1184-P: Presence of Depressive Symptoms as a Predictor of Engagement with Diabetes Self-Management Habits in Adolescents and Young Adults with Type 1 Diabetes

Introduction: In type 1 diabetes (T1D), depressive symptoms (DS) can negatively impact engagement with diabetes self-management behaviors.

Objective: In adolescents and young adults (AYA) with T1D, we examined whether DS independently predicted engagement with six key diabetes self-management habits, assessed as a total habit score (THS). THS has been shown to have an inverse relationship with HbA1c.

Methods: We retrospectively analyzed electronic health record and depression screening data from 1,834 AYA (12-22 years old; T1D duration ≥1yr) receiving care from a diabetes clinic network in the Midwest USA (January 2020 - November 2023). We used mixed-effects Poisson regression to adjust for multiple encounters per AYA and examined predictors of THS (range: 0-6). The six habits comprising the THS included: (1) using a continuous glucose monitor or checking glucose ≥4 times/day; (2) giving ≥3 boluses/day; (3) using an insulin pump; (4) bolusing before meals; (5) reviewing glucose data between visits; and (6) adjusting insulin doses between visits. We defined a positive screen for DS as a Patient Health Questionnaire-2 (PHQ-2) score ≥3 (i.e., experiencing DS most days).

Results: AYA (52.5% male; 78.7% White; mean [SD] age, 15.7 [2.1] years; 60.4% private insurance) screened positive for DS at 7.6% (632/8,309) of encounters. We observed negative associations between THS and older age (incidence risk ratio, 0.98; 95% CI, 0.97-0.99), Black race (0.78; 0.72-0.84; vs. White), other minority race (0.85; 0.80-0.91; vs. White), and not having private insurance (0.88; 0.85-0.90). THS did not differ in individuals who did, versus did not, screen positive for DS (0.97, 0.93-1.02).

Conclusion: Age, race, and insurance status - but not DS - were independent predictors of THS. Future studies should evaluate whether more sensitive and specific measures of DS predict THS and whether DS impact engagement with individual self-management behaviors.