Associations Between Depressive Symptoms, Fear of Hypoglycemia, Adherence to Management Behaviors and Metabolic Control in Children and Adolescents with Type 1 Diabetes

  • Brittney JurgenEmail author
  • Courtney N. Baker
  • Jodi L. Kamps
  • James M. Hempe
  • Stuart A. Chalew


We examined the relationship between two malleable risk factors, depressive symptoms and fear of hypoglycemia, in children and adolescents with Type 1 diabetes and their relationship to two important outcomes, adherence behaviors and metabolic control. To assess this relationship, we used a multidimensional measure of adherence, assessing frequency of both blood glucose monitoring and healthy behaviors including diet and exercise. We predicted that higher levels of depressive symptoms and higher levels of fear of hypoglycemia would be associated with worse metabolic control as mediated by poor adherence. Eighty-three children and adolescents ages 8 to 20 (M = 13.87, SD 3.21) were recruited from March 2014 to October 2014 at an outpatient diabetes clinic in a moderately sized Southeastern city within the USA. Nested models were evaluated using structural equation modeling. Adherence significantly mediated the relationship between depressive symptoms and metabolic control with more depressive symptoms leading to worse metabolic control. Adherence marginally mediated the relationship between fear of hypoglycemia and metabolic control; however, less fear of hypoglycemia was associated with worse metabolic control. In a combined model, adherence continued to significantly mediate the relationship between depressive symptoms and metabolic control, while also independently significantly mediating the relationship between fear of hypoglycemia and metabolic control. This finding was also contrary to the predicted relationship with less fear of hypoglycemia leading to worse metabolic control. The results indicate that youth with fewer depressive symptoms and more fear of hypoglycemia had better adherence to their treatment regimen, which was associated with better metabolic control. The results of this study highlight the importance of screening for depression and fear of hypoglycemia during routine clinic visits to optimize adherence and metabolic control.


Type 1 diabetes Treatment adherence Metabolic control Depressive symptoms Fear of hypoglycemia 



This work was supported in part by the Mid-South Transdisciplinary Collaborative Center for Health Disparities Research through the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health under (Award Number U54MD008176 to J. M. Hempe). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding was also provided by Children’s Hospital of New Orleans, the Louisiana State University Health Sciences Center, and the P and C Carroll Foundation, New Orleans, LA.

Compliance with Ethical Standards

Conflicts of interest

The authors whose names are listed immediately below certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board at the Louisiana State University Health Sciences Center as well as Children’s Hospital IRB and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyTulane UniversityNew OrleansUSA
  2. 2.Department of PsychologyChildren’s Hospital of New OrleansNew OrleansUSA
  3. 3.Department of PediatricsLouisiana State University Health Sciences CenterNew OrleansUSA
  4. 4.Research Institute for Children, Children’s HospitalNew OrleansUSA
  5. 5.Department of PediatricsChildren’s Hospital of New OrleansNew OrleansUSA
  6. 6.BostonUSA

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