The role of socioeconomic status, depression, quality of life, and glycemic control in type 1 diabetes mellitus.
OBJECTIVE
To test the hypothesis that poor glycemic control in type 1 diabetes mellitus (T1DM) is associated with depression and poor quality of life (QOL), with a higher prevalence in persons of lower socioeconomic status (SES).


METHODS
Subjects with T1DM age 8 to 17 years (n = 222) were evaluated using the Childrens Depression Inventory, the Hollingshead Four-Factor Index to determine SES, and PedsQL questionnaires to ascertain QOL. HbAlC > 8% was considered indicative of poor glycemic control.


RESULTS
A total of 110 well-controlled subjects and 112 poorly controlled subjects (HbA1C 7.1% +/- 0.7% vs 9.9% +/- 1.6%) were recruited. It was found that 9.5% of poorly controlled subjects were depressed, compared with 3% of well-controlled subjects. Logistic regression revealed a 27% increase in probability of depression per unit rise in HbA1C (P < .03). Higher SES was associated with better glycemic control (P < .0005) and QOL (P < .0005); longer duration of illness was not associated with poorer glycemic control. Diabetes QOL deteriorated with poorer glycemic control (P < .002).


CONCLUSIONS
Poor glycemic control in peridatric T1DM is associated with lower SES and depression. The probability of depression increases as glycemic control worsens. Screening for depression should be routinely carried out in patients with T1DM, targeting patients with deteriorating glycemic control.
Hassan
Krishnavathana
K
Department of Pediatric Endocrinology and Metabolism, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA. kvhassan@texaschildrenshospital.org
Loar
Robert
R
Anderson
Barbara J
BJ
Heptulla
Rubina A
RA
D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis*; D002648:Child; D003863:Depression / Q000453:epidemiology*; D048909:Diabetes Complications / Q000097:blood / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000628:therapy*; D006801:Humans; D011788:Quality of Life; D012923:Social Class
D001786:Blood Glucose