Association between depression and CGM metrics in adults with type 1 diabetes mellitus

Rationale: Type 1 diabetes mellitus (T1DM) is associated with increased risk of depression determining worse metabolic control. Little is known about the relationship between continuous glucose monitoring (CGM) metrics and depression. This study aimed to assess the potential association between CGM metrics and scores in questionnaires for depression and quality of life (QoL). Materials and methods: We enrolled adults with T1DM without psychiatric disorders on multiple daily injection (MDI) or subcutaneous insulin infusion (CSII), using CGM for 14 days. Participants completed validated questionnaires for depression and QoL: Center of Epidemiological Studies-Depression Scale (CES-D), Patient Health Questionnaire (PHQ-9), Diabetes Treatment Satisfaction Questionnaire (DTSQ), Problem Areas In Diabetes (PAID-5). The association between CGM metrics and all the questionnaires was assessed by linear and multiple regressions. Results: 75 adults with T1DM, age [mean (std dev)] 46.5 (14.9) years, 35 (47%) women, BMI 25.7(2.9) kg/m2, diabetes duration 23.7 (13.6) years, HbA1c 6.6 (1.1)%, 52 (69%) on CSII, were enrolled. 42/52 (82%) subjects were on advanced hybrid closed loop systems. Mean TIR was 71.3 (14)% and DTSQ score was 37.3 (5.3). Mean CES-D score was 11.7 (8.0): 36% of participants had scores compatible with mild to severe depression. Median PHQ9 score was 3[IQR 2.5-7]. TIR was not associated with CES-D (beta=-0.03, p=0.64), PHQ-9 (beta=-0.198, p=0.62) and PAID-5 (beta=0.06, p=0.46) but was associated with DTSQ (beta=0.678, p=0.04). CES-D was significantly associated with DTSQ (beta=-0.55, p<0.001) and PAID-5 (beta=-0.15, p=0.002), even when corrected for age, sex, age at onset and diabetes duration. Conclusions: These preliminary data showed no association between TIR and scores in tests for depression screening. Notably many participants were on AHCL which can explain this lack of association. Depression scores were associated with scores about satisfaction of treatment and burden of diabetes even if TIR was good.