Korey K Hood1, Joseph R Rausch, Lawrence M Dolan. 1. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. korey.hood@cchmc.org
Abstract
OBJECTIVE: To determine whether depressive symptoms in adolescents with type 1 diabetes predict change in glycemic control over time. RESEARCH DESIGN AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVE: To determine whether depressive symptoms in adolescents with type 1 diabetes predict change in glycemic control over time. RESEARCH DESIGN AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Amy J Kogon; Ji Young Kim; Nina Laney; Jerilynn Radcliffe; Stephen R Hooper; Susan L Furth; Erum A Hartung Journal: Pediatr Nephrol Date: 2019-05-02 Impact factor: 3.714
Authors: Sara J Coulon; Cruz Velasco-Gonzalez; Richard Scribner; Chi L Park; Ricardo Gomez; Alfonso Vargas; Sarah Stender; Jovanny Zabaleta; Patrice Clesi; Stuart A Chalew; James M Hempe Journal: Pediatr Diabetes Date: 2016-01-18 Impact factor: 4.866
Authors: Dayna E McGill; Lisa K Volkening; David M Pober; Andrew B Muir; Deborah L Young-Hyman; Lori M Laffel Journal: J Adolesc Health Date: 2017-12-06 Impact factor: 5.012
Authors: Matthew J Bitsko; Melanie K Bean; Sarah Bart; Rebecca H Foster; Leroy Thacker; Gary L Francis Journal: J Clin Psychol Med Settings Date: 2013-09
Authors: Amy J Kogon; Ann Vander Stoep; Noel S Weiss; Jodi Smith; Joseph T Flynn; Elizabeth McCauley Journal: Pediatr Nephrol Date: 2013-05-23 Impact factor: 3.714