Depressive Symptoms, Perceived Stress, and Cortisol in School-Age Children With Type 1 Diabetes: A Pilot Study

Despite adequate insulin regimens and concurrent treatments for Type 1 diabetes (T1D), many children have trouble achieving glycemic control, as evidenced by elevated HbA1c levels. Maternal and child depressive symptoms, as well as child perceived stress, are associated with less optimal glycemic control. Cortisol, a stress hormone, may mediate the relationships among depressive symptoms, perceived stress, and glycemic control. The purposes of this pilot study were to (1) examine the feasibility of collecting salivary samples to measure cortisol change in prepubertal school-age children diagnosed with T1D and (2) determine effect sizes for the relationships among maternal depressive symptoms and child depressive symptoms, perceived stress, cortisol levels, and glycemic control. Participants were recruited using convenience sampling from a pediatric endocrinology clinic in the southeastern United States. All data, including surveys, salivary samples, HbA1c, height, and weight, were collected the same day as a clinic visit. The study included 30 children, ages 6.9-12.2 years, and their mothers. Most children were female (70%) and Caucasian (76.7%), but the sample was socioeconomically diverse. HbA1c values ranged from 6.1% to 12.2%. Of the children, 18 showed normal declines in cortisol over 3 hr, while 12 had increases in cortisol. Results show recruitment, participation, and data collection are feasible in school-age children with T1D. Examination of relevancy thresholds for effect sizes between variables of interest supports the need for future research in a larger, more representative sample on research questions that include the role cortisol plays as a potential mediator among examined variables.