Glycemic Factors Related to Depression in Adults with Type 1 Diabetes

Abstract

Objective: To compare glycemic factors (home glucose monitoring, glucose variability, A1c) in adults with type 1 diabetes (T1D) with probable depression to those without depression in a real world setting. Methods: Adults with T1D at our diabetes center are routinely screened for depression with the PHQ2. If the PHQ2 score is >3, PHQ9 is completed. Medical records were reviewed including device downloads for adults with PHQ9 scores =10 (“depressed”) and age-matched “not depressed” controls (PHQ2 scores =3). Patients with T1D duration <1 year, GFR =30 mL/min/1.73m2, hemoglobinopathy or dementia were excluded. Results: Of 1292 adults screened, 83 (6.4%) were depressed, and compared to an age-selected group of 171 non-depressed T1D adults (age range 18-72 years, 86% white, 8% black, 99% non-Hispanic, 42% Medicaid). Depressed [mean (SD) PHQ9 score 16.8 (4.3)] did not differ from non-depressed on age [41.7 (15.6) vs. 41.8 (15.7) years], BMI [29.3 (8.8) vs. 28.9 (6.2) kg/m2], T1D duration [21.2 (13.4) vs. 22.0 (15.0) years], or % male [42.2 vs. 40.9]. Meter downloads were available for 215/254 patients (74% of depressed, 90% of non-depressed). The depressed group had higher A1c [9.6% (2.3) vs. 8.6% (1.8) p<0.001], and fewer glucose tests/day [2.8 (2.3) vs. 3.6 (2.5) p=0.048] based on meter downloads. Prior work found that depression did not relate to self-reported glucose monitoring in T1D adults. The groups did not differ on meter % coefficient of variation (CV; mean 42%) or % with hypoglycemia (glucose reading <54 mg/dL). Continuous glucose monitoring (CGM) was used by 38 patients; CGM % CV was also not different in those depressed [35.0 (6.2), n=5] vs. non-depressed [36.0 (6.0), n=33]. The depressed group using CGM had lower A1c, suggesting that CGM use should not be withheld in the presence of depression. The small number of patients using CGM is a limitation. Conclusion: Adults with T1D and probable depression had higher A1c, less meter use, fewer glucose readings/day, but no difference in glucose variability (% CV) or hypoglycemia (<54 mg/dL). Disclosure I. Egbuonu: None. P.M. Trief: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. C.A. Roe: None. R.S. Weinstock: Research Support; Self; Medtronic MiniMed, Inc., Mylan, Kowa Pharmaceuticals America, Inc., Diasome Pharmaceuticals, Inc., Calibra Medical, Dexcom, Inc., Ultradian Diagnostics LLC., JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases.