Higher A1c in adolescents with T1D may result from consistently elevated A1c since diagnosis or increasing A1c across time. Identifying modifiable risk factors may allow for individualized care to reduce A1c. Prevalence of elevated (≥5) scores on the Patient Health Questionnaire-9 was examined in 888 youth ≥10 years. Five A1c trajectory groups (Figure) were identified using Proc Traj (i.e., mid increasing group had moderately elevated A1c with rising levels over time). The association between elevated depressive symptoms and A1c trajectory groups was examined. Prevalence of elevated depressive symptoms was 31%, and increased significantly across A1c trajectory groups: low stable =21%, mid stable =31%, high stable =41%, mid increasing =34%, and high increasing =52% (p<0.0001). Odds of elevated depressive symptoms in the high increasing vs. low stable group was 3.6 (95% CI 1.9-6.8). Similarly, being in the high stable (OR 2.4, 95% CI 1.5-3.9), mid stable (OR 1.7, 1.2-2.5) and mid increasing (OR 1.9, 1.01-3.4) groups were associated with higher odds compared to being in the low stable group. Even mildly elevated depressive symptoms may contribute to persistently elevated or rising A1c throughout childhood. Screening, monitoring, and discussing depressive symptoms in youth may help prevent a rise in A1c over time. Future studies should assess whether A1c trajectory can be changed through early intervention of depressive symptoms.
S. Majidi: Advisory Panel; Self; Companion Medical. C.R. Geno Rasmussen: None. K.A. Driscoll: None. H. ODonnell: None. E.M. Youngkin: None. J.K. Snell-Bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc.
