What does this research mean for the field?

Higher depressive symptoms, both on average and relative to a patient's own baseline, are associated with small but significant long-term increases in HbA1c levels in youth and young adults with type 1 diabetes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to investigate the long-term relationship between depressive symptoms and HbA1c levels in youth and young adults with type 1 diabetes.

June 8, 2026

1224-OR: Long-Term Association between Depressive Symptoms and Glycemic Control in Youth and Young Adults with Youth-Onset Type 1 Diabetes

Key Points

This research aims to investigate the long-term relationship between depressive symptoms and HbA1c levels in youth and young adults with type 1 diabetes.
Analyzed longitudinal data from the SEARCH studies with 970 participants using linear mixed-effect models.
Depressive symptoms were measured thrice between 2016-2022, while HbA1c was measured at baseline and follow-up.
Accounted for diabetes duration, sociodemographic, and clinical factors during analysis.
At baseline, average HbA1c was 9.1% with 12% experiencing moderate/severe depressive symptoms.
Higher mean CES-D correlated with 0.1 percentage-point increase in HbA1c (β = 0.13, p = 0.001) after adjustment.
Each 10-point increase in CES-D relative to a participant's average corresponded to 0.2 percentage-point higher HbA1c (β = 0.22, p = 0.001).

Abstract

Introduction and Objective: To date, limited long-term evidence links depressive symptoms to subsequent glycated hemoglobin (HbA1c) trajectories in youth and young adults (YYAs) with youth-onset type 1 diabetes (T1D). We explored the within- and between-person associations of depressive symptoms and changes therein with HbA1c in YYAs with T1D. Methods: We analyzed longitudinal data from the SEARCH for Diabetes in Youth Study and the SEARCH Food Security Cohort Study of 970 YYA with T1D using linear mixed-effect models, adjusting for diabetes duration, sociodemographic and clinical covariates. Depressive symptoms were assessed 3 times between 2016-2022 (t1, t2, and t3) using the Center for Epidemiologic Studies Depression Scale (CES-D; range 0-60), and HbA1c was measured twice at t1 and t3. We computed each participant’s average CES-D score across all timepoints (mean CES-D; between-person measure) and a deviation score (ΔCES-D; within-person measure) defined as the difference between their time-specific CES-D score and their own mean. Results: At t1, 88% of YYA had minimal/mild and 12% had moderate/severe depressive symptoms, and the average HbA1c for all YYA was 9.1%. In unadjusted models, higher mean CES-D over time and higher-than-usual CES-D (ΔCES-D) were associated with higher HbA1c at t3 (β = 0.41, p 0.001 and β = 0.23, p = 0.008, respectively). After adjustment, each 10-point higher mean CES-D was associated with ~ 0.1 percentage-point higher HbA1c (β = 0.13, p = 0.001), and a 10-point higher CES-D score relative to a participant’s own average (ΔCES-D) was associated with ~ 0.2 percentage-point higher HbA1c at t3 (β = 0.22, p = 0.001). Conclusion: The findings suggest that depressive symptoms are associated with worse HbA1c levels over time, though the magnitude of this is small, highlighting the clinical importance of integrating routine mental health screening and concurrent treatment for depression to optimize glycemic outcomes and improve overall patient care in individuals with diabetes. Disclosure A.M. Alfalki: None. E.F. Julceus: None. K. Flory: None. A. Mclain: None. M. Lohman: None. J.A. Mendoza: None. A. Bellatorre: None. F. Malik: None. C. Pihoker: None. A.D. Liese: None. Funding National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (R01DK117461, 1R01DK127208, 1UC4DK108173), and National Institute of General Medical Sciences (T32-GM081740)

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