title: Associations between HbA1c and depressive symptoms in young adults with early-onset type 1 diabetes.
abstract: OBJECTIVE
  This study sought to evaluate the associations between metabolic control and each DSM-5 (Diagnostic and Statistical Manual, fifth edition) symptom of depression among young women and men with early-onset long-duration type 1 diabetes.
  
  
  METHODS
  The data of 202 18-21-year-old patients with type 1 diabetes from a population-based, nationwide survey (40.1% male) with a mean age of 19.4 (standard deviation 0.9) years, a mean HbA1c level of 8.3% (1.6%) (i.e., 67 [17.5]mmol/mol), and a mean diabetes duration of 15.7 (1.0) years were included. The German version of the Patient Health Questionnaire (PHQ-9) was used to assess depression symptoms. For each PHQ-9 depressive symptom, the mean HbA1c values of screening-positive and screening-negative patients were compared via t-test. The associations between HbA1c levels and depressive symptoms were analyzed using multiple linear regression analyses and stepwise adjustments for individual, socioeconomic and health-related covariates.
  
  
  RESULTS
  Exactly 43.0% and 33.3% of female and male participants reported at least one depressive symptom, and 5.0% and 2.5% met the DSM-5 criteria for major depressive syndrome. HbA1c levels increased with psychomotor agitation/retardation (women), overeating/poor appetite (men/women), lethargy (men), and sleep difficulty (men). Overeating/poor appetite, lethargy, and total PHQ-9 score (per score increase by one) were associated with increased HbA1c levels of 1.10, 0.96 and 0.09 units (%), respectively.
  
  
  CONCLUSIONS
  The associations between depressive symptoms and HbA1c levels vary by symptom and sex. Differentiating the symptoms of depression and targeted interventions might help to improve metabolic outcomes in young adults with early-onset type 1 diabetes and depression.
authors.affiliation: German Diabetes Center, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Germany. Electronic address: christina.baechle@ddz.uni-duesseldorf.de.
authors.forename: Christina
authors.initials: C
authors.lastname: Bächle
authors.affiliation: Hannover Medical School, Department of Medical Psychology, Carl-Neuberg-Str. 1, OE 5430, D-30626 Hannover, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Lange
authors.affiliation: German Diabetes Center, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Stahl-Pehe
authors.affiliation: German Diabetes Center, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Germany.
authors.forename: Katty
authors.initials: K
authors.lastname: Castillo
authors.affiliation: German Center for Diabetes Research (DZD), Germany; University of Ulm, Institute of Epidemiology and Medical Biometry, Albert-Einstein-Allee 41, D-89081 Ulm, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
authors.affiliation: German Diabetes Center, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Giani
authors.affiliation: German Diabetes Center, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Rosenbauer
mesh_terms: D000293:Adolescent; D000855:Anorexia / Q000378:metabolism / Q000523:psychology; D003863:Depression / Q000378:metabolism / Q000523:psychology*; D003865:Major Depressive Disorder / Q000378:metabolism / Q000523:psychology*; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006963:Hyperphagia / Q000378:metabolism / Q000523:psychology; D053609:Lethargy / Q000378:metabolism / Q000523:psychology; D008297:Male; D011595:Psychomotor Agitation / Q000378:metabolism / Q000523:psychology; D011596:Psychomotor Disorders / Q000378:metabolism / Q000523:psychology; D007319:Sleep Initiation and Maintenance Disorders / Q000378:metabolism / Q000523:psychology; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Depression; Depressive disorder; Duration; Hemoglobin A1c; Metabolic control; Type 1 diabetes