The Relationship Between Glycosylated Hemoglobin (HbA1c) Levels and Depression in Children and Adolescents with Type 1 Diabetes Mellitus

Rasaee, Kimia; Bagheri, Sepideh; Mirzadeh, Mansoureh; Moosavinesuad, Robabeh; Mirsadraee, Raheleh

doi:10.22038/jpp.2026.98742.5733

The Relationship Between Glycosylated Hemoglobin (HbA1c) Levels and Depression in Children and Adolescents with Type 1 Diabetes Mellitus

Articles in Press

Document Type : original article

Authors

Kimia Rasaee ¹

Sepideh Bagheri ²

Mansoureh Mirzadeh ³

Robabeh Moosavinesuad ⁴

Raheleh Mirsadraee ⁵

¹ Student Research Committee, MMS.C., Islamic Azad University, Mashhad, Iran.

² Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

³ Department of Psychiatry, MMS.C., Islamic Azad University, Mashhad, Iran.

⁴ Department of Pediatric Endocrinology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

⁵ Department of Pediatrics, MMS.C., Islamic Azad University, Mashhad, Iran.

10.22038/jpp.2026.98742.5733

Abstract

Background: Type 1 diabetes mellitus (T1DM) imposes a significant psychological burden on children, and depression is a common comorbidity. Evidence on the quantitative relationship between depression severity and glycemic control (HbA1c) among Iranian children is limited. This study investigated the association between HbA1c levels and depression severity in children and adolescents with T1DM.
Methods: This cross-sectional study enrolled 70 children aged 7–16 years with T1DM from the Pediatric Endocrinology Clinic at 22 Bahman Hospital in Mashhad, Iran, between 2024 and 2025. Data were collected using a demographic-clinical questionnaire and the Children's Depression Inventory (CDI). HbA1c was averaged from the three most recent measurements over the preceding six months. Statistical analyses included Mann-Whitney, Kruskal-Wallis, Pearson correlation, and General Linear Model tests.
Results: The mean age was 12.39 ± 2.66 years, and 60% were female. The mean HbA1c was 9.41 ± 2.24%. Based on CDI scores, 34.3% had clinical depression, 34.3% were at threshold, and 31.4% had no depressive symptoms. A significant positive correlation was observed between HbA1c and depression scores (r=0.55, P=0.0001). The mean HbA1c was significantly higher in the depressed group (11.04 ± 2.25) than in the threshold (8.70 ± 1.71) and healthy groups (8.40 ± 1.75) (P=0.0001). Daily insulin dose also correlated positively with depression (r=0.35, P=0.02). Disease duration and sex showed no significant association with depression. In the multivariable General Linear Model, HbA1c (F=24.93, P<0.0001) and insulin dose (F=5.23, P=0.025) remained independently associated with higher depression scores.
Conclusion: Poor glycemic control and higher daily insulin requirements are significantly and independently associated with depression severity among children with T1DM, though the cross-sectional design precludes establishing causality. Routine psychological screening should be integrated into standard diabetes care, particularly for patients with elevated HbA1c or increasing insulin requirements.

Keywords

Children

Children's Depression Inventory (CDI)

Depression

Glycosylated Hemoglobin

Type 1 Diabetes Mellitus

Subjects

Glandular

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