Don't Ignore Depression in Youth With Type 1 Diabetes

Among younger people with type 1 diabetes, depression may be negatively affecting their glucose control, researchers reported.

In patients with type 1 diabetes and a mean age of 17.7, depressive symptoms, as measured by higher Patient Health Questionnaire-9 Adolescent Version (PHQ-9) scores, were significantly associated with a higher HbA1c (B=0.06, P<0.001), according to Julie M. Gettings, PhD, of Children's Hospital of Philadelphia (CHOP), and colleagues.

As depressive symptoms worsened, so did HbA1c, Gettings' group reported in a poster at the American Diabetes Association (ADA) annual meeting.

"There is a clear relationship between degree of depression symptoms and glycemic control, and it is possible that depression symptoms are affecting effort with diabetes management," they wrote.

Those whose depressive symptoms fell into the subthreshold category on the PHQ-9 scale (score between 5-10) only saw somewhat elevated HbA1c levels, not reaching statistical significance (B=0.331, P=0.07). However, those whose depressive symptoms were at or above the threshold of depression symptom risk category (score of 11+) saw significant association with higher HbA1c levels (B=0.799, P=0.003).

Gettings' group found that a history of suicide attempt was also associated with a higher HbA1c level (B=1.13, P<0.001), but suicidal ideation within the past 2 weeks was not (B=0.53, P=0.14). They also pointed out that even after adjusting for each other, PHQ-9 scores and history of suicide attempt were both independently associated with having a higher HbA1c.

"It is possible that those with suicide attempt history may be a subgroup of adolescents and young adults with type 1 diabetes with more entrenched mental health concerns that could be impairing daily diabetes function," they pointed out.

A total of 759 adolescents and young adults were electronically administered the PHQ-9 during outpatient visits at CHOP and another diabetes center. The duration of type 1 diabetes was around 8 years. Most of the patients were white (64.8%) and 22.3% were Black.

The last HbA1c reading was an average of 8.49% across the cohort and PHQ-9 score was 3.27, falling into the "normal" category. The majority fell into the "normal" PHQ-9 category, while 19.9% were "subthreshold" and 7.5% were at "threshold." Around 4% of the cohort reported suicidal ideation within the past 2 weeks and 5.3% had a history of suicide attempt.

Gettings and colleagues suggested that future studies focus on how suicidal ideation and suicide attempts may help to predict suicide risk for this young population with type 1 diabetes.

They also noted that, because of the "potential for symptoms overlap between somatic symptoms of depression and prolonged hyperglycemic, future work should separately examine the possible relationships between somatic symptoms and cognitive symptoms and how they relate to HbA1c." These may include symptoms like fatigue, changes in sleeping and eating, and trouble concentrating.

The link between suicidality and type 1 diabetes was a major theme at ADA. One international research group -- RESCUE (Reducing Suicide Rates Amongst Individuals With Diabetes) Collaborative Community -- led a symposium highlighting grim statistics -- up to 7% of the deaths that occur in patients with type 1 diabetes are due to suicide.

"Suicide and self-harm is an all-too-common reality for young adults with type 1 diabetes, but it doesn't have to be," said Katharine Barnard-Kelly, PhD, of the RESCUE Collaborative Community, in a statement. "With a multi-pronged approach to awareness, education, and identification, we have the opportunity to intervene on the link between suicide and diabetes."

Here is a list of support resources recommended by the RESCUE Collaborative Community for people with type 1 diabetes.

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