| dc.description.abstract | Background - Despite technology innovations in management of type 1 diabetes (T1D) glycemic control in adolescents continues to be suboptimal with only 17 to 21% meeting the American Diabetes Association (ADA) recommended HbA1c of < 7.0%. Given the short- and long-term complications of diabetes, understanding factors influencing adolescent self-management is essential. Adolescents with T1D have a 2-3 times higher prevalence of depression than their healthy counterparts. Routine depression screening is recommended by the ADA and International Society for Pediatric and Adolescent Diabetes (ISPAD). However, screening instruments used in T1D include varied validated tools standardized in a general population. One such tool commonly used for depression screening in adolescents is PHQ-9.
Purpose - The purpose of this study was to (a) examine the severity of depressive symptoms and differences in symptom presentation using the PHQ-9 between adolescents with and without T1D, (b) examine the relationship of item to total scores using the PHQ-9 in adolescents with and without T1D, and (c) examine the association between identified item-level drivers of depression symptoms with diabetes-related variables.
Methods – This was a retrospective case-control study which included 1403 adolescents with T1D and of those 432 had diabetes device reports in the EHR. For the case-control portion of the study, the adolescents with T1D were matched with adolescents from a general pediatric population for age, sex, and race resulting in n=477 matched pairs. Data were retrospectively collected from EHRs for the 12 months before completion of the first PHQ-9. For a randomly selected subsample of adolescents with T1D device reports were retrieved from the EHR.
Results - The study findings indicate using a standard depression screening for adolescents with T1D may be acceptable. However, some of the depressive symptoms showed a significantly different endorsement pattern in those with T1D. These symptoms are: (a) difficulty falling asleep, (b) fatigue, (c) excess or poor appetite, and (d) trouble concentration. Given the similarity of physical and cognitive manifestations of glucose excursions to these depressive symptoms, further exploration of underlying pathways for depressive symptom endorsement in T1D is warranted. Additionally, future prospective studies are warranted to further explore the interaction of depressive symptoms with T1D self-management and glycemic control taking advantage of the device data available in the EHR. | |
