Depressive symptoms predict change in glycemic control in adolescents with type 1 diabetes: rates, magnitude, and moderators of change

Pediatr Diabetes. 2011 Dec;12(8):718-23. doi: 10.1111/j.1399-5448.2011.00771.x. Epub 2011 May 12.


Objective: To determine whether depressive symptoms in adolescents with type 1 diabetes predict change in glycemic control over time.

Research design and methods: A total of 145 adolescents (aged 13-18 yr) participated in two study visits (baseline and 6 months). They completed a measure of depressive symptoms (Children's Depression Inventory; CDI) and had their A1c values and adherence to blood glucose monitoring (BGM) documented.

Results: Three variables predicted A1c change over 6 months: CDI change score (B = 0.11; p < 0.001), BGM frequency at baseline (B = -0.21; p = 0.03), and A1c at baseline (B = -0.23; p = 0.002). A three-way interaction among these variables was significant (p < 0.01) and showed that adolescents with high adherence to BGM who were achieving optimal glycemic control (≤7.5%) at baseline were resistant to increasing A1c values, even if depressive symptoms worsened. However, as adherence to BGM declines, there is a synergistic effect with depressive symptoms to accelerate the increase of A1c values over time, making it more difficult to bring A1c back to optimal levels.

Conclusions: Results suggest that depressive symptoms are important predictors of A1c change by themselves as well as when considered with adherence to BGM. There is a need to screen for depressive symptoms and expand and develop prevention and intervention strategies in order to put adolescents with type 1 diabetes in the best position for optimal glycemic control.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Blood Glucose / metabolism*
  • Blood Glucose Self-Monitoring / psychology*
  • Depression / blood*
  • Diabetes Mellitus, Type 1 / blood*
  • Female
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Male
  • Patient Compliance


  • Blood Glucose
  • Glycated Hemoglobin A