Depression not linked with glycemic control in adolescents with type 2 diabetes

Symptoms of depression were not associated with glycemic control in adolescents with type 2 diabetes, although depression was common, according to findings from a randomized clinical trial.

“Depression is a mental health disorder often first evidenced in childhood or adolescence,” Dorothy J. Van Buren, PhD, associated professor of psychiatry at Washington University in St. Louis School of Medicine, and colleagues wrote. “Type 2 diabetes, once considered an ‘adult’ disease, is increasingly prevalent in this age group. Although depression has been associated with poorer glycemic control in youth with type 1 diabetes and in adults with type 2 diabetes, little is known about the course of depressive symptoms or their relationship to glycemic control in youth with type 2 diabetes.”

In the Treatment Options for type 2 diabetes in Adolescents and Youth (TODAY) Trial, Van Buren and colleagues randomly assigned 699 adolescents with type 2 diabetes to treatment with metformin alone, metformin plus rosiglitazone, or metformin plus an intensive lifestyle intervention. The researchers conducted medical management every 2 months in the first year and quarterly afterward. They assessed depressive symptoms at baseline, 6 months and 24 months using the Child Depression Inventory questionnaire for patients aged 15 years or younger and the Beck Depression Inventory-II for those aged 16 years or older.

The mean age was 13.9 years. Most patients were female (65.5%), and 20.2% were white. Slightly more than 40% lived in households with annual incomes below $25,000 (41.3%).

Overall, 14.5% of patients reported clinically significant depressive symptoms, Van Buren and colleagues reported. Of patients in the longitudinal analysis (n = 576), most (n = 454; 78.8%) never reported clinically significant depressive symptoms, whereas 12% (n = 69) showed symptoms at one of the three visits. Another 7.6% (n = 44) demonstrated depressive symptoms at two visits, and 1.6% (N = 9) showed symptoms at all three visits, the researchers wrote.

At baseline, 493 patients were negative for depression. Of these, 7.9% (n = 39) showed signs of depression at 6 months and/or 24 months. Survival analysis revealed that baseline clinically significant depressive symptoms were not predictive of the adequacy of glycemic control (P = .29).

The researchers reported finding no relationship between depressive symptoms and treatment failure at baseline or with an increasing number of visits reporting symptoms of depression.

“Although we did not observe a relationship between clinically significant symptoms of depression and inadequate glycemic control in our youth, the long-term impact of depressive symptoms on comorbidities and disease progression in this cohort are unknown,” the researchers wrote.

“Clinically significant depressive symptoms emerged in 8% of the TODAY cohort who did not report clinically significant symptoms of depression upon entry into the study. These findings lend support to ADA recommendations to assess for depressive symptoms at regular intervals throughout the course of treatment and to refer for management of these symptoms as appropriate,” they wrotes – by Andy Polhamus

Disclosures: Van Buren reports no relevant financial disclosures. Please see the study for a complete list of all other authors’ relevant financial disclosures.