{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T18:40:12Z","timestamp":1761763212047,"version":"build-2065373602"},"reference-count":61,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T00:00:00Z","timestamp":1703116800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in children and adolescents, and is associated with stress and other psychological alterations. This study aims to assess psychological and sleep disorders and health-related quality of life in young people with T1DM and to determine the relationship between these parameters and levels of salivary cortisol, a hormone widely associated with stress and several psychological symptoms. Materials and Methods: In our cross-sectional study performed in 60 Moroccan children and adolescents with T1DM, detailed psychological evaluations were performed to assess symptoms of anxiety, attention-deficit hyperactivity disorder (ADHD), sleep quality and diabetes-specific quality of life (using the RCMAS-2, ADHD rating scale, Pittsburgh scale and the DQoL scale, respectively), and cortisol concentration was measured from saliva samples taken mid-morning. Results: A total of 60 children and adolescents with T1DM were recruited. The mean age was 11.05 \u00b1 0.35 (6\u201317). The mean salivary cortisol level in ng\/mL was 4.7 \u00b1 0.49 (0.7\u201320.2) and was significantly associated with an anxiety RCMAS2 score for the Worry subdomain and DQoL subdomain \u201cAnxiety\u201d. Linear regression analysis showed that salivary cortisol was significantly higher in girls compared to boys (p = 0.004) (beta coefficient: 3.384 CI95%: 1.137\u20135.630) and with Hb1AC level as a continuous variable (p = 0.0001) (beta coefficient: 1.135 CI95%: 0.509\u20131.760). The other variables included in the model were not significant (p &gt; 0.05). There was an association between salivary cortisol concentration with anxiety RCMAS2 score for Worry subdomain and QoL sub-domain \u201cAnxiety\u201d. Still, a significant (p = 0.018) association emerged for anxiety RCMAS2 score Worry subdomain and QoL anxiety subdomain (p = 0.044). Conclusions: Children and adolescents with T1DM experienced significantly elevated symptoms of anxiety and sleep disturbances, particularly in girls, and frequent symptoms of ADHD, particularly in boys. Salivary cortisol concentration collected in the morning is associated with anxiety burden but not with other psychological alterations. Further studies are needed to clarify the associations between salivary cortisol concentration and anxiety in type 1 diabetes in order to propose the hormone as a biomarker for interventions aimed to reduce anxiety levels in these patients.<\/jats:p>","DOI":"10.3390\/medicina60010019","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T08:16:02Z","timestamp":1703146562000},"page":"19","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Psychological Alterations in Youths with Type I Diabetes: Associations with Salivary Cortisol Concentration"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8403-2754","authenticated-orcid":false,"given":"Nisrin","family":"El Mlili","sequence":"first","affiliation":[{"name":"Institute of Nursing and Health Technology (ISPITS), Tetouan 93000, Morocco"},{"name":"Department of Biology and Health, Faculty of Sciences, Abdelmalek Essa\u00e2di University, Tetouan 93000, Morocco"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanan","family":"Ahabrach","sequence":"additional","affiliation":[{"name":"Institute of Nursing and Health Technology (ISPITS), Tetouan 93000, Morocco"},{"name":"Department of Biology and Health, Faculty of Sciences, Abdelmalek Essa\u00e2di University, Tetouan 93000, Morocco"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hind","family":"Bahri","sequence":"additional","affiliation":[{"name":"Institute of Nursing and Health Technology (ISPITS), Tetouan 93000, Morocco"},{"name":"Interdisciplinary Laboratory for Research in Pedagogical Engineering (LIRIP), Ecole Normale Sup\u00e9rieure, Abdelmalek Essa\u00e2di University, Tetouan 93000, Morocco"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdelilah","family":"Kerkeb","sequence":"additional","affiliation":[{"name":"Koelma Urban Health Center, Tetouan 93000, Morocco"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6300-5346","authenticated-orcid":false,"given":"Mayra Alejandra","family":"Mafla-Espa\u00f1a","sequence":"additional","affiliation":[{"name":"Department of Nursing, University of Valencia, 46010 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5669-4943","authenticated-orcid":false,"given":"Omar","family":"Cauli","sequence":"additional","affiliation":[{"name":"Department of Nursing, University of Valencia, 46010 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S2213-8587(22)00218-2","article-title":"Global Incidence, Prevalence, and Mortality of Type 1 Diabetes in 2021 with Projection to 2040: A Modelling Study","volume":"10","author":"Gregory","year":"2022","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.diabet.2012.10.001","article-title":"Nocturnal Activity of 11\u03b2-Hydroxy Steroid Dehydrogenase Type 1 Is Increased in Type 1 Diabetic Children","volume":"39","author":"Barat","year":"2013","journal-title":"Diabetes Metab."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1111\/pedi.12737","article-title":"ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic Control Targets and Glucose Monitoring for Children, Adolescents, and Young Adults with Diabetes","volume":"19","author":"DiMeglio","year":"2018","journal-title":"Pediatr. 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