Relationship between bullying and type 1 diabetes mellitus in children and adolescents: a systematic review

Andrade, Carlos Jefferson do Nascimento; Alves, Crésio de Aragão Dantas

doi:10.1016/j.jped.2018.10.003

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Review articles • J. Pediatr. (Rio J.) 95 (5) • Sep-Oct 2019 • https://doi.org/10.1016/j.jped.2018.10.003 copy

Relationship between bullying and type 1 diabetes mellitus in children and adolescents: a systematic review^☆ ☆ Please cite this article as: Andrade CJ, Alves CA. Relationship between bullying and type 1 diabetes mellitus in children and adolescents: a systematic review. J Pediatr (Rio J). 2019;95:509-18.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To carry out a systematic review on the relationship of bullying with type 1 diabetes in children and adolescents.

Methods:

Systematic review, according to the PRISMA methodology, in which the databases PubMed, Web of Science, Scopus, Thomson Reuters, Eighteenth Century Collections Online, Begell House Digital Library, LILACS, and SciELO were searched using the terms "bullied", "aggression", "peer victimization", "victimization", "school violence", "diabetes mellitus", "type 1 diabetes mellitus", "autoimmune diabetes", "children" and "adolescents." The authors included original studies, involving bullying associated with type 1 diabetes, with children and adolescents, without language restriction and publication period, with texts available in full.

Results:

Of the 32 articles found, four studies met the selection criteria. Of these studies 85.7% identified occurrence of victimization in diabetics or found a higher frequency in diabetic children and adolescents when compared with young people with other chronic conditions or with healthy peers. Association between bullying and worse glycemic control was observed in two studies, and all the studies mention the fact that type 1 diabetes is a limiting factor for socialization related to diabetes, with less social support and difficulties for the management of the disease in public environments, such as school. The type of bullying suffered varied, including physical, verbal, social, psychological, and sexual.

Conclusion:

Most of the studies showed an association between bullying and type 1 diabetes when compared to individuals with no such condition. Knowledge of this association has become essential for the follow-up of these patients and the implementation of preventive programs.

KEYWORDS
Adolescent; Bullying; Child; Type 1 Diabetes

Authors	Country/year of publication	Interview location	Study design	Sample	Characteristics of the population
Kendall-Tackett and Marshall²⁴24 Kendall-Tackett KA, Marshall R. Victimization and diabetes: an exploratory study. Child Abuse Negl. 1999;23:593-6.	England/1999	Basic adult care service	Retrospective study	130	130 adult patients with T1D (65 abused, 65 controls)
Storch et al.¹⁹19 Storch EA, Lewin A, Silverstein JH, Heidgerken AD, Strawser MS, Baumeister A, et al. Peer victimization and psychosocial adjustment in children with T1D. Clin Pediatr. 2004;43:467-71.	United States/2004	Pediatric Endocrinology Service	Cross-sectional	64	32 children with T1D and 32 children without medical diagnosis (control group), matched by age and sex
Storch et al.²⁰20 Storch EA, Heidgerken AD, Geffken GR, Lewin AB, Ohleyer V, Freddo M, et al. Bullying, regimen self-management, and metabolic control in youth with T1D. J Pediatr. 2006;148:784-7.	United States/2006	Pediatric Endocrinology Service	Cross-sectional	167	167 young people with T1D
Peters et al.²³23 Peters CD, Storch EA, Geffken GR, Heidgerken AD, Silverstein JH. Victimization of youth with T1D by teachers: relations with adherence and metabolic control. J Child Health Care. 2008;12:209-20.	United States/2008	Pediatric Endocrinology Service	Cross-sectional	167	167 young people with T1D

Authors	Objectives	Specific results	Scale rating
Kendall-Tackett and Marshall²⁴24 Kendall-Tackett KA, Marshall R. Victimization and diabetes: an exploratory study. Child Abuse Negl. 1999;23:593-6.	To identify diabetes and symptoms of diabetes in patients with a past history of victimization.	Four patients in the abused group reported diabetes, vs. none in the control group; those with a history of victimization reported significantly (three or more) symptoms of diabetes than those without a history.	The authors developed and applied a five-page, 169-item, closed-ended (yes-no), self-administered form questionnaire, which was designed for clinical use. The questionnaire included demographic information, self-rated health, and past medical history. The data were analyzed by comparing the abused group with the non-abused group.
Storch et al.¹⁹19 Storch EA, Lewin A, Silverstein JH, Heidgerken AD, Strawser MS, Baumeister A, et al. Peer victimization and psychosocial adjustment in children with T1D. Clin Pediatr. 2004;43:467-71.	To investigate the frequency and psychosocial correlates of peer victimization in a sample of youths with diabetes.	The relational victimization was significantly related with depressive symptoms, social anxiety, and loneliness; children with diabetes reported higher rates of relational victimization than those without diabetes.	The Social Experience Questionnaire (SEQ) provides indices of overt (e.g., hitting, threatening, pushing) and relational victimization (e.g., spreading rumors, ignoring, telling children's secrets), and prosocial peer support (e.g., help from peers).
Storch et al.²⁰20 Storch EA, Heidgerken AD, Geffken GR, Lewin AB, Ohleyer V, Freddo M, et al. Bullying, regimen self-management, and metabolic control in youth with T1D. J Pediatr. 2006;148:784-7.	To determine the association among diabetes-related bullying, diabetes self-management, metabolic control, and depression in children and adolescents with type I diabetes (TID).	Diabetes-related bullying was significantly correlated with overall regimen self-management activity. Diabetes-related bullying was also significantly correlated with HbA1c concentration.	Participants' experience of diabetes-related peer victimization over the past month was assessed using the Diabetes Related Bullying Scale (DRBS). Items were developed based upon interviews with children with TID, as well as through feedback by pediatric endocrinologists, nurse practitioners, and psychologists who work extensively with this population.
Peters et al.²³23 Peters CD, Storch EA, Geffken GR, Heidgerken AD, Silverstein JH. Victimization of youth with T1D by teachers: relations with adherence and metabolic control. J Child Health Care. 2008;12:209-20.	To examine diabetes-related teacher victimization.	The mean of the total composite score of teacher victimization was 4.35. Of 167 students, 7% reported that they put off or delay checking 'sometimes', while four (2%) students reported 'often', and three (2%) students reported 'always'; 5% reported that they avoid checking 'sometimes', while 1% of the students reported 'often' and 1% reported 'always;' 1% reported that they put off or delayed taking insulin at school 'often' and 1% of the students reported that they 'always' put off or delay taking insulin at school; 1% reported that they avoid taking insulin at school 'often' and 1% of the students reported that they 'always' avoid taking insulin at school.	Metabolic control was measured with HbA1c values and diabetes self-management was assessed using the parent version of the Diabetes Self-Management Profile (DSMP). Youngsters completed four questions to assess diabetes-related victimization by teachers. Items were derived and rated on a five-point scale (where 1 = never and 5 = always) over the past month.

Authors	Investigation	Types of bullying	Aggressors	Outcome
Kendall-Tackett and Marshall²⁴24 Kendall-Tackett KA, Marshall R. Victimization and diabetes: an exploratory study. Child Abuse Negl. 1999;23:593-6.	Considers the relationship between diabetes and its symptoms in patients with a history of victimization	Physical, verbal, and sexual	Peers	A history of victimization was significantly more likely to be reported, in childhood or adolescence, by diabetics.
Storch et al.¹⁹19 Storch EA, Lewin A, Silverstein JH, Heidgerken AD, Strawser MS, Baumeister A, et al. Peer victimization and psychosocial adjustment in children with T1D. Clin Pediatr. 2004;43:467-71.	Investigates the frequency and psychosocial correlates of victimization among peers in a sample of young people with diabetes	Physical, verbal, and social	Peers	The results indicated that children with diabetes reported higher rates of victimization and lower levels of social support from their peers when compared to young people without diabetes.
Storch et al.²⁰20 Storch EA, Heidgerken AD, Geffken GR, Lewin AB, Ohleyer V, Freddo M, et al. Bullying, regimen self-management, and metabolic control in youth with T1D. J Pediatr. 2006;148:784-7.	Determines the association between diabetes-related bullying, self-management of diabetes, and metabolic control in children and adolescents with T1D mellitus	Verbal, psychological, and social	Peers	Bullying in diabetic patients was positively related to HbA1c concentration and negatively related to self-care, specifically, and adherence to glucose testing and feeding tasks.
Peters et al.²³23 Peters CD, Storch EA, Geffken GR, Heidgerken AD, Silverstein JH. Victimization of youth with T1D by teachers: relations with adherence and metabolic control. J Child Health Care. 2008;12:209-20.	Examines victimization rates and teacher relationships between teacher-initiated victimization, adherence and metabolic control in young people with T1D	Psychological	Teachers	Teacher-initiated victimization was significantly and negatively associated with diet, adherence to insulin therapy, and overall care for younger children (8-11 years), but not for older children (12-17 years).

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[1] * Corresponding author. E-mail:carlosjefferson_2@hotmail.com (C.J. Andrade).