How are Depression, Diabetes Distress and Glycemic Control Related in Adolescents With Type 2 Diabetes?How are Depression, Diabetes Distress and Glycemic Control Related in Adolescents With Type 2 Diabetes? https://pediatricsnationwide.org/wp-content/themes/corpus/images/empty/thumbnail.jpg 150 150 Mary Bates, PhD Mary Bates, PhD https://secure.gravatar.com/avatar/c6233ca2b7754ab7c4c820e14eb518c8?s=96&d=mm&r=g
- August 02, 2022
- Mary Bates, PhD
For adolescents with T2D, obesity and attempts at weight loss may contribute more to depression and diabetes distress than the demands of diabetes management.
Diabetes distress is a negative emotional response to living with diabetes, a life-threatening illness that requires chronic, demanding, self-management. It is frequently mistaken for depression and the two are interrelated.
Previous research showed that in adolescents with type 1 diabetes (T1D), both depression and diabetes distress can result in poor glycemic control and increased hemoglobin A1c (HbA1c), though diabetes distress is more closely related to diabetes control than is depression.
Less is known about the interrelationships between depression, diabetes distress and glycemic control in adolescents with type 2 diabetes (T2D). To address this gap, researchers from Nationwide Children’s conducted a cross-sectional observation study of 364 patients with diabetes between the ages of 13-17 years who were annually screened in their Pediatric Diabetes Clinic between July 2018 and March 2019. All patients completed screening tests for depression (Patient Health Questionnaire, PHQ-9) and diabetes distress (Problem Areas in Diabetes – Teen version, PAID-T). The research team reviewed medical records for demographic information and follow-up HbA1c levels over three years.
The researchers found that depression scores were higher in adolescent females with T2D compared to those with T1D; however, they did not find any difference in diabetes distress scores between these groups.
The reasons for the higher depression scores in females with T2D are unclear but increased body mass index could play a role, says Robert Hoffman, MD, a member of the Section of Endocrinology at Nationwide Children’s and one of the study’s authors.
“We think that in females with T2D, the stigma of obesity may be increasing depression, and that stigma is overwhelming all the other effects that are there,” he says.
Additionally, Dr. Hoffman and colleagues found that diabetes distress scores were increased in male adolescents with T2D compared to males with T1D. This indicates that male adolescents with T2D perceive a greater burden from the disease.
Finally, the researchers found that diabetes distress and depression scores were closely linked in adolescents with T2D, as has been found for adolescents with T1D. However, unlike in T1D, these scores were not related to glycemic control and did not differ by treatment regimen in T2D. Since depression and distress scores did not differ by treatment regimen, Dr. Hoffman and colleagues suggest that the biggest sources of depression and diabetes distress in adolescents with T2D may be related to weight concerns, diet and exercise, rather than the demands of diabetes care.
Dr. Hoffman, who is also a professor of pediatrics at The Ohio State University College of Medicine, says that further research is needed to assess how obesity and attempts at weight loss impact mental health in adolescents with T2D, and whether reducing depression and diabetes distress may be beneficial to diabetes control and enhance weight loss.
“Does treating depression in adolescents with T2D, medically or through psychotherapy, lead to weight reduction or improved glycemic control? Those are questions for which we don’t have an answer yet. We have identified a problem; we now need to find the solution.”
Hoffman RP, Damilano CP, Hong KMC, Glick BA, Kamboj MK. Glycemic control, depression, diabetes distress among adolescents with type 2 diabetes: effects of sex, race, insurance, and obesity. Acta Diabetologica. 2022;59:1083–1089. Doi: 10.1007/s00592-022-01902-2.
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