Aim: Depression is a heterogeneous construct that includes various symptoms (e.g., cognitive, somatic) and is linked to worse diabetes outcomes. We examined the associations of depressive symptom clusters with glycemic outcomes using continuous glucose monitoring (CGM) data in youth with T1D.

Methods: Participants (N=120) provided blood samples for HbA1c, completed a validated survey for depressive symptoms (CES-DC) , and wore CGM for one week. CGM glucose metrics were derived: % time in range (TIR) 70-180 mg/dL; % time <70 mg/dL; % time >180 mg/dL; % time >250 mg/dL; mean glucose; and glucose variability (GCV) . CES-DC items were categorized as somatic, cognitive, anhedonic, and interpersonal for analyses.

Results: Youth (49% male) had a mean (±SD) age of 12.7±2.7 years, T1D duration 6.1±3.5 years, HbA1c 7.9±0.8%. Overall, higher total CES-DC score was associated with higher HbA1c (r=0.21, p=0.02) . In youth with HbA1c ≤8% (n=68) , there were no significant associations between depressive clusters and glycemic outcomes, but several significant associations emerged in youth with HbA1c >8% (n=52) . For those with HbA1c >8%, higher CES-DC total score was associated with higher HbA1c (r=0.55, p<0.0001) , greater % time >250 (r=0.29, p=0.03) , and higher mean glucose (r=0.33, p=0.02) . More symptoms on the cognitive and interpersonal clusters were associated with higher HbA1c (r=0.29, p=0.03; r=0.43, p=0.002, respectively) . More somatic symptoms were associated with greater % time >180 (r=0.34, p=0.01) , less % TIR (r=-0.34, p=0.01) , and higher mean glucose (r=0.31, p=0.03) .

Conclusions: In our sample of youth with T1D, associations between depressive symptoms and glucose varied according to overall glycemic control, with notable associations in youth with HbA1c >8%. Somatic depressive symptoms were especially related to uncontrolled glucose levels, highlighting the importance of targeting glucose TIR to reduce adverse physical complaints.


A.Shapira: None. L.K.Volkening: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc.


T32DK007260, P30DK036836, R01DK089349

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at