Depression and HRQOL Influence Disease Trajectory Among Patients With Youth-Onset Type 2 Diabetes

T2D Adolescent
A teenaged diabetes patient checking his blood sugar at home. Juvenile diabetes concept.
Investigators assessed whether depressive symptoms, eating disorders, and health-related quality of life were related to a diagnosis of type 2 diabetes in youth and young adults.

Psychiatric symptoms and impaired health-related quality of life (HRQOL) have been reported among adolescents and young adults with youth-onset type 2 diabetes (T2D), according to the results of a study published in Diabetes Care.

The Treatment Options for T2D in Adolescents and Youth (TODAY) study ( Identifier: NCT00081328) was conducted betweeFtn 2004 and 2011 to evaluate the efficacy of 3 treatment modalities. In 2011, a subset of patients were enrolled in the TODAY2 study ( Identifier: NCT02310724), which assessed psychiatric symptoms, eating behaviors, and HRQOL during annual examinations conducted between 2014 and 2020 and evaluated their relationship with glycemia and diabetic complications.

The study population in 2014 consisted of 514 patients aged mean 21.7±2.5 years, 65.2% were girls or women, 37.7% were Hispanic, 34.4% were Black, body mass index (BMI) was 36.5±8.3 kg/m2, glycated hemoglobin (HbA1C) was 9.2%±3.1%, systolic blood pressure was 118.5±11.9 mm Hg, diastolic blood pressure was 74.0±10.1 mm Hg, and low-density lipoprotein cholesterol was 97.0±30.8 mg/dL.

Over the 6-year follow-up period, Beck Depression Inventory II (BDI-II) total scores increased significantly (P =.0003), and the proportion of patients with scores indicating depression (BDI-II ≥14 points) increased from 12.6% to 17.6% (P =.01).

Although there was no evidence of an overall change in the Eating Disorder Diagnostic Scale (EDDS) global score (P =.15), the proportion of patients who reported purging behavior increased from 3.6% to 6.9% (P =.02).

Total HRQOL scores decreased significantly over time (P <.0001), with the proportion of individuals with self-reported impairment (HRQOL <71.8 points) increasing from 13.1% in year 1 to 16.7% in year 6 (P =.009). Physical and psychosocial HRQOL scores decreased over time (both P <.0001).

BDI-II total scores were correlated with EDDS symptom composite scores (r, 0.49; P <.0001) and with HRQOL total scores (r, -0.68; P <.0001), and the EDDS symptom composite score was correlated with the HRQOL total score (r, -0.49; P <.0001).

Elevated BDI-II (P <.0001) and HRQOL scores (P =.01) were reported more frequently in female vs male study participants. No significant differences based on sex were observed for EDDS scores (P =.91).

High BDI-II scores (≥14 points) were associated with retinopathy progression (adjusted odds ratio [aOR], 1.75; P =.007), hypertension (aOR, 1.46; P =.04), and increased HbA1C (aOR, 1.09 per 1%; P =.04); binge eating was associated with increased BMI (aOR, 1.18 per 5 kg/m2; P =.004); and low HRQOL scores (<71.8 points) were associated with retinopathy progression (aOR, 1.80; P =.01), hypertension (aOR, 1.65; P =.02), increased systolic blood pressure (aOR, 1.28 per 10 mm Hg; P =.03), and increased BMI (aOR, 1.12 per 5 kg/m2; P =.04).

This study was limited by not including a psychiatric interview to evaluate symptomology and diagnosable disorders.

These data indicated that adolescents and young adults with youth-onset T2D frequently had depressive symptoms and impaired HRQOL. These symptoms were found to be related to progression of disease and likely contribute to ongoing risk for medical morbidity. Additional research is needed to assess for potential effective interventions.


TODAY Study Group. Longitudinal association of depressive symptoms, binge eating, and quality of life with cardiovascular risk factors in young adults with youth-onset type 2 diabetes: the TODAY2 study.Diabetes Care. Published online March 15, 2022. doi:10.2337/dc21-1995