title: Depression, metabolic control, and antidepressant medication in young patients with type 1 diabetes.
abstract: OBJECTIVE
  Recent literature suggests an association between type 1 diabetes (T1D) and depression. So far, most studies explored this link in adult populations, with few data being available on diabetes and depression from minors and young adults. This study aimed to look for associations between symptoms of depression/antidepressant treatment and metabolic outcomes of T1D.
  
  
  METHODS
  We conducted an observational study using the German diabetes database (Diabetes-Patienten-Verlaufsdokumentation--DPV) and searched for patients up to the age of 25 yr, with depressive symptoms and/or receiving antidepressant medication.
  
  
  RESULTS
  Of 53 986 T1D patients below the age of 25 yr, antidepressant medication and/or depressive symptoms were reported in 419 (0.78%). After adjustment for age, gender, diabetes duration and center heterogeneity, minors and young adults with depressive symptoms showed worse outcome parameters such as a higher rate of severe hypoglycemia (0.56 vs. 0.20/patient year, p = 0.005) and more episodes of diabetic ketoacidosis (0.20 vs. 0.07/patient year, p < 0.001). Hemoglobin A1c (HbA1c) was higher in the depression group (74.50 vs. 67.58 mmol/mol, p < 0.001) and young patients with T1D and depression showed longer duration of inpatient treatment (7.04 vs. 3.10 hospital days/patient year, p < 0.001) and more frequent admissions to hospital care (0.63 vs. 0.32/patient year, p < 0.001). Antidepressant medication was recorded in 52.3% of the depressed patients, with selective serotonin reuptake inhibitors (SSRIs) being the most widely described class of antidepressants (29.1%).
  
  
  CONCLUSIONS
  Our findings demonstrate an adverse treatment outcome for young patients with T1D and comorbid depressive symptoms underlining an urgent need for collaborative mental and somatic health care for patients with T1D and depression.
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Plener
authors.forename: Esther
authors.initials: E
authors.lastname: Molz
authors.forename: Gabriele
authors.initials: G
authors.lastname: Berger
authors.forename: Edith
authors.initials: E
authors.lastname: Schober
authors.forename: Kirsten
authors.initials: K
authors.lastname: Mönkemöller
authors.forename: Christian
authors.initials: C
authors.lastname: Denzer
authors.forename: Lutz
authors.initials: L
authors.lastname: Goldbeck
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D001786:Blood Glucose
keywords: adolescents; antidepressants; depression; metabolic control; type 1 diabetes