The incidence of both type 1 and type 2 diabetes is increasing in children and adolescents, with a more rapid annual increase observed in type 2 diabetes, a trend often linked to the rising prevalence of obesity among youth [1-3]. Overweight and obesity are also increasingly common among adolescents with type 1 diabetes. Therefore, lifestyle interventions are needed in both groups, and mental health is an important factor in their successful implementation and maintenance. Mental health problems may hinder lifestyle modification by making it more difficult to maintain healthy eating patterns and regular physical activity [4]. Emotional distress has been associated with maladaptive eating behaviors, including irregular eating patterns, binge eating, and emotional eating [5]. Depression and related psychological difficulties have been associated with reduced physical activity and increased sedentary behavior in young people [6]. In addition, these problems may be accompanied by dysregulated daily routines, such as excessive screen time, and irregular sleep-wake patterns. Furthermore, psychological difficulties such as depression, anxiety, diabetes distress, or low motivation may reduce adherence to insulin administration, oral medication, and glucose monitoring, contributing to poor glycemic control [7]. Persistent inadequate lifestyle management and suboptimal treatment may increase the risk of diabetes-related complications over time, which in turn can adversely affect long-term quality of life.
In this context, both the International Society for Pediatric and Adolescent Diabetes (ISPAD) and American Diabetes Association (ADA) guidelines emphasize that psychological care should be integrated into routine diabetes management rather than treated as simply an optional adjunct [8,9]. ISPAD guidelines recommend that a psychological assessment be integrated into routine monitoring as part of comprehensive diabetes care. This approach requires an interdisciplinary team, with attention not only to the patient’s psychological well-being but also to proper family functioning. Ultimately, access to evidence-based psychosocial, behavioral, and psychiatric interventions is essential to optimize diabetes outcomes. The 2026 ADA Standards of Care recommend that psychosocial and behavioral support be provided at diagnosis and routinely thereafter for children and adolescents with diabetes. Routine psychosocial screening includes assessment of diabetes distress, depression, anxiety, eating disorders, family factors, and behavioral health concerns that may affect diabetes management, with attention to family involvement and collaboration with behavioral health professionals. Fear of hypoglycemia should be assessed when clinically indicated.
Korean pediatric studies on psychosocial factors and glycemic control remain limited and have focused mainly on youth with type 1 diabetes. Previous studies suggested that poorer psychological adjustment, adverse family environment, and less supportive parental behavior may be associated with worse metabolic control [10,11]. Recent data have begun to evaluate the relationship between early mental health screening and subsequent glycemic outcomes in both type 1 and type 2 diabetes [12]. This study supports the importance of early mental health screening in achieving optimal glycemic control. These findings suggested that psychological factors should be recognized as an important component in the management of pediatric diabetes.
Glycemic control after the diagnosis of diabetes may be influenced by a complex interplay of environmental, psychosocial, and family-related factors [8,13,14]. Therefore, multidisciplinary care that includes attention to mental health is important for optimal diabetes management and better long-term outcomes in children and adolescents.
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