The information characterizing anxiety and depression levels and associated factors in long-term T1D advanced diabetes technology users is sparse. A cross-sectional observational study in T1D adults using continuous glucose monitors (CGMs) ≥1 year was conducted in a tertiary academic medical center. The Hospital Anxiety and Depression Scale was used to evaluate anxiety levels (HADS-A) and depression levels (HADS-D). CGM % of time with glucose <70 mg/dL, hypoglycemia awareness (measured with Gold questionnaire), hypoglycemia beliefs (with Attitude to Awareness of Hypoglycemia questionnaire) and demographic information were collected. Multivariable linear regression was used to identify factors associated with higher HADS-A and HADS-D. Among 196 participants (63% female; mean±SD age 47±16; 91% non-Hispanic Caucasian; 80% using insulin pumps with 55% closed-loop pump users), mean±SD HADS-A was 6.5±4.0 (40% scores≥8), HADS-D was 4.1±3.1 (15% score≥8), and % of CGM time <70 mg/dL was 2.0±3.0%; 34% had impaired hypoglycemia awareness. Higher HADS-A was independently associated with less time with glucose <70 mg/dL, female sex, younger age, lower hypoglycemia awareness, weaker hypoglycemia concern minimization, and stronger hyperglycemia avoidance prioritization (P<0.05). Higher HADS-D was independently associated with less time with glucose <70 mg/dL, lower hypoglycemia awareness, and stronger hyperglycemia avoidance prioritization (P<0.05).

In summary, clinically significant anxiety and depression presented in 40% and 15% of T1D patients using advanced diabetes technologies, respectively. Hypoglycemia awareness and hypoglycemia beliefs, rather than time spent in hypoglycemia, were associated with greater anxiety and depression levels. Attention to hypoglycemia awareness, hypoglycemia beliefs and mental health are needed to improve overall outcomes in T1D advanced technology users.

Disclosure

Y. Lin: None. J.E. Aikens: None. W. Ye: None. G. Piatt: None. S. Fisher: None. R. Busui: Board Member; American Diabetes Association. Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp. Research Support; Novo Nordisk. Consultant; Novo Nordisk, Roche Diagnostics. Research Support; Medtronic, National Institutes of Health. Consultant; Procter & Gamble.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K23DK129724); Michigan Center for Clinical and Translational Research (P30DK092926)

© 2023 by the American Diabetes Association
2023
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