SUN-188 - Depression Risk and the CGM Glycemic Profile in Youth with Type 1 Diabetes: A Single-Center Study

Background
Depression is common in youth with type 1 diabetes (T1D) and has been associated with suboptimal glycemic control. However, its relationship with the continuous glucose monitoring (CGM) glycemic profile and objective CGM engagement in routine care is incompletely defined. This study examined associations between depression risk based on PHQ-9 score and CGM-derived glycemic outcomes in adolescents with T1D and explored predictors of time in range (TIR).

Methods
We conducted a retrospective cohort of adolescents (10–18 years) with T1D at Nationwide Children’s Hospital (Jan 2020–Jun 2024) with ≥28 days of CGM data (≥70% active time) within 2 months of PHQ-9 screening. We categorized depression risk based on PHQ-9 score into low (≤5), moderate (6–14), and high (≥15) groups. Outcomes included TIR (70–180 mg/dL), time above range (TAR), time below range (TBR), mean glucose, CGM active time, glucose management indicator (GMI), and coefficient of variation (CV). Group comparisons used Kruskal–Wallis and χ² tests; associations used Spearman correlations, and predictors of TIR were assessed with multivariable robust rank-order regression.

Results
Among 261 adolescents (median age 15 years; 51% female; 53% on insulin pump therapy), depression risk by PHQ-9 was low in 70.4% (n=184), moderate in 22.9% (n=60), and high in 6.5% (n=17). CGM metrics did not differ significantly across PHQ-9 categories. However, higher PHQ-9 scores were associated with lower TIR (rₛ=−0.124), higher TAR (rₛ=0.118), and higher mean glucose (rₛ=0.144), with no association with CV (rₛ=−0.033) or TBR (rₛ=−0.047). Higher PHQ-9 scores were also inversely associated with CGM active time (rₛ=−0.31). In multivariable analysis, insulin pump therapy (β=+8.42% TIR; 95% CI 3.24–13.60), White race (β=+5.00%; 95% CI 1.10–8.80), and CGM active time (β=+0.27% per 1% active; 95% CI 0.03–0.50) independently predicted higher TIR, while PHQ-9 score predicted lower TIR (β=−0.49% per 1-point increase; 95% CI −0.97 to −0.026).

Conclusion
In adolescents with T1D, greater depressive symptom burden on routine PHQ-9 screening aligns with lower CGM engagement and greater hyperglycemia exposure. Pump therapy, White race and greater CGM active time predicted higher TIR, while higher PHQ-9 score independently predicted lower TIR, suggesting that depression risk may be linked to glycemic control partly through technology disengagement. These findings support integrating depression screening with structured, equity-focused workflows that reinforce CGM use and address barriers to diabetes technology and underscore the need for longitudinal studies to clarify bidirectional relationships between depressive symptoms, device engagement, and CGM outcomes.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*