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Depression is the New Predictor of Diabetes Control in Teens

Depression is the New Predictor of Diabetes Control in Teens 1024 683 Pam Georgiana

A new study reveals that depressive symptoms, not diabetes-specific stress, forecast long-term glycemic outcomes in adolescents with type 1 diabetes.

Managing type 1 diabetes is challenging at any age, but for adolescents, the burden can be especially overwhelming. Previous cross-sectional studies have shown a link between diabetes-specific emotional distress, or the frustration and stress related to managing a chronic condition, and poor glycemic control. However, endocrinologists at Nationwide Children’s Hospital set out to determine whether this type of distress could actually predict changes in diabetes control over time.

A new longitudinal study led by Cecilia P. Damilano, MD, and Robert P. Hoffman, MD, both endocrinologists in the Section of Endocrinology and Metabolism at Nationwide Children’s, offers new insights. Published in the Journal of Pediatric Endocrinology and Metabolism, this study is the first to evaluate whether mental health indicators, specifically depression and diabetes distress, can predict glycemic outcomes in adolescents with type 1 diabetes over three years.

The study followed 275 patients with type 1 diabetes, aged 13-17, measuring depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) and diabetes distress using the Problem Areas in Diabetes-Teen version (PAID-T). The researchers tracked participants’ average blood glucose (HbA1c) levels at baseline and one, two and three years post-screening. They used the American Diabetes Association’s recommended target of an HbA1c below 7% as a benchmark for optimal glycemic control.

The results showed that while both depressive symptoms and diabetes distress were associated with poor glycemic control at baseline, only depression predicted continued deterioration in control over time. Diabetes distress, though common, did not forecast future outcomes. The findings suggest that general emotional health may play a more critical role in long-term diabetes management than diabetes-specific frustrations.

“It was very surprising to find that diabetes distress did not predict future control,” says Dr. Hoffman, who is also a professor of pediatrics at The Ohio State University. “It may be that kids adapt or respond to behavioral interventions over time. However, with depression, we saw a clear signal. Those scores told us who would struggle more with glycemic control years down the road.”

The research also showed that adolescents with higher HbA1c levels at the start of the study tended to maintain poorer control over time. In addition, youth with public insurance had worse outcomes than those with private insurance. This finding seems to point to the role of socioeconomic differences in diabetes care. The authors suggest differences could include varied access to healthcare services, medication costs and family support systems. The researchers stress that more study is needed to uncover the factors causing these disparities and develop strategies to address them.

“This study highlights the need for routine mental health screening and early intervention in adolescent diabetes clinics,” explains Dr. Damilano. “The team approach is critical for success. At Nationwide Children’s, when we see kids struggling with their mental health, they are immediately connected with in-house social workers or psychologists.”

“You cannot tell a teen to “do better” in managing their diabetes if you are not addressing their mental health,” concludes Dr. Hoffman. “We need to provide them with the tools and support they need to manage their diabetes long-term.”

 

 

References:

Damilano CP, Hong KMC, Glick BA, Kamboj MK, Hoffman RP. Diabetes distress, depression, and future glycemic control among adolescents with type 1 diabetes. Journal of Pediatric Endocrinology and Metabolism. 2025;38(4):311-317.

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About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

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