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Glycemic control, depression, diabetes distress among adolescents with type 1 diabetes: effects of sex, race, insurance, and obesity

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Abstract

Aims

To determine whether diabetes distress or depression screening better predict increased hemoglobin A1c (HbA1c) and to assess interactions with age, sex, race, obesity, and insurance status.

Background

Diabetes distress is a negative emotional reaction to diabetes, diabetes complications, self-management demands, unresponsive providers, and/or poor interpersonal relationships. Guidelines recommend annual depression screening, however diabetes distress may be mistaken for depression.

Method

Depression (PHQ-9) and diabetes distress (PAID-T) scores from self-administered tests were studied in 313 patients with type 1 diabetes (T1D) between the ages of 13–17. Spearman correlations and robust rank order multivariable regression analysis were used to assess relationships to age, duration, HbA1c. Kruskal–Wallis test was used to assess differences between sexes, races, and insurance status. Receiver operator curves (ROC) were constructed to see whether PAID-T or PHQ-9 scores more closely predicted HbA1c greater than 9%.

Results

HbA1c was more strongly correlated with PAID-T (rs = 0.37, p < 0.01), than PHQ-9 (rs = 0.27, p < 0.01) scores. Area under ROC curve for poor HbA1c was 0.75 for PAID and 0.64 for PHQ-9. PAID-T and PHQ-9 scores were increased in females and subjects with public insurance and both were significantly related to HbA1c even when accounting for age, sex, race obesity, and insurance status. PHQ-9 and PAID-T scores correlated with BMI-Z scores in Blacks, but not Whites.

Conclusions

Both depression and diabetes distress are associated with increased HbA1c in adolescents with T1D, though distress is more so. Diabetes distress and depression should be routinely assessed in T1D adolescents, particularly those with public insurance.

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Acknowledgements

The authors thank staff and patients from the Nationwide Children’s Hospital Endocrinology Section.

Funding

There was no funding and financial support.

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Authors and Affiliations

  1. Division of Endocrinology, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, 43105, USA

    K. Ming Chan Hong, Bethany A. Glick & Manmohan K. Kamboj

  2. Pediatric Endocrinology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA

    Robert P. Hoffman

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  1. K. Ming Chan Hong
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Contributions

K.M.H., B.G., and R.P. H. conceived the idea, planned the experiment, discussed the results, and contributed to the manuscript. M.K. was involved in creating the survey process in the clinic. K.M.H. carried out the experiment. R.P.H. performed the computations, verified the analytical methods, and supervised the findings of this work and overall experiment. R.P.H. is the guarantor.

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Correspondence to Robert P. Hoffman.

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Approved Nationwide Children's Hospital Institutional Review Board. Informed Consent waved.

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This article belongs to the topical collection Health Education and Psycho-Social Aspects, managed by Massimo Porta and Marina Trento.

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Hong, K.M.C., Glick, B.A., Kamboj, M.K. et al. Glycemic control, depression, diabetes distress among adolescents with type 1 diabetes: effects of sex, race, insurance, and obesity. Acta Diabetol 58, 1627–1635 (2021). https://doi.org/10.1007/s00592-021-01768-w

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  • DOI: https://doi.org/10.1007/s00592-021-01768-w

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