.
• PID: 20.500.12556/RUL-152595
• UDC: 159.944.4:616.379-008.64-052(043.3)
• COBISS.SI-ID: 176927747
• Publication date in RUL: 30.11.2023

Secondary language

• Language: English
• Title: The role of attachment in stress reactivity and metabolic control in children and adolescents with type1 diabetes

Abstract

SBT1 is one of the most prevalent chronic diseases in childhood and its incidence is increasing. Metabolically dysregulated SBT1 can lead to many acute and chronic complications which significantly reduce the quality of life of an individual with this disease. The goal of SBT1 treatment is good metabolic control the indicator of which is the level of HbA1c in the blood. It is influenced by many biopsychosocial factors. Research shows that the attachment style in an individual affects how he behaves during illness. In addition, the attachment style is associated with the body's response to stress. The mechanism of action of the stress axis (HPA axis) is important in the pathogenesis of many diseases and represents the essence of the biopsychosocial model of disease emergence. We hypothesized that the attachment style could play a role in metabolic regulation and physical response to stress in children and adolescents with SBT1. 101 children and adolescents with SBT1 and their parents were included in the research. The Child Attachment Interview (CAI) was used to assess the attachment. The HbA1c value was used to assess metabolic control in the blood while the stress response was assessed with the synacthen test. The parents filled in a demographic data questionnaire. The results showed no statistically significant differences in average HbA1c and stress reactivity according to individual attachment style. Nevertheless, even small differences in HbA1c can be clinically significant. The observed small differences in HbA1c could be the result of treatment at the level of the health system and the fact that the attachment of the child most likely does not reflect the metabolic regulation of the child in the described age group (11.7 years). During this period, their parents have the greatest responsibility for managing the disease. Therefore, it would make sense to also evaluate parental attachment. Low-stress reactivity in individuals with disorganized attachment could be the result of reduced HPA axis activity or changes in the attachment because of SBT1. The peculiarities of treatment at the Division of Paediatrics, the University Medical Centre Ljubljana, and possible directions for further research are presented.

• Keywords: SBT1, metabolic control, attachment, stress reactivity, cortisol, HPA axis, HbA1c, clinical treatment of children