Original article
The role of socioeconomic status, depression, quality of life, and glycemic control in type 1 diabetes mellitus

https://doi.org/10.1016/j.jpeds.2006.05.039Get rights and content

Objective

To test the hypothesis that poor glycemic control in type 1 diabetes mellitus (T1DM) is associated with depression and poor quality of life (QOL), with a higher prevalence in persons of lower socioeconomic status (SES).

Study design

Subjects with T1DM age 8 to 17 years (n = 222) were evaluated using the Childrens Depression Inventory, the Hollingshead Four-Factor Index to determine SES, and PedsQL questionnaires to ascertain QOL. HbAlC > 8% was considered indicative of poor glycemic control.

Results

A total of 110 well-controlled subjects and 112 poorly controlled subjects (HbA1C 7.1% ± 0.7% vs 9.9% ± 1.6%) were recruited. It was found that 9.5% of poorly controlled subjects were depressed, compared with 3% of well-controlled subjects. Logistic regression revealed a 27% increase in probability of depression per unit rise in HbA1C (P < .03). Higher SES was associated with better glycemic control (P < .0005) and QOL (P < .0005); longer duration of illness was not associated with poorer glycemic control. Diabetes QOL deteriorated with poorer glycemic control (P < .002).

Conclusions

Poor glycemic control in peridatric T1DM is associated with lower SES and depression. The probability of depression increases as glycemic control worsens. Screening for depression should be routinely carried out in patients with T1DM, targeting patients with deteriorating glycemic control.

Section snippets

Methods

The Institutional Review Board at Baylor College of Medicine approved the study protocol. Study participants included children with T1DM age 8 to 17 years and their parents or legal guardians. Subjects were included if they had had T1DM for 6 months or longer, with at least 1 positive islet cell antibody, insulin autoantibody, or antibody to glutamic acid decarboxylase. They were either English- or Spanish-speaking, and the presence of a legal guardian was required. Subjects were excluded if

Results

The Table presents the clinical characteristics of the study subjects. By definition, there were 110 well-controlled subjects and 112 poorly controlled subjects, and, as expected, the difference in HbA1C levels between the 2 groups was significant (P < .0005). There was approximately equal sex distribution in the 2 groups, and BMI was not significantly different between the groups. The mean HbA1C was 8.5% ± 1.9%.

Of the 222 participants, parents of 19 opted not to reveal information to ascertain

Discussion

T1DM is the third most common chronic condition in children under age 16 years, after asthma and cerebral palsy.20 In diabetics, depression is a contributing factor to poor metabolic control, decreased QOL, and increased medical morbidity and mortality.21 Our cross-sectional study attempts to examine multiple variables and their associations with depression and poor metabolic control in pediatric T1DM. Consistent with previous research,22 we found that low SES was significantly associated with

References (38)

  • B.J. Blanz et al.

    IDDM is a risk factor for adolescent psychiatric disorders

    Diabetes Care

    (1993)
  • B. Lernmark et al.

    Symptoms of depression are important to psychological adaptation and metabolic control in children with diabetes mellitus

    Diabetes Med

    (1999)
  • P.J. Lustman et al.

    Depression in adults with diabetes

    Diabetes Care

    (1992)
  • S.M. Stewart et al.

    Depressive symptoms predict hospitalization for adolescents with type 1 diabetes mellitus

    Pediatrics

    (2005)
  • P.T. Cirino et al.

    Measuring socioeconomic status: reliability and preliminary validity for different approaches

    Assessment

    (2002)
  • W.M. Reynolds et al.

    Measuring depression in children: a multi-method assessment investigation

    J Abnorm Child Psychol

    (1985)
  • W.V. Tamborlane et al.

    Comparison of fingerstick hemoglobin A1c levels assayed by DCA 2000 with the DCCT/EDIC central laboratory assay: results of a Diabetes Research in Children Network (DirecNet) Study

    Pediatr Diabetes

    (2005)
  • J.W. Varni et al.

    The PedsQL: measurement model for the pediatric quality of life inventory

    Med Care

    (1999)
  • J.W. Varni et al.

    PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations

    Med Care

    (2001)
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    Partially supported by an unrestricted educational grant from Novo Nordisk.

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