Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In this cross-sectional study, a strong positive correlation existed between a child’s glycated hemoglobin (HbA1c) levels and their depression and anxiety scores.

2. However, the association between a diabetic child’s HbA1c level and their anxiety and depression is fully mediated by parental anxiety.

Evidence Rating Level: 2 (Good)

Type 1 diabetes (T1D) is a common autoimmune disorder that results in significant lifestyle changes in those affected. The burden of illness can result in mental health disorders, such as anxiety and depression, in the affected child and their parents. Depression and anxiety are known to have a negative impact on glycemic control in diabetes, particularly on glycated hemoglobin (HbA1c) levels. However, few studies have examined the factors that may affect the relationship between HbA1c level and anxiety and depression in children. Therefore, this study aimed to investigate both individual and surrounding factors and their effect on the relationship between HbA1c level and anxiety and depression in children.

This cross-sectional study included 251 child-parent dyads. Participants were included if they were aged 12-18 years and had a diagnosis of T1D, and one of the child’s parents participated in the survey. The Generalized Anxiety Disorder Scale-7 (GAD-7) and Patient Health Questionnaire 9 (PHQ-9) Scale were used to assess mental health in both the parent and child. Data relating to demographics was obtained from a questionnaire made by the study authors, and clinical information was obtained from patients’ medical records. The primary outcomes were the association between HbA1c and mental health scores in children with T1D and the factors that mediated that association.

The results demonstrated a strong correlation between a child’s HbA1c level and their scores on the GAD-7 and PHQ-9 scales. There was also a strong correlation between the child’s HbA1c level and the parent’s scores on both mental health scales. Mediation analysis found that the parent’s anxiety fully mediated the association between HbA1c and a child’s depression and anxiety. However, the study was limited by its cross-sectional nature, which limited the ability to investigate causality. Nonetheless, this study suggested that not only does a child’s mental health impact their diabetes management, but parental anxiety also plays a role, indicating the need to address mental health concerns in both the parent and child to achieve optimal glycemic control.

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