Depressive symptoms, family functioning, and glycemic control in adolescents with type 1 diabetes: A cross-sectional study

Type 1 diabetes mellitus (T1DM) in adolescents requires rigorous self-management and lifelong insulin therapy, posing significant challenges for both metabolic control and psychological well-being. In this cross-sectional study, we investigated the interrelationships among depressive symptoms, family functioning, and glycemic control in 63 adolescents (aged 10–18 years) with T1DM in Greece. Depressive symptoms were measured using the Children’s Depression Inventory, and family functioning was assessed with the General Functioning Scale of the Family Assessment Device. Glycemic control was determined from the most recent glycated hemoglobin (HbA1c) value obtained from medical records. Approximately 29% of adolescents exhibited depressive symptoms in the pathological range, and the median HbA1c was 7.1% (interquartile range [IQR]: 6.7–7.8%), with only 46% meeting the recommended target of ≤7.0%. Spearman’s correlation analysis revealed a moderate positive association between depressive symptoms and HbA1c (r = 0.30; p=0.017) and a strong positive correlation between poorer family functioning and increased depressive symptoms (r = 0.53; p<0.001). However, family functioning was not significantly associated with glycemic control (r = −0.04; p=0.753), potentially indicating that its impact on metabolic control may be mediated through depressive symptoms or other factors related to adherence. Logistic regression analysis demonstrated that poorer family functioning significantly increased the odds of pathological depressive symptoms (odds ratio [OR] = 10.33; 95% confidence interval [CI]: 2.26–47.18; p=0.003) but did not directly predict glycemic control. Older adolescents reported higher levels of depressive symptoms and poorer family functioning compared to younger peers. These findings underscore the importance of addressing family functioning–including communication patterns, emotional support, and problem-solving abilities–and routine screening for depression in clinical practice to enhance psychological well-being and indirectly improve diabetes management in adolescents with T1DM. Future longitudinal research is warranted to establish causal relationships and explore potential mediators.