To compare the diagnostic accuracy and cost-effectiveness of screening models based on glycated hemoglobin level (HbA1c) and psychometric measures in detecting mood disorders among children with type 1 diabetes (T1DM)

A random sample of 26% out of 632 available subjects aged 8–18 years with T1DM lasting longer than 12 months were enrolled to the study. All subjects were tested using a semi-structured clinical interview (KSADS-PL, duration = 120 mins/patient) as a standard of reference for the diagnosis of major depression disorders (MDD) and mood disorders (MD). Four screening approaches evaluated by the authors were: 1- Children Depression Inventory (CDI, duration = 30 mins/patient); 2- centile of HbA1c; 3- centile of HbA1c with CDI; 4- centile of HbA1c with Children's Depression Rating Scale (CDRS duration=40 mins/patient). All tests were performed in all individuals and cost-effectiveness of all 4 approaches was calculated as total time needed to successfully detect one case of MD or MDD.

The HbA1c+CDRS model was the best screening procedure for both MD and MDD. Diagnostic threshold for HbA1c was established at 93rd percentile (8.7%) for MD and 95th (9.0%) for MDD. Cut-off points for CDRS assessed after filtering by HbA1c percentile equaled 26 (MD) and 30 (MDD) points. Application of this procedure would result in a 76% workload reduction for one diagnosed patient with MD and 83% with MDD in comparison to standard screening with CDI.

Centile of HbA1c level with subsequent examination with CDRS is cost-effective procedure for screening individuals with T1D prior to psychiatric.