Resumen de Efficacy of Metabolic and Psychological Screening for Mood Disorders Among Children With Type 1 Diabetes
Gnieszka Butwicka, Wojciech Fendler, Adam Zalepa, Agnieszka Szadkowska, Beata Mianowska, Agnieszka Gmitrowicz, Wojciech Mtynarskl
To compare the diagnostic accuracy and time expenditure of screening models based on glycated hemoglobin (HbA^sub 1c^) level and psychometric measures for mood disorder (MD) among children with type 1 diabetes. With semistructured clinical interviews (Schedule for Affective Disorders and Schizophrenia for Children-Present and Lifetime version, 120 min/patient) as a reference for diagnosing MD, including major depressive disorder (MDD), we tested 163 subjects, aged 8 to 18 years, with type 1 diabetes. We evaluated four screening approaches: 1) Children's Depression Inventory (CDI) at 30 min/patient, 2) HbA^sub 1c^ level, 3) HbA^sub 1c^ level plus CDI, and 4) HbA^sub 1c^ level plus Children's Depression Rating Scale (CDRS) at 40 min/patient. These tests were conducted with all participants, and the total time expenditure for all four approaches was calculated as the total time needed to implement successfully the screening for MD or MDD in the center. HbA^sub 1c^ performed on par with individual psychometric tests in diagnosing MD or MDD. The HbA^sub 1c^ plus CDRS model was the best screening procedure for both MD and MDD, with diagnostic thresholds for HbA^sub 1c^ established at 8.7% and 9.0%, respectively. Cutoff points for CDRS assessed after filtering by HbA^sub 1c^ were 26 (MD) and 30 (MDD) points. Center-wide application of this procedure would result in an 83% reduction of the examination time necessary for the psychiatrist for MD screening and a 91% reduction for MDD screening, as compared with standard screening with CDI. Use of HbA^sub 1c^ level followed by CDRS is a time-efficient procedure to screen for MD in children with type 1 diabetes. [PUBLICATION ABSTRACT]
