1433-P: Do Depressive Symptoms Mediate the Relation of Household Food Insecurity with Hemoglobin A1c among Youth and Young Adults with Youth-Onset Type 1 Diabetes?

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Introduction and Objective: We explored whether and how depressive symptoms in youth and young adults (YYA) with youth-onset type 1 diabetes (T1D) mediate the effects of household food insecurity (HFI) on hemoglobin A1c (HbA1c). Methods: Cross-sectional data from the SEARCH for Diabetes in Youth Study (2016-2019) included 1,093 YYA with T1D. We applied causal mediation modeling to estimate the effects of HFI (measured with the Household Food Security Survey Module) on HbA1c (measured from whole blood samples) mediated by depressive symptoms (measured with the Centre for Epidemiologic Studies Depression Scale). Results: Overall, HFI was associated with a one percentage point higher average HbA1c (mean Hb1Ac, HFI 9.91% vs. 8.88%) and 19% of this association was mediated by depressive symptoms. Irrespective of level of confounder adjustment, both the direct effect (range 0.43-0.69) and the indirect effect (range 0.12-0.17) remained significant and the percent mediation ranged from 18 to 21%. Conclusion: These results highlight the importance of depressive symptoms as a key pathway between HFI and HbA1c, with consistent direct and indirect effects observed even after adjustment for factors as clinically relevant. Future studies should examine whether mental health interventions are an effective strategy to mitigate the effects of HFI on HbA1c. Disclosure A.M. Alfalki: None. E.F. Julceus: None. F. Malik: None. T.A. Bekelman: None. A. Merchant: None. J.A. Mendoza: None. A.D. Liese: None. Funding the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (R01DK117461, 1R01DK127208, 1UC4DK108173); National Institute of General Medical Sciences (T32-GM081740)

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