Depressive symptoms predict change in glycemic control in adolescents with type 1 diabetes: Rates, magnitude, and moderators of change

Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Pediatric Diabetes (Impact Factor: 2.57). 05/2011; 12(8):718-23. DOI: 10.1111/j.1399-5448.2011.00771.x
Source: PubMed


To determine whether depressive symptoms in adolescents with type 1 diabetes predict change in glycemic control over time.
A total of 145 adolescents (aged 13-18 yr) participated in two study visits (baseline and 6 months). They completed a measure of depressive symptoms (Children's Depression Inventory; CDI) and had their A1c values and adherence to blood glucose monitoring (BGM) documented.
Three variables predicted A1c change over 6 months: CDI change score (B = 0.11; p < 0.001), BGM frequency at baseline (B = -0.21; p = 0.03), and A1c at baseline (B = -0.23; p = 0.002). A three-way interaction among these variables was significant (p < 0.01) and showed that adolescents with high adherence to BGM who were achieving optimal glycemic control (≤7.5%) at baseline were resistant to increasing A1c values, even if depressive symptoms worsened. However, as adherence to BGM declines, there is a synergistic effect with depressive symptoms to accelerate the increase of A1c values over time, making it more difficult to bring A1c back to optimal levels.
Results suggest that depressive symptoms are important predictors of A1c change by themselves as well as when considered with adherence to BGM. There is a need to screen for depressive symptoms and expand and develop prevention and intervention strategies in order to put adolescents with type 1 diabetes in the best position for optimal glycemic control.

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    • "The lack of knowledge concerning rates and characteristics of disordered affect in young people with type 1 diabetes presents a potentially significant shortcoming in treatment capacity as AD such as anxiety and depression are linked to poor outcomes right across the biopsychosocial spectrum. Depression symptoms have been shown to be a significant predictor of reductions in metabolic control (Hood et al., 2011) with symptoms such as lassitude, anhedonia, disordered eating, and sleep hygiene impacting on motivation and capacity to maintain important self-care practices. Similarly characteristics of depression such as impaired cognition can lead to mistakes and "
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    ABSTRACT: BACKGROUND: There is evidence for increased risk of affective disorders (AD) in adults with type 1 diabetes however, the prevalence and characteristics of AD in young people with the condition is unclear. Comorbid AD in type 1 diabetes is associated with deleterious self-management, sub-optimal clinical indicators, reduced quality of life, poorer physical health, increased complications, increased high risk behaviours in adolescence and young adulthood, and earlier mortality. The present study investigated the prevalence and character of AD in young people with type 1 diabetes. METHODS: The self-report PH-PANAS-C was employed in a cross-sectional, case-control design to identify and differentiate full-syndrome (FS) and subthreshold (St) levels of AD in 53 participants with type 1 diabetes (case) and 54 age-balanced controls (N=107; 7-18 yrs). RESULTS: Case participants reported greater AD than controls. When differentiated, only anxiety was significantly more prevalent. Case participants reported less positive affect, and greater negative affect and autonomic arousal. Further, 1:3 case participants presented with St symptoms of AD. LIMITATIONS: Self-report measures are known to produce moderated responses therefore symptoms may be more severe than reported. There has been some suggestion that responses to somatic items in the PH-PANAS-C may relate to diabetes-specific states rather than affect-related symptoms however, recent evidence has refuted this argument. CONCLUSIONS: AD, particularly anxiety, represents a significant clinical concern in young people with type 1 diabetes both as a disorder in its own right and as a major impediment to primary care and management of the diabetes. The significant dominance of anxiety-related symptoms and prevalence of subthreshold presentation warrant further investigation.
    Journal of Affective Disorders 11/2012; 147(1-3). DOI:10.1016/j.jad.2012.10.006 · 3.38 Impact Factor
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    ABSTRACT: Diabet. Med. 30, 199–208 (2013) Aims To determine: (1) prevalence of depression among young people with Type 1 diabetes compared with control groups or population norms; (2) implications of depression for HbA1c level; and (3) the relationship between history of depressive symptoms and future depressive symptoms. Background Among adults with Type 1 diabetes depression is higher than the general population, and has been associated with adverse implications for self-care and HbA1c level. The last published review of depression among young people with Type 1 diabetes only included studies up to 1999. Method Systematic searches were conducted for articles published from January 1999 to December 2011 including young people (up to 25 years old) with Type 1 diabetes. Results Twenty-three articles met the inclusion criteria. Of five studies that reported prevalence of depression compared with control groups, three found no differences. Of the three studies that investigated prevalence of depression making reference to population norms, all three showed higher rates of depressive symptoms. Fourteen of 15 studies found associations between more depressive symptoms and higher HbA1c level either cross-sectionally or longitudinally. Past depressive symptoms were associated with later depressive symptoms. Conclusions Current evidence is inconclusive about whether there is increased prevalence of depression among young adults with Type 1 diabetes, as established among adults, but those who are more depressed have higher HbA1c level. This review is limited by methodological problems and no identified work in the UK met the inclusion criteria. Given the adverse clinical outcomes, we conclude there is a case for routine mental health screening for young adults with Type 1 diabetes.
    Diabetic Medicine 06/2012; 30(2). DOI:10.1111/j.1464-5491.2012.03721.x · 3.12 Impact Factor
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    ABSTRACT: Although the prevalence of a mental disorder, in general, in patients with diabetes mellitus is regarded to be comparable to the general population, an increased prevalence of depressive disorders, often comorbid with anxiety, has been reported in patients with diabetes mellitus. The co-occurrence of depression in diabetes is attributed to a variety of factors, including the psychological and psychosocial impact of the disease, a potential common genetic susceptibility and common pathophysiological abnormalities involving neuroimmunological and neuroendocrinical pathways, as well as microvascular brain lesions due to diabetes mellitus. However, issues concerning pathogenesis and causality of this high co-occurrence are not fully determined yet. Still, the presence of depression in patients with diabetes mellitus is of vast importance, as it is usually associated with poor disease control, adverse health outcomes and quality of life impairment. This article aims to provide a comprehensive review of epidemiological findings, clinical considerations and management strategies concerning depression in patients with diabetes mellitus.
    Hippokratia 07/2012; 16(3):205-14. · 0.37 Impact Factor
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