Endocrine Abstracts

Background: There is a complex interaction between psychosocial factors and type 1 diabetes (T1D) resulting in compromised diabetes management and suboptimal glycemic control. Individuals with T1D are at increased risk of developing depression and anxiety. Screening for psychosocial risk factors from diagnosis of T1D has been recommended. International standard is integrated care by a multidisciplinary team.

Objective: We performed a systematic review and meta-analysis to update the evidence base in this area.

Methods: We searched EMBASE, MEDLINE, The Cochrane Library, and PsycINFO in April 2014 and updated our searches in May 2015. We focused on signs of depression and anxiety in youth with T1D and the association with glycemic control and diabetes management. When possible, we pooled data to estimate summary effects.

Results: Our searches identified 14 publications investigating the correlation of anxiety and depression with T1D in children and adolescents: eight cross-sectional studies, five cohort studies, and one case-control study. Using the Children’s Depression Inventory (CDI), the pooled prevalence of depressive symptoms was 30.04%, 95% CI [16.33; 43.74]. There were correlations between symptom levels and glycemic control as well as three-way interactions between HbA1c, blood glucose monitoring frequency or diabetes-specific stress and depression. Symptoms of anxiety were reported for up to 32% of patients. A negative impact on glycemic control was demonstrated.

Conclusion: Our analyses confirmed a high prevalence of signs of depression and anxiety in youth with T1D confirming the need for early screening for psychological comorbidity and regular psychosocial assessment from diagnosis of T1D. Future prospective studies and randomized controlled trials are needed to further explore the interaction of signs of depression and anxiety with glycemic control and diabetes management and develop evidence-based treatment models.