Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
Department of Pediatrics, Endocrinology, Children's Mercy Hospital, Kansas City, Missouri, USA.
Pediatr Diabetes. 2022 Mar;23(2):248-257. doi: 10.1111/pedi.13290. Epub 2022 Jan 5.
The prevalence of depression among adolescents with type 1 diabetes is estimated to be 2-3 times higher than in the general population. In adults with type 1 diabetes and depression, short-term outcomes are worse compared to individuals just diagnosed with type 1 diabetes. This study aims to determine if depressive symptom endorsement is associated with glycemic outcomes and short-term complications in adolescents with type 1 diabetes.
Analysis was conducted using electronic medical records from the T1D Exchange Quality Improvement Collaborative. Adolescents with type 1 diabetes, aged 12-18, receiving treatment in a diabetes clinic who had been screened for depression with the PHQ-9 between 2016 and 2018 were eligible for inclusion. Individuals must have also had HbA1c data available from the day of depression screening and from 10 to 24 weeks after screening; the final sample size was 1714.
Almost 30% of adolescents endorsed mild or greater (PHQ-9 ≥ 5) depressive symptoms. Endorsement of mild or greater depressive symptoms was associated with an 18% increased risk of an HbA1c ≥7.5% and a 42% increased risk of an HbA1c ≥9.0% on the day of screener administration. Depressive symptom endorsement was also associated with an 82% increased risk for DKA.
This study suggests that depression symptoms are associated with an increased risk for elevated HbA1c and short-term complications. With the rising incidence of type 1 diabetes in youth, routine screening, and appropriate management of depression is needed.
青少年 1 型糖尿病患者的抑郁患病率估计比普通人群高 2-3 倍。在患有 1 型糖尿病和抑郁症的成年人中，与刚被诊断为 1 型糖尿病的个体相比，短期预后更差。本研究旨在确定抑郁症状的存在是否与青少年 1 型糖尿病的血糖结果和短期并发症有关。
使用 T1D 交换质量改进合作组织的电子病历进行分析。在 2016 年至 2018 年期间，通过 PHQ-9 对糖尿病诊所接受治疗的 12-18 岁青少年进行抑郁筛查，且有接受过治疗的 1 型糖尿病患者符合纳入标准。个体还必须在抑郁筛查当天以及筛查后 10-24 周有 HbA1c 数据；最终样本量为 1714 人。
近 30%的青少年报告有轻度或更严重（PHQ-9≥5）的抑郁症状。轻度或更严重的抑郁症状与 HbA1c≥7.5%的风险增加 18%以及 HbA1c≥9.0%的风险增加 42%相关。在筛查当天，抑郁症状的存在也与 DKA 的风险增加 82%相关。
本研究表明，抑郁症状与 HbA1c 升高和短期并发症的风险增加有关。随着青少年 1 型糖尿病发病率的上升，需要进行常规筛查并对抑郁进行适当的管理。
