A systematic review and meta-analysis to compare the prevalence of depression between people with and without Type 1 and Type 2 diabetes

Depression among outpatients with diabetic peripheral neuropathy: prevalence and associated factors

AIM

This study aims to assess the prevalence of depression among patients with diabetic neuropathy and identify contributing factors.

METHODS

A cross-sectional descriptive design was used, recruiting 153 patients from outpatient clinics. Participants completed the Beck Depression Inventory II, Michigan Neuropathy Screening Instrument, and Douleur Neuropathique 4 questionnaires, with recent A1C results obtained from medical records.

RESULTS

The mean depression score was 16.5, with 98 patients (65%) reporting depression and 20 (13%) indicating moderate to severe depression. Approximately half of the sample experienced neuropathy and neuropathic pain. The mean Michigan Neuropathy Screening Instrument score was 5 (SD = 5), and the Douleur Neuropathique 4 score was 4 (SD = 3.5). Regression analyses showed significant demographic influences on depression. Higher Michigan Neuropathy Screening scores predicted greater depression severity, while DN4 scores did not significantly impact depression levels.

CONCLUSIONS

Depression in patients with diabetic neuropathy is influenced by the severity of neuropathy. Factors commonly associated with depression in diabetes, such as pain intensity and glycemic control, do not significantly affect depression in the context of neuropathy. These findings highlight the complexity of addressing depression in diabetes care, requiring comprehensive and ongoing approaches.

The burden of depression among patients with type 2 diabetes: An umbrella review of systematic reviews

OBJECTIVE

Depression is common among patients with type 2 diabetes (T2D) which is a major global health concern. This umbrella review aims to explore differences in reported depression prevalence among people with type 2 diabetes and to identify the factors contributing to the variation.

METHODS

A literature search was conducted in PubMed, EMBASE, PsycINFO and Cochrane. We included systematic reviews with or without a meta-analysis that investigated the prevalence of depression in adult patients (age 18 years or older) with T2D. Two independent reviewers screened titles and abstracts. The following data were extracted: study characteristics, depression assessment approach, and depression prevalence from systematic reviews and each primary study.

FINDINGS

Of the 23 systematic reviews meeting inclusion criteria, comprising 649 unique primary studies, pooled depression prevalence ranged from 8.9 % to 61.6 %, with substantial heterogeneity (I2 values ranged from 89.41 % to 99.96 %). Studies conducted in the African (0.11 [95%CI 0.04-0.17]), Eastern Mediterranean (0.19 [95%CI 0.15-0.24]) and South-East Asia (0.08 [95%CI 0.03-0.13]) reported higher prevalence compared to the Americas. Additionally, studies utilizing screenings other than the Hamilton Depression Rating Scale (HDRS) exhibited lower prevalence rates (between -22 % and -0.10 %).

CONCLUSION

The burden of depression was high among people with T2D. Substantial variation was found in the prevalence of depression among individuals with T2D, depending on the WHO region and the depression assessment approach.

Physical inactivity linked to depressive symptoms in people with and without diabetes: A longitudinal network analysis of health risk behaviours and individual depressive symptoms from the Survey of Health, Ageing and Retirement in Europe

This study examined cross-sectional (Ising) and longitudinal (cross-lagged panel) networks of depressive symptoms and health risk behaviours in people with diabetes, compared to those without. Participants (N = 22,510) from the Survey of Health, Ageing and Retirement in Europe with (n = 1781) and without (n = 20,729) diabetes with full data on smoking, high alcohol consumption, low fruit and vegetable consumption, physical inactivity and depressive symptoms (EURO-D) were included. Network models indicated that physical inactivity was by far the most closely connected behaviour to depressive symptoms for both groups. Networks were more densely connected for people without diabetes. Differences in whether sleep problems and physical inactivity activated or were activated by depressive symptoms were observed between people with and without diabetes. Identifying structural, symptom-level differences between health risk behaviours and depressive symptoms associated with the presence of diabetes holds potential for informing precision medicine.

Enriched environment alleviates NLRP3 inflammasome mediated neuroinflammation in diabetes complicated with depression rats

Depression is a serious and common complication of diabetes, with a well-established link between the two conditions. Recent studies indicate that activation of the NLRP3 inflammasome in hippocampal microglia plays a key role in the pathogenesis of diabetes complicated with depression (DD). While environmental enrichment (EE) has demonstrated significant anti-neuroinflammatory effects, its potential to alleviate neuroinflammation specifically induced by DD remains unclear. The DD rat model was established using a combination of a high-fat diet, streptozotocin injection, and chronic unpredictable mild stress. The effects of EE on NLRP3 inflammasome activation in the hippocampal microglia of DD rats were examined through a series of behavioral tests (open field test, forced swim test, and elevated plus maze), along with enzyme-linked immunosorbent assays, hematoxylin and eosin staining, TdT-mediated dUTP nick-end labeling staining, Western blot analysis, and immunofluorescence. Compared to the control group, DD rats exhibited impaired glucose metabolism and increased depressive-like behaviors, alongside hippocampal neuronal damage and elevated apoptosis rates. Activation of the NLRP3 inflammasome in hippocampal microglia was observed, with upregulation of the NLRP3 signaling pathway and inhibition of the PI3K/AKT signaling pathway. EE significantly mitigated these effects, reducing hippocampal neuroinflammation and alleviating depressive behaviors in DD rats. Neuroinflammation in the hippocampus is a key mechanism underlying the pathogenesis of DD. This study demonstrated that EE reduces neuroinflammation, likely by inhibiting the activation of the NLRP3 inflammasome in hippocampal microglia.

More or less equal? Trends in horizontal equity in mental health care utilization in Stockholm county, Sweden (2006-2022). Repeated survey-registry linked studies

BACKGROUND

Horizontal equity is defined as equal care for equal needs, regardless of socioeconomic factors. This study investigated trends in horizontal equity in mental health care (MHC) utilization in Sweden from 2006 to 2022. Monitoring equity provides valuable information for healthcare system governance (e.g., planning and resource allocation) necessary for ensuring equitable provision of services.

METHODS

A total of 81,650 Stockholm residents aged 18-64, who participated in the Hälsa Stockholm surveys of 2006, 2010, 2014 or 2021, were analysed. Their subsequent use of MHC (primary, in- and outpatient specialized care, and psychotropic medication) within six months after survey response was collected from registries between 2006 and 2022. Concentration index (CI) and need-standardized CI (Horizontal inequity index, HI), summative measures of inequalities, were used in this study. HI was estimated using self-reported psychological distress (measured with the General health questionnaire 12 in 2006-2014 and Kessler 6 in 2021) as the primary need indicator, with general health status and long-term limiting illness as additional need indicators. Equivalized disposable household income was used as the ranking variable, while education status, migration status, age, and sex were included as non-need variables that we controlled for in the analyses.

RESULTS

Lower-income individuals used MHC services more than their higher-income counterparts with comparable levels of psychological distress. These "pro-poor" inequities in the probability of MHC use increased from HI = -0.057 [95% Confidence Limits, CL: -0.079, -0.034] in 2006/2007 to HI = -0.130 [95% CL: -0.159, -0.102] in 2014/2015. By 2021/2022, the "pro-poor" inequities had decreased (HI = -0.034 [95% CL: -0.06, -0.009]), partly due to an increase in MHC use among higher-income groups but a decrease in the lowest income group. Standardizing for additional need indicators reduced the "pro-poor" inequities but maintained the observed trends. Among non-Nordic migrants, "pro-rich" inequities fell between 2006/2007 and 2014/2015 but rose in 2021/2022, with significant "pro-rich" inequities among non-European migrants in 2021/2022 (HI = 0.100 [95% CL: 0.024, 0.176]). Among patients in outpatient services, "pro-poor" inequities in visit frequency decreased over time (2006-2022).

CONCLUSION

We observed increasingly higher probability of MHC use among lower-income individuals than their higher-income peers with similar (measured) needs from 2006 to 2015. However, during the pandemic (2021/2022), potential access problems led to diminishing of "pro-poor" inequities in the total sample, and to "pro-rich" inequities among non-Nordic migrants. The Covid-19 disruption to the healthcare system-such as restrictions on in-person visits and the rapid transition to digital healthcare services-along with its impact on care-seeking, may explain the trend shifts.

"She has become my best friend": a qualitative study on the perspective of elderly with type 2 diabetes regarding the use of an interactive virtual assistant device for diabetes care and mental health promotion

AIMS

To qualitatively evaluate the experiences and emotional responses of elderly individuals with type 2 diabetes regarding the use of an interactive virtual assistant device.

METHODS AND RESULTS

This qualitative study included elderly individuals who were diagnosed with type 2 diabetes and who had been using the Smart Speaker EchoDot 3rd Gen (Amazon Echo®) device for three months. A structured face-to-face interview with open-ended questions was conducted to evaluate their experiences and emotional responses associated with the device. Data analysis was performed using inductive thematic content analysis with deductive coding followed by narrative synthesis to present the overall perceptions of the participants. Thirty individuals with a mean diabetes duration of 17.1 ± 9.45 years and a mean age of 71.9 ± 5.1 years were interviewed to ensure saturation of responses. Three major themes were identified through response analysis: (1) Emotional response to user experience; (2) Humanization feelings in human-device interactions; (3) Diabetes-related self-care. Overall, participants experienced a wide range of feelings regarding the use of the interactive virtual assistant device, predominantly with positive connotations, highlighting aspects of humanization of technology and its use, and experiencing assistance in self-care related to diabetes.

CONCLUSION

Our results highlight the overwhelmingly positive emotional responses and strong sense of humanization expressed by elderly individuals with diabetes toward an interactive virtual assistant device. This underscores its potential to improve mental health and diabetes care, although further studies are warranted to fully explore its impact.

Effectiveness of Nurse-Led Psychological Interventions on Diabetes Distress, Depression, and Glycemic Control in Individuals With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

PURPOSE

To explore the effect of nurse-led psychological interventions on diabetes distress, depression, and glycemic control in individuals with type 2 diabetes mellitus (T2DM).

METHOD

Seven databases were systematically searched. Outcome measures were diabetes distress, depression, and hemoglobin A1c (HbA1c) level. RoB 2.0 was used for risk of bias assessment. Data were synthesized using Review Manager 5.4 software.

RESULTS

Fourteen studies were included from 2,837 articles. Five studies pooled in the meta-analysis demonstrated reduction in diabetes distress (standard mean difference = -0.36, 95% confidence interval [-0.49, -0.24], p < 0.001), favoring nurse-led psychological interventions over controls. Effects of the interventions on depression and HbA1c level were inconsistent across studies.

CONCLUSION

Nurse-led psychological interventions demonstrated the effect of reducing diabetes distress and some promising benefits for depression and glycemic control. Integrating nurse-led psychological interventions into usual care will be beneficial for individuals with T2DM in the future. [Journal of Psychosocial Nursing and Mental Health Services, 63(3), 11-18.].

Telehealth occupational therapy improves psychosocial well-being but not glycemia among young adults with type 1 diabetes: The Resilient, Empowered, Active Living-Telehealth (REAL-T) randomized controlled trial

BACKGROUND

Young adults with type 1 diabetes mellitus often face challenges managing their condition, leading to elevated glucose and heightened psychosocial distress. Diabetes care traditionally focuses on biomedical outcomes, with less emphasis on well-being. Occupational therapy offers a holistic approach to managing diabetes by integrating changes to daily habits and routines and psychosocial support.

METHODS

This randomized controlled trial involved participants aged 18-30 with HbA1c ≥ 7.5 % (≥58 mmol/mol). Participants received either telehealth occupational therapy or usual care. The intervention addressed diabetes management, daily habits and routines, and emotional well-being. Data collected at baseline, 3 months, and 6 months included HbA1c, continuous glucose monitoring metrics, and psychosocial outcomes. Analyses employed intent-to-treat principles, using ANCOVA to evaluate between-group differences.

RESULTS

Participants (n = 209) were 24.3 (±3.7) years old, 59.8 % female, 44.5 % non-Hispanic White, and 47.4 % publicly insured. No significant differences were found in glycemic outcomes. Intervention participants had improved diabetes-related quality of life (DQoL; least-squares [LS] mean 0.67, 95 % CI 0.02 to 1.32, p = 0.045) and reduced diabetes distress (LS-mean -0.36, CI -0.65 to -0.07, p = 0.01).

CONCLUSION

Generalizability may be impacted by external factors related to COVID-19. The findings suggest occupational therapy may be beneficial for young adults experiencing diabetes-related distress and poor DQoL.

Diabetes-Related Extremity Amputation Depression and Distress (DREADD): A Multimethod Study

Of the roughly 38 million people diagnosed with type 2 diabetes mellitus in the United States, up to 34% will develop a diabetic foot ulcer at some point, up to 75% of those who develop an ulcer will experience recurrent ulcers, and approximately 18% of patients with a diabetic foot ulcer will undergo lower-limb amputation. The aim of this study was to determine whether depressive symptoms change after a minor, nontraumatic amputation. We conducted a multimethod study consisting of semi-structured interviews (n = 12) and a retrospective cohort (n = 20) of patients with type 2 diabetes mellitus who underwent a nontraumatic, minor amputation of a single toe (partial or total) or partial ray resection. Patient Health Questionnaire-9 (PHQ-9) scores were noted before and after surgery within 30 days of each other. The Wilcoxon matched pairs signed rank test was used to determine differences in the PHQ-9 scores before amputation and after amputation. Of the 20 patients in the retrospective cohort, 90% (18 of 20) had higher PHQ-9 scores within 30 days of amputation. Mean PHQ-9 scores were 3.65 and 12.35 before and after amputation, respectively (a difference of 8.7; P = .0001). Diabetes-related extremity amputation depression and distress is a potentially dangerous complication of diabetes mellitus. Nontraumatic amputations can be a traumatic experience for patients. Surgeons should screen their patients with type 2 diabetes mellitus before and after any (minor or major) nontraumatic amputation and make the appropriate referral, if necessary. Sufficient evidence exists in the literature to warrant the inclusion of psychiatrists and other mental health clinicians in multidisciplinary limb preservation teams.

Prevalence and Risk of Schizophrenia and Bipolar Disorder in Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis

Purpose of the Review

Schizophrenia and bipolar disorder are understood to have neuroinflammatory/neuro-immunological basis in their etiopathogenesis. There are few studies synthesizing the association of schizophrenia and bipolar disorder in type 1 diabetes mellitus (T1DM), a common immunological disorder.

Collection and Analysis of Data

We performed meta-analyses of studies assessing the prevalence and risk of schizophrenia and related disorders and bipolar disorder in individuals with T1DM. Fifteen studies consisting of a total sample of 9,768,028 (T1DM: 435,553; non-T1DM controls: 9,332,475) were included. Random-effects meta-analyses using the restricted maximum likelihood method for pooling logit transformed prevalence values and the Mantel-Haenszel test for pooling risk ratios were used. I 2 statistic and the rank correlation test for Funnel plots' asymmetry were used to assess heterogeneity and publication bias, respectively.

Results

Pooled (transformed-back-transformed) prevalence for schizophrenia and related psychotic disorders was 0.37% (95%CI: 0.19-0.73), and for bipolar disorder it was 0.39% (95%CI: 0.05-2.99) (together: 0.38% (95%CI: 0.2-0.71)] in T1DM. The prevalence models showed significant heterogeneity but were statistically significant, had low publication bias, and survived sensitivity analysis. The pooled risk ratio for schizophrenia and related disorders together with bipolar disorder was 1.80 (95%CI: 0.64-5.03), and for schizophrenia and related disorders alone it was 1.19 (95%CI: 0.46-3.11), indicating higher rates of these disorders in T1DM. The pooled risk ratios were not statistically significant and did not survive sensitivity analysis. Trial sequential analysis suggested the need for more studies to confirm increased risk.

Conclusion

With available studies, we could not provide convincing evidence for the hypothesis that the prevalence and risk of schizophrenia and related disorders and bipolar disorder are significantly greater in individuals with T1DM.

Risk of depression and dementia among individuals treated with sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists

PURPOSE OF THE REVIEW

To review whether sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists decrease the risk of depression, suicidal ideation and cognitive impairment in later life.

RECENT FINDINGS

The results of studies using information derived from large registries and administrative health datasets suggest that GLP-1 receptor agonists (RAs) increase the risk of suicidality, although findings have been inconsistent. One nested-case control study reported that SGLT2i decreases the risk of depression among adults with diabetes, and findings from a small trial of the SGLT2i empagliflozin provided supportive evidence. Several observational studies reported that SGLT2i and GLP-1 RAs decrease dementia risk, with a target trial finding greater cognitive benefit associated with the use of GLP-1 RAs compared with other medicines commonly used to manage diabetes.

SUMMARY

Recent results from large observational studies suggest that SGLT2i and GLP-1 RA may decrease the risk of cognitive impairment in later life. The effects of these medicines on mood have not been as well explored, but there are concerns about the potential increased risk of suicidality among GLP-1 RA users. Prescription bias could explain some of these associations, so that robust trial evidence is now needed to confirm or dismiss the reported findings.

Differential associations of somatic and cognitive-affective symptoms of depression with inflammation and insulin resistance: cross-sectional and longitudinal results from the Emotional Distress Sub-Study of the GRADE study

AIMS/HYPOTHESIS

Insulin resistance and inflammation are components of a biological framework that is hypothesised to be shared by type 2 diabetes and depression. However, depressive symptoms include a large heterogeneity of somatic and cognitive-affective symptoms, and this may obscure the associations within this biological framework. Cross-sectional and longitudinal data were used to disentangle the contributions of insulin resistance and inflammation to somatic and cognitive-affective symptoms of depression.

METHODS

This secondary analysis used data from the Emotional Distress Sub-Study of the GRADE trial. Insulin resistance and inflammation were assessed using the HOMA-IR estimation and high-sensitivity C-reactive protein (hsCRP) levels, respectively, at baseline and at the study visits at year 1 and year 3 (HOMA-IR) and every 6 months (hsCRP) for up to 3 years of follow-up. Depressive symptoms were assessed at baseline using the Patient Health Questionnaire (PHQ-8), and a total score as well as symptom cluster scores for cognitive-affective and somatic symptoms were calculated. For the cross-sectional analyses, linear regression analyses were performed, with inflammation and insulin resistance at baseline as dependent variables. For the longitudinal analyses, linear mixed-effect regression analyses were performed, with inflammation and insulin resistance at the various time points as dependent variables. In all analyses, depressive symptoms (total score and symptom cluster scores) were the independent variables, controlled for important demographic, anthropometric and metabolic confounders. For the analysis of insulin resistance (HOMA-IR), data from 1321 participants were analysed. For the analysis of inflammation (hsCRP), data from 1739 participants were analysed.

RESULTS

In cross-sectional analysis and after adjustment for potential confounders, a one-unit increase in PHQ-8 total score was significantly associated with a 0.8% increase in HOMA-IR (p=0.007), but not with hsCRP (0.6% increase, p=0.283). The somatic symptom score was associated with a 5.8% increase in HOMA-IR (p=0.004). Single-item analyses of depressive symptoms showed that fatigue (3.6% increase, p=0.002) and increased/decreased appetite (3.5% increase, p=0.009) were significantly associated with HOMA-IR cross-sectionally. The cognitive-affective symptom score was not significantly associated with HOMA-IR at baseline. In longitudinal analyses, a one-unit increase in PHQ-8 total score was significantly associated with a 0.8% increase in hsCRP over time (p=0.014), but not with HOMA-IR over time (0.1% decrease, p=0.564). Again, only the somatic symptom cluster was significantly associated with hsCRP over time (5.2% increase, p=0.017), while the cognitive-affective symptom score was not.

CONCLUSION/INTERPRETATION

The results highlight the associations of depressive symptoms with markers of inflammation and insulin resistance, both cross-sectionally and longitudinally, in individuals with type 2 diabetes. In particular, somatic symptoms of depression appear to be the driver of these associations, even after controlling for concomitant conditions, with a potential role for fatigue and issues with appetite.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01794143.

The Interconnected Complexity of Diabetes and Depression

Diabetes and depression have a bidirectional relationship, with negative impacts on glycemia, self-care, long-term complications, quality of life, and mortality. This review highlights key aspects of the interconnected and complex relationship between diabetes and depression, including how it affects health outcomes, depression duration and recurrence, age-specific manifestations, and recommendations for screening and nonpharmacological treatment.

Incidence and factors associated with new depressive episodes in adults with newly treated type 2 diabetes: A cohort study

AIMS

Several methods are available to help identify people with depression; however, there is little guidance on when to start screening. This study estimated the incidence of new depressive episodes and identified factors associated with onset in adults with newly treated type 2 diabetes.

METHODS

Administrative health data from Alberta, Canada was used to identify people starting metformin between April 2011 and March 2015. People with a history of depression before metformin initiation were excluded. Person-time analysis was used to calculate the incidence rate of new depressive episodes over the next 3 years, stratified by sex, age, and year. Multivariable logistic regression was used to identify factors independently associated with a new depressive episode.

RESULTS

42,694 adults initiated metformin; mean age 56 years, 38 % female. A new depressive episode occurred in 2752 (6 %) individuals, mean time to onset was 1.4 years and overall incidence rate was 22.3/1000 person-years. Factors associated with a new depressive episode were female sex, younger age, previous mental health conditions, frequent healthcare utilization, and multiple comorbid conditions.

CONCLUSIONS

Screening for depression should begin within 1-2 years of metformin initiation and focus on females, those < 55 years old, those with a history of mental health conditions, and those with multiple comorbid conditions.

Effects of Personalized DiaBetes TEXT Messaging Combined with Peer Support Education on Patients With Type 2 Diabetes: A Randomized Controlled Trial

BACKGROUND

To investigate the effects of personalized DiaBetes TEXT messaging combined with Peer Support Education (DB-TEXT+ PSE) on clinical outcomes in patients with type 2 diabetes.

METHODS

An assessor-blinded, three-arm randomized controlled trial recruited 84 participants between December 2022 and July 2023. Participants were randomly assigned to a DB-TEXT + PSE group, a DB-TEXT group, or a professional education program (PEP) group. Primary outcomes included glycated hemoglobin (HbA1c), fasting blood glucose (FBG) levels, and clinical remission rates, whereas secondary outcomes measured lipid profiles, fatigue, sleep quality, depression, and quality of life (QoL). Outcomes were assessed at baseline (T0), three months (T1), and six months (T2) postintervention.

RESULTS

Relative to PEP, personalized DB-TEXT + PSE and DB-TEXT alone led to significantly reduced HbA1c levels at T1 and decreased FBG levels at T1 and T2. Type 2 diabetes remission was achieved by 35.7% and 50% of the participants in the DB-TEXT + PSE group, by 17.9% and 25% in the DB-TEXT group, and by 3.7% and 3.7% in the PEP group at T1 and T2, respectively. Relative to the PEP, DB-TEXT + PSE led to significantly reduced TC levels, diastolic blood pressure (DBP), and systolic blood pressure (SBP) and improved sleep quality and QoL over time.

CONCLUSIONS

Personalized DB-TEXT + PSE is more effective at enhancing clinical outcomes, reducing fatigue, improving sleep quality, and improving quality of life in patients with type 2 diabetes than DB-TEXT alone and PEPs are. Educators can incorporate personalized DB-TEXT + PSE as a component of diabetes education programs and thereby integrate digital interventions and supplementary programs.

Green sanctuaries: residential green and garden space and the natural environment mitigate mental disorders risk of diabetic patients

BACKGROUND

The co-occurrence of diabetes and mental disorders is an exceedingly common comorbidity with poor prognosis. We aim to investigate the impact of green space, garden space, and the natural environment on the risk of mental disorders among the population living with diabetes.

METHODS

We performed a longitudinal analysis based on 39,397 participants with diabetes from the UK Biobank. Residential green and garden space modeled from land use data and the natural environment from Land Cover Map were assigned to the residential address for each participant. Cox proportional hazards model was used to analyze the associations between nature exposures and mental disorders of diabetes. Casual mediation analysis was used to quantify indirect effect of air pollution.

RESULTS

During a mean follow-up of 7.55 years, 4513 incident mental disorders cases were identified, including 2952 depressive disorders and 1209 anxiety disorders. Participants with natural environment at 300 m buffer in the second and third tertiles had 7% (HR = 0.93, 95%CI: 0.86-0.99) and 12% (HR = 0.88, 95%CI: 0.82-0.94) lower risks of incident mental disorders compared with those in the first tertile, respectively. The risk of mental disorders incidence among diabetes patients will decrease by 13% when exposed to the third tertile of garden space at 300 m buffer. The natural environment and garden space individually prevented 6.65% and 10.18% of mental disorders incidents among diabetes patients. The risk of incident mental disorders was statistically decreased when exposed to the third tertile of green space at 1000 m buffer (HR = 0.84, 95% CI: 0.78-0.90). Protective effects of three nature exposures against depressive and anxiety disorders in diabetes patients were also observed. Air pollution, particularly nitrogen dioxide, nitrogen oxides, and fine particulate matter, significantly contributed to the associations between nature exposures and mental disorders, mediating 48.3%, 29.2%, and 62.4% of the associations, respectively.

CONCLUSIONS

Residential green and garden space and the natural environment could mitigate mental disorders risk in diabetes patients, with air pollution playing a vital mediator. This highlights the potential for local governments to enhance the sustainability of such interventions, grounded in public health and urban planning, through strategic planning initiatives.

Psychometric properties of the Swedish version of the Patient Health Questionnaire-9: an investigation using Rasch analysis and confirmatory factor analysis

Depression is one of the most common psychiatric conditions. Given its high prevalence and disease burden, accurate diagnostic procedures and valid instruments are warranted to identify those in need of treatment. The Patient Health Questionnaire-9 (PHQ-9) is one of the most widely used self-report measures of depression, and its validity and reliability has been evaluated in several languages. However, the Swedish translation has yet not been subject to psychometric evaluation, and no previous psychometric evaluation of the instrument have used both Rasch analysis and classic test theory. The aim of this study was to investigate validity and reliability of the PHQ-9 in a Swedish sample of individuals with self-reported current or past mental health problems using Rasch analysis and confirmatory factor analysis. A sample of 4958 participants was recruited from an online survey covering different aspects of covid-19 and mental health targeted towards individuals with mental health problems. Results showed that a one-factor solution fit the data after removing one item and that some items had a different response pattern for older respondents. Furthermore, after removing item 2 and merging the two middle response categories for item 9, the Swedish translation of PHQ-9 showed adequate psychometric properties. The findings suggests that the Swedish translation of PHQ-9 may need to be adapted in order to make adequate interpretations of an individual score and to differentiate between populations. Further tests of its validity and reliability in other Swedish samples are needed to fully understand the properties of the Swedish version of PHQ-9.

Psychological interventions for depression in people with diabetes mellitus

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the effects of psychological interventions for depression in people with diabetes mellitus.

The Burden of Comorbid Depression and Type 2 Diabetes: An Empirical Study Using Commercial Insurance Data

INTRODUCTION

Despite rising rates of depression and diabetes, assessments of depression's burden on diabetes management and its economic burden remain limited. In this study, we evaluate the burden of depression on diabetes management and quantify the financial implications of comorbid depression and diabetes.

METHODS

We performed propensity score matching on Texas commercial claims data (2016-2019) to match type 2 diabetes patients with depression (n = 613) to those without (n = 583). Depression flagged in 2016/2017 indicated initial depression, and an A1C level of ≥8% in 2018/2019 indicated follow-up uncontrolled diabetes. Healthcare costs included total, diabetes-related, outpatient, and inpatient costs incurred during 2018/2019.

RESULTS

A depression flag in the initial period was linked to a 2.7 percentage point increase (P = .031) in the probability of having an A1C level of ≥8% in the follow-up, compared to individuals without a depression flag. Having both a depression flag and uncontrolled A1C in the initial period was associated with $2,037 higher total medical costs (P = .004), $494 higher diabetes-related costs (P = .020), and $336 higher outpatient costs (P = .008) in the follow-up, compared to the respective averages of $6,900, $474, and $583 for individuals without a depression flag or uncontrolled A1C.

CONCLUSIONS

Our findings highlight the detrimental effect of depression on uncontrolled diabetes and the subsequent increase in healthcare costs. Further research is warranted to determine the effectiveness of proactive treatments for depression in managing diabetes, improving glycemic control, and reducing healthcare costs.

Unraveling the Role of the Blood-Brain Barrier in the Pathophysiology of Depression: Recent Advances and Future Perspectives

Depression is a highly prevalent psychological disorder characterized by persistent dysphoria, psychomotor retardation, insomnia, anhedonia, suicidal ideation, and a remarkable decrease in overall well-being. Despite the prevalence of accessible antidepressant therapies, many individuals do not achieve substantial improvement. Understanding the multifactorial pathophysiology and the heterogeneous nature of the disorder could lead the way toward better outcomes. Recent findings have elucidated the substantial impact of compromised blood-brain barrier (BBB) integrity on the manifestation of depression. BBB functions as an indispensable defense mechanism, tightly overseeing the transport of molecules from the periphery to preserve the integrity of the brain parenchyma. The dysfunction of the BBB has been implicated in a multitude of neurological disorders, and its disruption and consequent brain alterations could potentially serve as important factors in the pathogenesis and progression of depression. In this review, we extensively examine the pathophysiological relevance of the BBB and delve into the specific modifications of its components that underlie the complexities of depression. A particular focus has been placed on examining the effects of peripheral inflammation on the BBB in depression and elucidating the intricate interactions between the gut, BBB, and brain. Furthermore, this review encompasses significant updates on the assessment of BBB integrity and permeability, providing a comprehensive overview of the topic. Finally, we outline the therapeutic relevance and strategies based on BBB in depression, including COVID-19-associated BBB disruption and neuropsychiatric implications. Understanding the comprehensive pathogenic cascade of depression is crucial for shaping the trajectory of future research endeavors.

Risk of Suicide Across Medical Conditions and the Role of Prior Mental Disorder

Importance

According to the World Health Organization, more than 700 000 individuals worldwide die by suicide each year. Medical conditions likely increase the risk of suicide.

Objective

To (1) provide age- and sex-specific pairwise estimates of the risk of suicide across a comprehensive range of medical conditions, (2) investigate whether there is a dose-response-like relationship at play (ie, the higher the disability burden due to medical morbidity, the higher the risk of suicide), and (3) determine if the risk of suicide with medical conditions is particularly pronounced among those who had mental disorder preceding the medical conditions.

Design, Setting, and Participants

This cohort study was an observational study of population-based data for all individuals living in Denmark at some point between 2000 and 2020. The data analysis took place from September 2023 to May 2024.

Exposures

Thirty-one specific medical conditions as well as prior mental disorder.

Main Outcomes and Measures

The main outcome was suicide. Associations between the 31 specific medical conditions, nested within 9 categories, and suicide were examined via Poisson regression, yielding incidence rate ratios (IRRs). Subsequent analyses included an interaction term to assess whether a previous hospital-treated mental disorder modified the associations. Finally, the association between the disability burden of medical conditions and suicide was examined for those with and without prior mental disorder, respectively.

Results

A total of 6 635 857 individuals (3 337 613 females and 3 298 244 males) were included in the analyses of the associations between medical conditions and suicide. Except for endocrine disorders, all categories of medical conditions were associated with a statistically significant increased risk of suicide (which was most pronounced for gastrointestinal conditions [IRR, 1.7; 95% CI,1.5-1.8], cancer [IRR, 1.5; 95% CI, 1.4-1.6], and hematological conditions [IRR, 1.5; 95% CI, 1.3-1.6]). Interaction between mental disorder and individual medical conditions did not seem to play a major role for suicide risk. For those without but not for those with mental disorder, there was a dose-response-like relationship between the disability burden of medical conditions and suicide.

Conclusions and Relevance

Medical conditions are generally associated with increased risk of suicide in a dose-response-like manner. Individuals with hospital-treated mental disorder appear to be at such elevated risk of suicide that additional disability associated with medical conditions has little impact in this regard.

Urban Environmental Threat Moderates the Relationship Between Depression and Insulin Resistance Among Latinxs With Type 2 Diabetes

As the largest minoritised ethnic group in the United States, Latinxs face a greater risk for type 2 diabetes and depression. The aim of the present study was to explore whether the relationship between depressive symptoms and insulin resistance among Latinxs with type 2 diabetes was moderated by toxic stressors arising from urban environmental threat (i.e., uncomfortable or unsafe aspects of city life). A community sample of Latinx adults with type 2 diabetes (n = 121) was recruited from Hartford, Connecticut. Participants self-reported depressive symptoms and exposure to urban environmental threat using items from the Patient Health Questionnaire and Urban Hassles Index, respectively. Insulin and glucose levels assessed via fasting blood draw were used to calculate insulin resistance using the HOMA-IR formula. After controlling for demographic, financial and health-related factors, results from a regression analysis revealed a significant interaction between depressive symptoms and urban environmental threat; more severe symptoms of depression predicted greater insulin resistance, but only amongst those with frequent exposure to urban environmental threats. Findings from the current study suggest that improving urban living conditions may offer an alternate avenue for attenuating the deleterious impacts of depression on type 2 diabetes progression in Latinxs.

Exploring the link between SIRT1 gene variants and depression comorbidity in type 2 diabetes

This study aims to (1) analyze the clinical characteristics and risk factors of patients with type 2 diabetes and comorbid depression and (2) explore the association between SIRT1 gene single-nucleotide polymorphism sites and this comorbidity. A total of 450 type 2 diabetes patients hospitalized in the General Medicine Department at The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology from July 2022 to September 2023, and 300 healthy individuals from the physical examination department were selected as study subjects. Both groups were assessed using general information surveys and questionnaires. Statistical analyses were performed to compare clinical indicators across 3 groups: individuals with only type 2 diabetes, those with comorbid depression, and healthy controls. The age, gender, disease duration, marital status, income and drug expenditure, employment status, fasting blood glucose level, fasting insulin level difference, insulin resistance index difference, glycated hemoglobin, high-density lipoprotein level, and HCY difference among the 3 groups of patients were risk factors for type 2 diabetes comorbid depression patients. The SIRT1 mRNA level was significantly reduced in type 2 diabetes comorbid depression patients. The SIRT1 gene had 3 sites: rs12415800, rs3758391, and rs932658, which were related to the patient's type 2 diabetes comorbid depression. They were the additive model and dominant model of rs12415800 and rs3758391, respectively. In addition, the GTGGT haplotype composed of rs12415800-rs932658-rs7895833-rs2273773-rs1467568 and the AGACT haplotype composed of rs3758391-rs932658-rs33957861-rs3818292-rs1467568 were significantly associated with type 2 diabetes comorbid depression. Numerous factors influence the presence of depression in patients with type 2 diabetes, with the SIRT1 gene playing a significant role, serving as a potential biomarker for this comorbidity.

Depression in Cardiac Patients Is a Major Cardiovascular Event Risk Factor: A 12-Month Observational Study

Background: Depression is a known factor in poor cardiovascular outcomes but is often underassessed in cardiac units. This study evaluates the impact of depression on cardiovascular outcomes in patients undergoing cardiac interventions. Methods: The study included 133 patients who underwent uncomplicated procedures for degenerative aortic valve stenosis (n = 40), acute coronary syndrome (n = 29), or chronic coronary artery disease (n = 64). Depression was assessed using the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAM-D). The primary endpoint was a major adverse cardiac and cerebrovascular event (MACCE). Patients were followed up for 12 months. Cox proportional hazards analysis was used to identify MACCE risk factors. Results: Depression was more frequently screened by HAM-D than BDI (42.9% vs. 30.8%, p < 0.001). During follow-up, 26 (19.5%) MACCEs occurred. In univariate analysis, risk factors included BDI score ≥ 11, HAM-D score ≥ 8, diabetes on insulin, anticoagulant use, atrial fibrillation, and serum creatinine level ≥ 130 µmol/L. Depression in the BDI increased the risk of the MACCE 3.6-fold (95%CI: 1.64-8.0, p = 0.001), whereas in the HAM-D, it increased the risk 4.9-fold (95%CI: 1.97-12.24, p < 0.001). Multivariate analysis showed HAM-D score ≥ 8 as the strongest predictor of MACCE (HR: 3.08, 95%CI: 1.18-8.08). Conclusions: Depression is a common finding in cardiovascular patients, and it is a strong risk factor for one-year cardiovascular mortality and adverse event risk. Therefore, we believe that common guidelines should be elaborated between relevant psychiatry and cardiology scientific societies.

Metformin treatment improves depressive symptoms associated with type 2 diabetes: A 24-week longitudinal study

OBJECTIVE

Metformin is a medication that is widely used for lowering blood sugar in patients with type 2 diabetes. Metformin was shown to have significant antidepressant effects; however, it is not clear whether metformin treatment improves outcomes in patients with type 2 diabetes who have concomitant depressive symptoms.

METHODS

A total of 475 patients with type 2 diabetes mellitus with depressive symptoms were included in this study and divided into metformin and nonmetformin groups according to whether they were taking metformin. The DASS-21 was used to assess patients' depression and anxiety scores before and after a 24-week intervention. In addition, general information about whether the patients had developed complications from diabetes and whether they had been diagnosed with other diseases was assessed.

RESULTS

(1) After 24 weeks, anxiety and depression scores were significantly lower in the metformin group than in the nonmetformin group. (2) The prevalence of depressive symptoms was significantly greater in female type 2 diabetic patients than in male patients (OR = 2.039, 95 % CI = 1.160-3.568). (3) People with type 2 diabetes who develop complications from diabetes (OR = 1.794, 95 % CI = 1.015-3.171) and those diagnosed with other conditions are more likely to experience depressive symptoms.

CONCLUSION

Metformin has an ameliorative effect on type 2 diabetes. However, women, those with diabetes complications, and those with type 2 diabetes who are also diagnosed with other conditions are more likely to experience depressive symptoms.

Depression, Anxiety, and Health-Related Quality of Life in Adults with Type 2 Diabetes

Background: Adults with type 2 diabetes are at a greater probability of suffering from mental health issues, which could result in a substantial effect on their HRQoL (health-related quality of life). Thus, the focus of this research was to investigate the relationship between comorbid anxiety, depression, and HRQoL among individuals with type 2 diabetes. Methods: Data from the Medical Expenditure Panel Survey from 2016 to 2021 were used to identify adult patients with type 2 diabetes diagnoses for this research. The MEPS used the SF-12 to measure HRQoL. The study employed multivariable linear regression to analyze the association between anxiety, depression, and HRQoL in individuals with type 2 diabetes, taking into consideration several confounding variables such as age, gender, and comorbidities. Results: This study included 5259 individuals with type 2 diabetes, of which the mean age was 52.9 years, 50.7% were men, and 49.3% were women. The findings from this sample show a negative relationship between anxiety, depression, and type 2 diabetic patients' HRQoL. It shows that after adjusting for other factors, diabetes patients with depression (MCS: = -6.817), anxiety (MCS: = -4.957), and both (MCS: = -0.344) have a significantly poorer HRQoL than those without these mental health comorbidities (p-value < 0.001). It also demonstrated the adverse effects on HRQoL of having coexisting chronic illnesses like heart disease, hypertension, and other chronic illnesses, along with a low socioeconomic status. Additionally, it revealed the benefits of employment, education, and regular exercise for HRQoL. Conclusions: The study's findings highlight the links between anxiety, depression, and type 2 diabetes patients' poor HRQoL. It also showed the adverse effects of coexisting chronic diseases and low socioeconomic status on HRQoL and the benefit of work and exercise on HRQoL. These findings can help policymakers to reform healthcare and enforce the early detection and treatment of anxiety and depression to enhance the HRQoL of type 2 diabetic patients.

Suicide death, suicidal ideation and suicide attempt in patients with diabetes: A systematic review and meta-analysis

AIMS

Diabetes has been indicated to be a risk factor for suicide. We aim to estimate the prevalence of suicide in patients with diabetes.

DESIGN

A meta-analysis using PRISMA methodology was adopted to examine the incidence of suicide in diabetic patients.

DATA SOURCES

From inception to October 2022, three online databases (PubMed, China National Knowledge Infrastructure and Web of Science) were used to search studies.

REVIEW METHODS

We used random-effects model to analysis. And our primary outcome was the incidence of suicide death per 100 person-years, and other outcomes were prevalence of suicidal ideation and suicide attempt. To explore the sources of heterogeneity in our study, we performed subgroup and meta-regression analyses.

RESULTS

The suicide death rate in diabetic patients was 0.027 per 100 person-years, with a higher rate for Type 1 Diabetes Mellitus compared to Type 2 Diabetes Mellitus. The prevalence of suicidal ideation in diabetes patients was 0.175, with a higher prevalence in Type 1 Diabetes Mellitus compared to Type 2 Diabetes Mellitus. The prevalence of suicide attempts in diabetes patients was 0.033, indicating a higher rate for Type 2 Diabetes Mellitus compared to Type 1 Diabetes Mellitus.

CONCLUSIONS

The results indicate a high rate of suicide among people with diabetes, and this study identifies populations and regions at high risk for suicide. Our review emphasizes interventions in mental health and the improvement of suicide prevention programmes.

IMPACT

The study investigated suicide death, suicidal ideation and suicide attempt in diabetic individuals. Suicide rates are elevated among diabetic patients, and various patient groups face distinct suicide risks. It is important to prioritize the mental well-being of diabetic individuals and enhance interventions, including personalized approaches, to inform public health efforts aimed at preventing and addressing suicide among diabetic patients.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public involvement.

Effect modification of tumor necrosis factor-α on the kynurenine and serotonin pathways in major depressive disorder on type 2 diabetes mellitus

Major depressive disorder (MDD) is strongly associated with type 2 diabetes mellitus (T2DM). The kynurenine and serotonin pathways, as well as chronic low-grade inflammation, are being considered potential links between them. MDD associated with T2DM is less responsive to treatment than that without T2DM; however, the underlying mechanism remains unknown. We aimed to investigate the effects of inflammatory cytokines on the kynurenine and serotonin pathways in patients with comorbid MDD and T2DM and those with only MDD. We recruited 13 patients with comorbid MDD and T2DM and 27 patients with only MDD. We measured interleukin-6 and tumor necrosis factor-α (TNF-α) levels as inflammatory cytokines and metabolites of the kynurenine pathway and examined the relationship between the two. TNF-α levels were significantly higher in patients with comorbid MDD and T2DM than in those with only MDD in univariate (p = 0.044) and multivariate (adjusted p = 0.036) analyses. TNF-α showed a statistically significant effect modification (interaction) with quinolinic acid/tryptophan and serotonin in patients from both groups (β = 1.029, adjusted p < 0.001; β =  - 1.444, adjusted p = 0.047, respectively). Limitations attributed to the study design and number of samples may be present. All patients were Japanese with mild to moderate MDD; therefore, the generalizability of our findings may be limited. MDD with T2DM has more inflammatory depression components and activations of the kynurenine pathway by inflammatory cytokines than MDD without T2DM. Hence, administering antidepressants and anti-inflammatory drugs in combination may be more effective in patients with comorbid MDD and T2DM.

Bidirectional Associations Between Mental Health Disorders and Chronic Diabetic Complications in Individuals With Type 1 or Type 2 Diabetes

OBJECTIVE

To determine bidirectional associations between the timing of chronic diabetes complications (CDCs) and mental health disorders (MHDs) in individuals with type 1 or type 2 diabetes.

RESEARCH DESIGN AND METHODS

We used a nationally representative health care claims database to identify matched individuals with type 1 or 2 diabetes or without diabetes using a propensity score quasirandomization technique stratified by age (0-19, 20-39, 40-59, and ≥60 years). CDCs and MHDs were identified using ICD-9/10 codes. We fit Cox proportional hazards models with time-varying diagnoses of CDCs or MHDs to investigate their association with the hazard of developing MHDs or CDCs, respectively.

RESULTS

From 2001 to 2018, a total of 553,552 individuals were included (44,735 with type 1 diabetes, 152,187 with type 2 diabetes, and 356,630 without diabetes). We found that having a CDC increased the hazard of developing an MHD (hazard ratio [HR] 1.9-2.9; P < 0.05, with higher HRs in older age strata), and having an MHD increased the hazard of developing a CDC (HR 1.4-2.5; P < 0.05, with the highest HR in age stratum 0-19 years). In those aged <60 years, individuals with type 1 diabetes were more likely to have CDCs, whereas individuals with type 2 diabetes were more likely to have MHDs. However, the relationship between CDCs and MHDs in either direction was not affected by diabetes type (P > 0.05 for interaction effects).

CONCLUSIONS

We found a consistent bidirectional association between CDCs and MHDs across the life span, highlighting the important relationship between CDCs and MHDs. Prevention and treatment of either comorbidity may help reduce the risk of developing the other.

Discussions About Binge Eating and Type 2 Diabetes in a Facebook Group: A Qualitative Analysis

OBJECTIVE

Binge eating has adverse health effects and may be 10 times more common in people with type 2 diabetes (T2D) than in the general population. Still, binge eating is not consistently addressed in diabetes treatment. People with T2D and binge eating may, therefore, seek guidance on the topic on social media. The study objective was to explore discussions about binge eating among members of a T2D-specific Facebook group.

METHOD

Interactions among members of the Facebook group were observed over 8 months and supplemented by keyword searches within group content. The data were imported into NVivo12 and analyzed using Interpretive Description.

RESULTS

The overarching theme described how group members exchanged guidance concerning co-existing T2D and binge eating based on personal experiences while trying to resolve co-members' misapprehensions regarding binge eating. Two subthemes were generated, describing frequently discussed topics relating to binge eating triggers and inhibitors. Triggers were confusion about the health impacts of carbohydrates and encounters with unsupportive clinicians, while inhibitors included the possibility of speaking openly about binge eating with peers and hunger cues being suppressed by glucagon-like peptide 1 receptor agonists.

DISCUSSION

Social media may constitute an important source of support for people with T2D and binge eating, as the topic is typically not addressed in routine care. Besides being aware of the extent of binge eating in people with T2D and the health risks involved, clinicians should keep in mind that people with both conditions may seek information on social media that can affect diabetes management.

Exploring factors associated with self-rated health in individuals with diabetes and its impact on quality of life: Evidence from the Survey of Health, Ageing, and Retirement in Europe

BACKGROUND

Self-rated health (SRH), a measure of self-reported general health, is a robust predictor of morbidity and mortality in various populations, including people with diabetes. Diabetes is negatively associated with SRH and quality of life (QoL). Little is known about how people with diabetes rate their health and which aspects influence the rating. Also, the predictive value of SRH on future QoL has not yet been evaluated.

METHODS

We analyzed data from 46 592 participants of the Survey of Health, Ageing and Retirement in Europe (SHARE). Using linear regression, we aimed to determine which sociodemographic, socioeconomic, medical, social, mental, and health behavior factors determine SRH in people with diabetes. In addition, we analyzed the predictive value of SRH on future QoL using the generalized estimating equations procedure.

RESULTS

We determined that country, current job situation, hospitalization, pain, polypharmacy, memory, eyesight, activities of daily living, number of chronic diseases, and depression are all linked to SRH. Together these variables explained 38% of the SRH's variance, whereas depression, pain, and memory had the greatest influence on SRH of people with diabetes. We also found that SRH independently predicted future QoL, supported by a regression coefficient of β = -1.261 (Wald chi-square test, χ2 = 22.097, df = 1, p < .05).

CONCLUSIONS

As SRH is linked to future QoL, we conclude that incorporating SRH assessment into medical evaluations can help health care professionals gaining a more comprehensive understanding of an individual's health trajectory and supporting patients to enhance their QoL.

Towards the standardisation of adult person-reported outcome domains in diabetes research: A Consensus Statement development panel

Diabetes is unique among chronic diseases because clinical outcomes are intimately tied to how the person living with diabetes reacts to and implements treatment recommendations. It is further characterised by widespread social stigma, judgement and paternalism. This physical, social and psychological burden collectively influences self-management behaviours. It is widely recognised that the individual's perspective about the impact of trying to manage the disease and the burden that self-management confers must be addressed to achieve optimal health outcomes. Standardised, rigorous assessment of mental and behavioural health status, in interaction with physical health outcomes is crucial to aid understanding of person-reported outcomes (PROs). Whilst tempting to conceptualise PROs as an issue of perceived quality of life (QoL), in fact health-related QoL is multi-dimensional and covers indicators of physical or functional health status, psychological and social well-being. This complexity is illuminated by the large number of person reported outcome measures (PROMs) that have been developed across multiple psychosocial domains. Often measures are used inappropriately or because they have been used in the scientific literature rather than based on methodological or outcome assessment rigour. Given the broad nature of psychosocial functioning/mental health, it is important to broadly define PROs that are evaluated in the context of therapeutic interventions, real-life and observational studies. This report summarises the central themes and lessons derived in the assessment and use of PROMs amongst adults with diabetes. Effective assessment of PROMs routinely in clinical research is crucial to understanding the true impact of any intervention. Selecting appropriate measures, relevant to the specific factors of PROs important in the research study will provide valuable data alongside physical health data.

Depression and type 2 diabetes: A causal relationship and mechanistic pathway

Depression is a mood disorder that may increase risk for the development of insulin resistance (IR) and type 2 diabetes (T2D), and vice versa. However, the mechanistic pathway linking depression and T2D is not fully elucidated. The aim of this narrative review, therefore, was to discuss the possible link between depression and T2D. The coexistence of T2D and depression is twice as great compared to the occurrence of either condition independently. Hyperglycaemia and dyslipidaemia promote the incidence of depression by enhancing inflammation and reducing brain serotonin (5-hydroxytryptamine [5HT]). Dysregulation of insulin signalling in T2D impairs brain 5HT signalling, leading to the development of depression. Furthermore, depression is associated with the development of hyperglycaemia and poor glycaemic control. Psychological stress and depression promote the development of T2D. In conclusion, T2D could be a potential risk factor for the development of depression through the induction of inflammatory reactions and oxidative stress that affect brain neurotransmission. In addition, chronic stress in depression may induce the development of T2D through dysregulation of the hypothalamic-pituitary-adrenal axis and increase circulating cortisol levels, which triggers IR and T2D.

The Interrelationship between Diabetes Mellitus and Emotional Well-Being: Current Concepts and Future Prospects

Diabetes mellitus is a lifelong metabolic disorder that impacts people's well-being and biopsychosocial status. Psychiatric problems and diabetes mellitus have a complex, reciprocal interaction in which one condition affects the other. In this narrative review, we provide an overview of the literature on the psychological effects of diabetes, expound on the evaluation of emotional disorders in the setting of diabetes, and suggest interventions aimed at enhancing both mental and physical health. Diabetes can make daily life complicated and stressful. Frequent blood glucose testing, taking medications on a regular basis, adhering to a tight diet plan, and exercising are some examples of the suggested daily routine of subjects with diabetes. Furthermore, comorbid diseases and typical diabetic complications can have a detrimental impact on quality of life. When mental health conditions coexist with diabetes mellitus, there is a greater likelihood of medication noncompliance, a decreased commitment to diabetes-related self-care, increased functional impairment, inadequate glycemic control, a higher risk of complications, and overall higher healthcare expenses. Thus, evaluation of the mental health status of patients with diabetes is crucial. When treating psychological issues and psychiatric disorders, a comprehensive biopsychosocial approach should be taken, and where appropriate, psychopharmacological therapies or psychotherapy should be applied. The goal of continuous education and assistance for self-care is to give individuals with the disease the information and abilities they need to control their condition over time.

Type 1 diabetes-related distress: Current implications in care

Type 1 diabetes (T1D) is a complex chronic disease associated with major health and economic consequences, also involving important issues in the psychosocial sphere. In this regard, T1D-related distress, defined as the emotional burden of living with T1D, has emerged as a specific entity related to the disease. Diabetes distress (DD) is an overlooked but prevalent condition in people living with T1D, and has significant implications in both glycemic control and mental health in this population. Although overlapping symptoms may be found between DD and mental health disorders, specific approaches should be performed for the diagnosis of this problem. In recent years, different DD-targeted interventions have been postulated, including behavioral and psychosocial strategies. Moreover, new technologies in this field may be helpful to address DD in people living with T1D. In this article, we summarize the current knowledge on T1D-related distress, and we also discuss the current approaches and future perspectives in its management.

Risk factors associated with loneliness among mexican-origin adults in southern Arizona

This study examines factors associated with symptoms of loneliness among a sample (n = 213) of mostly Mexican-origin adults at risk of chronic diseases in Southern Arizona's Pima, Yuma, and Santa Cruz counties. It uses baseline data from a community-based participatory research partnership and multinominal logistic regression models. Controlling for chronic diseases and sociodemographic characteristics, perceived social support and hope exhibit negative main effects on loneliness when comparing individuals who experienced loneliness for 5-7 days in the preceding week with those who did not encounter such feelings during the same period (adjusted odds ratio, AOR = 0.49 and 0.47; 95% confidence interval, CI = 0.34-0.73 and 0.29-0.75, respectively). However, when considered together, perceived social support and hope display a positive and statistically significant combined effect on loneliness (AOR = 1.03; 95% CI = 1.01-1.06). Holding all covariates constant, individuals reporting loneliness for 5-7 days exhibit a relative risk ratio of 1.24 (95% CI = 1.06-1.46) for a one-unit increase in physical problem severity compared to those who do not experience loneliness. Moreover, being 65 years old or older (AOR = 0.16, 95% CI = 0.03-0.84), and having been born in Mexico and lived in the US for less than 30 years (AOR = 0.12, 95% CI = 0.02-0.74) are associated with negative main effects on loneliness when comparing individuals who experienced loneliness 1-2, and 5-7 days in the preceding week with those who did not feel loneliness during the same timeframe, respectively. Recognizing the crucial role of loneliness in shaping health outcomes for Mexican-origin adults, our findings underscore the significance of fostering supportive environments that not only enhance well-being but also cultivate robust community bonds within the US-Mexico border region.

Targeting self-care adherence for glycaemic control in multimorbid type 2 diabetes mellitus with depression using bupropion: a protocol for cross-over randomised controlled trial

INTRODUCTION

Diabetes and depression are among the 10 biggest health burdens globally. They often coexist and exhibit a strong bidirectional relationship. Depression leads to decreased adherence to self-care activities. This impacts glycaemic control and worsens type 2 diabetes mellitus (T2D). Both conditions have a synergistic effect and lead to greater complications, hospitalisations, healthcare expenditure and a worse quality of life. There is no consensus on managing people with comorbid T2D and depression. Bupropion is an efficacious antidepressant with many properties suitable for T2D with depression, including a favourable metabolic profile, persistent weight loss and improvement in sexual dysfunction. We will assess the efficacy and safety of add-on bupropion compared with standard care in people with T2D and mild depression. This study can give valuable insights into managing the multimorbidity of T2D and depression. This can help mitigate the health, social and economic burden of both these diseases.

RESEARCH DESIGN AND METHODS

This cross-over randomised controlled trial will recruit people with T2D (for 5 years or more) with mild depression. They will be randomised to add-on bupropion and standard care. After 3 months of treatment, there will be a washout period of 1 month (without add-on bupropion while standard treatment will continue). Following this, the two arms will be swapped. Participants will be assessed for glycosylated haemoglobin, adherence to diabetes self-care activities, lipid profile, urine albumin-to-creatinine ratio, autonomic function, sexual function, quality of life and adverse events.

ETHICS AND DISSEMINATION

The Institutional Ethics Committee at All India Institute of Medical Sciences, Jodhpur has approved this study (AIIMS/IEC/2022/4172, 19 September 2022). We plan to disseminate the research findings via closed group discussions at the site of study, scientific conferences, peer-reviewed published manuscripts and social media.

TRIAL REGISTRATION NUMBER

CTRI/2022/10/046411.

Small Island Developing States: addressing the intersecting challenges of non-communicable diseases, food insecurity, and climate change

Small Island Developing States (SIDS) include 37 UN member countries sharing economic, environmental, and social vulnerabilities and intractable health challenges. In over 80% of SIDS, more than one in six adults die prematurely from a non-communicable disease (NCD), with poor diet being a major factor. Complex upstream food system determinants include marginalised local food production and reliance on low nutritional quality food imports. These drivers need to be seen against colonial and post-colonial political-economic legacies as well as the environmental and climate crises that challenge local production systems. A range of policy commitments (eg, the 2023 Bridgetown Declaration on NCDs and Mental Health) highlight these complex interdependencies and call for cross-sectoral food system policies to improve food security, food sovereignty, and nutrition, including integrating measures for climate change adaptation and mitigation. Although addressing these intersecting challenges will also depend on global efforts, the unique approach of SIDS can inform other settings.

Global prevalence of erectile dysfunction and its associated risk factors among men with type 1 diabetes: a systematic review and meta-analysis

Various observational studies have examined the prevalence and determinants of erectile dysfunction (ED) in men with type 1 diabetes across different geographical areas. Nevertheless, a comprehensive systematic review and meta-analysis to consolidate the worldwide prevalence and risk factors remains lacking. Hence, the primary study objective was to perform an extensive systematic review and meta-analysis that specifically examined ED prevalence and determinants in men with type 1 diabetes. A thorough exploration was conducted by examining electronic databases, such as PubMed, Embase, and Web of Science. The general ED prevalence and a 95% confidence interval (CI) in men with type 1 diabetes were summarized. The relevant risk factors were analyzed by deriving a comprehensive odds ratio (OR) from merging the ORs using fixed- or random-effects models. The sources of heterogeneity were investigated using subgroup analyses and meta-regression. This systematic review and meta-analysis included 19 articles involving 3788 men with type 1 diabetes. The meta-analysis revealed that men with type 1 diabetes had a combined ED prevalence of 42.5% (95% CI: 34.3%-50.8%). This prevalence showed significant heterogeneity (I2 = 96.2%, P < 0.01). Meta-regression revealed that age (P = 0.016) and type 1 diabetes duration (P = 0.004) were significant causes of heterogeneity. Furthermore, the ED risk in men with type 1 diabetes was significantly influenced by age, type 1 diabetes duration, body mass index, glycated hemoglobin (HbA1c), retinopathy, and smoking habits (all P < 0.05). In summary, this systematic review and meta-analysis revealed a significant prevalence of ED in men with type 1 diabetes, highlighting the importance of clinicians addressing concerns regarding ED in this specific group of individuals.

Acceptance of smart sensing, its determinants, and the efficacy of an acceptance-facilitating intervention in people with diabetes: results from a randomized controlled trial

Background

Mental health problems are prevalent among people with diabetes, yet often under-diagnosed. Smart sensing, utilizing passively collected digital markers through digital devices, is an innovative diagnostic approach that can support mental health screening and intervention. However, the acceptance of this technology remains unclear. Grounded on the Unified Theory of Acceptance and Use of Technology (UTAUT), this study aimed to investigate (1) the acceptance of smart sensing in a diabetes sample, (2) the determinants of acceptance, and (3) the effectiveness of an acceptance facilitating intervention (AFI).

Methods

A total of N = 132 participants with diabetes were randomized to an intervention group (IG) or a control group (CG). The IG received a video-based AFI on smart sensing and the CG received an educational video on mindfulness. Acceptance and its potential determinants were assessed through an online questionnaire as a single post-measurement. The self-reported behavioral intention, interest in using a smart sensing application and installation of a smart sensing application were assessed as outcomes. The data were analyzed using latent structural equation modeling and t-tests.

Results

The acceptance of smart sensing at baseline was average (M = 12.64, SD = 4.24) with 27.8% showing low, 40.3% moderate, and 31.9% high acceptance. Performance expectancy (γ = 0.64, p < 0.001), social influence (γ = 0.23, p = .032) and trust (γ = 0.27, p = .040) were identified as potential determinants of acceptance, explaining 84% of the variance. SEM model fit was acceptable (RMSEA = 0.073, SRMR = 0.059). The intervention did not significantly impact acceptance (γ = 0.25, 95%-CI: -0.16-0.65, p = .233), interest (OR = 0.76, 95% CI: 0.38-1.52, p = .445) or app installation rates (OR = 1.13, 95% CI: 0.47-2.73, p = .777).

Discussion

The high variance in acceptance supports a need for acceptance facilitating procedures. The analyzed model supported performance expectancy, social influence, and trust as potential determinants of smart sensing acceptance; perceived benefit was the most influential factor towards acceptance. The AFI was not significant. Future research should further explore factors contributing to smart sensing acceptance and address implementation barriers.

Economic Evaluation of a Web Application Implemented in Primary Care for the Treatment of Depression in Patients With Type 2 Diabetes Mellitus: Multicenter Randomized Controlled Trial

BACKGROUND

Depressive disorder and type 2 diabetes mellitus (T2DM) are prevalent in primary care (PC). Pharmacological treatment, despite controversy, is commonly chosen due to resource limitations and difficulties in accessing face-to-face interventions. Depression significantly impacts various aspects of a person's life, affecting adherence to medical prescriptions and glycemic control and leading to future complications and increased health care costs. To address these challenges, information and communication technologies (eg, eHealth) have been introduced, showing promise in improving treatment continuity and accessibility. However, while eHealth programs have demonstrated effectiveness in alleviating depressive symptoms, evidence regarding glycemic control remains inconclusive. This randomized controlled trial aimed to test the efficacy of a low-intensity psychological intervention via a web app for mild-moderate depressive symptoms in individuals with T2DM compared with treatment as usual (TAU) in PC.

OBJECTIVE

This study aimed to analyze the cost-effectiveness and cost-utility of a web-based psychological intervention to treat depressive symptomatology in people with T2DM compared with TAU in a PC setting.

METHODS

A multicenter randomized controlled trial was conducted with 49 patients with T2DM, depressive symptoms of moderate severity, and glycosylated hemoglobin (HbA1c) of 7.47% in PC settings. Patients were randomized to TAU (n=27) or a web-based psychological treatment group (n=22). This web-based treatment consisted of cognitive behavioral therapy, improvement of diabetes self-care behaviors, and mindfulness. Cost-effectiveness analysis for the improvement of depressive symptomatology was conducted based on reductions in 3, 5, or 50 points on the Patient Health Questionnaire-9 (PHQ-9). The efficacy of diabetes control was estimated based on a 0.5% reduction in HbA1c levels. Follow-up was performed at 3 and 6 months. The cost-utility analysis was performed based on quality-adjusted life years.

RESULTS

Efficacy analysis showed that the web-based treatment program was more effective in improving depressive symptoms than TAU but showed only a slight improvement in HbA1c. Incremental cost-effectiveness ratios of 186.76 for a 3-point reduction in PHQ-9 and 206.31 for reductions of 5 and 50 percentage points were obtained. In contrast, the incremental cost-effectiveness ratio for improving HbA1c levels amounted to €1510.90 (€1=US $1.18 in 2018) per participant. The incremental cost-utility ratio resulted in €4119.33 per quality-adjusted life year gained.

CONCLUSIONS

The intervention, using web-based modules incorporating cognitive behavioral therapy tools, diabetes self-care promotion, and mindfulness, effectively reduced depressive symptoms and enhanced glycemic control in patients with T2DM. Notably, it demonstrated clinical efficacy and economic efficiency. This supports the idea that eHealth interventions not only benefit patients clinically but also offer cost-effectiveness for health care systems. The study emphasizes the importance of including specific modules to enhance diabetes self-care behaviors in future web-based psychological interventions, emphasizing personalization and adaptation for this population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03426709; https://clinicaltrials.gov/study/NCT03426709.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/S12888-019-2037-3.

Adolescents and type 1 diabetes: A grounded theory on adolescents' experiences of adaptation to type 1 diabetes

PURPOSE

Type 1 diabetes influences adolescents' health status and therapeutic management. Adaptation for adolescents with type 1 diabetes is considered a significant issue for this cohort group and is based on many factors, including availability of resources, and family and community support. Thus, this study aimed to explore Palestinian adolescents' experiences of adaptation to type 1 diabetes in the West Bank.

DESIGN AND METHODS

A qualitative grounded theory approach was adopted. The purposive sample consisted of fourteen adolescents aged from 12 to 18 years and diagnosed with type 1 diabetes. The data were collected using semi-structured and face-to-face individual interviews during the period from March to June 2023. A constant comparative method was used to analyze data.

FINDINGS

The core category had emerged with categories and subcategories. There were three categories and ten subcategories including difficulties in the management of type 1 diabetes, for example, "insulin injections, dietary management, and control of HbA1c levels", burdens of type1 diabetes, for example, "burden regarding follow-up treatment, the burden of interaction and communication, emotional burden, and economic burden", and fears and worries of unexpected future life, for example, "worries about disease complications, worries regarding social relationships, and worries about marriage and parenthood".

CONCLUSION

Adolescents diagnosed with type 1 diabetes suffer from difficult experiences influencing their adaptation to this disease.

PRACTICE IMPLICATIONS

Counseling programs concerning self-care management for those adolescents need to be developed in addition to support programs. Health education programs are needed to develop their adaptation and coping skills to these experiences.

Interactions between physical activity and psychological factors in the association with the risk of lean type 2 diabetes mellitus

Background: The extent to which physical activity and psychological factors may affect the risk of diabetes mellitus among lean individuals remains unclear.Purpose: This study aimed to investigate the associations of total physical activity (TPA) and psychological factors with lean type 2 diabetes mellitus (T2DM) risk.Research Design: A prospective cohort study.Study Sample: The study population included 1,945 Korean adults who maintained a body mass index <23 kg/m2.Data Collection and Analysis: Baseline data on TPA and psychological factors were collected and T2DM incidence was assessed for 10 years. For analysis, a multivariable Cox proportional hazards regression model was used.Results: TPA was inversely associated with T2DM risk and this association was more pronounced in participants who were depressed or distressed; the top TPA quartile exhibited significant reductions in T2DM risk of 66% (95% confidence interval [CI]: 0.15, 0.78) and 65% (95% CI: 0.14, 0.88) among participants who reported depressed mood and those who perceived high distress, respectively, compared with the bottom TPA quartile.Conclusions: The current study demonstrated the preventive effects of physical activity on T2DM in lean adults through its interaction with psychological factors.

Improving mental health in chronic care in general practice: study protocol for a cluster-randomised controlled trial of the Healthy Mind intervention

BACKGROUND

Mental health issues are common among patients with chronic physical conditions, affecting approximately one in five patients. Poor mental health is associated with worse disease outcomes and increased mortality. Problem-solving therapy (PST) may be a suitable treatment for targeting poor mental health in these patients. This study protocol describes a randomised controlled trial of the Healthy Mind intervention, a general practice-based intervention offering PST to patients with type 2 diabetes and/or ischaemic heart disease and poor mental well-being.

METHODS

A stepped-wedge cluster-randomised controlled trial with 1-year follow-up will be conducted in Danish general practice. At the annual chronic care consultation, patients with type 2 diabetes and/or chronic ischaemic heart disease will be screened for poor mental well-being. Patients in the control group will be offered usual care while patients in the intervention group will be offered treatment with PST provided by general practitioners (GPs) or general practice staff, such as nurses, who will undergo a 2-day PST course before transitioning from the control to the intervention group. The primary outcome is change in depressive symptoms after 6 and 12 months. Secondary outcomes include change in mental well-being, anxiety, and diabetes distress (patients with type 2 diabetes) after 6 and 12 months as well as change in total cholesterol levels, low-density lipoprotein (LDL) levels, and blood glucose levels (patients with diabetes) after 12 months. Process outcomes include measures of implementation and mechanisms of impact. We aim to include a total of 188 patients, corresponding to approximately 14 average-sized general practices.

DISCUSSION

The Healthy Mind trial investigates the impact of PST treatment for patients with chronic disease and poor mental well-being in general practice. This will be the first randomised controlled trial determining the effect of PST treatment for patients with chronic diseases in general practice. The results of this study will provide relevant insights to aid GPs, and general practice staff manage patients with poor mental well-being.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05611112. Registered on October 28, 2022.

Insulinemic potential of lifestyle is associated with depression and anxiety in adults: A large community-based study

BACKGROUND

We aimed to investigate the association between an empirical lifestyle index for hyperinsulinemia (ELIH), empirical lifestyle index for insulin resistance (ELIR), and depression and anxiety in an adult Iranian population.

METHODS

In this cross-sectional study, a total of 6450 participants, aged 35-65 years were recruited as part of the MASHAD cohort study. Dietary intakes were assessed using a validated food frequency questionnaire (FFQ). Depression and anxiety were screened using Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). ELIH and ELIR were calculated using dietary intake, body mass index, and physical activity information. Multivariable ordinal logistic regression models were applied to determine the association between ELIH, ELIR, and depression and anxiety severity.

RESULTS

In a fully adjusted model, participants with the highest ELIH quartile had a higher odds of more severe depression and anxiety compared to those in the lowest category (OR = 1.44; 95 % CI = 1.22-1.71 and OR = 1.62; 95 % CI = 1.37-1.25, respectively). Participants with the highest ELIR had higher odds of more severe depression and anxiety compared to those in the lowest category (OR = 1.22; 95 % CI = 1.04-1.43 and OR = 1.21; 95 % CI = 1.03-1.42, respectively).

LIMITATIONS

The assessment of dietary intake and mental health by questionnaires may increases the rate of misclassification. Due to the study's cross-sectional nature, causal relationships cannot be established.

CONCLUSION

There was a significant positive association between the hyperinsulinemia and insulin resistance potential of lifestyle and severity of depression and anxiety among Iranian adults.

Emotional Distress Predicts Reduced Type 2 Diabetes Treatment Adherence in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)

OBJECTIVE

We examined longitudinal associations between emotional distress (specifically, depressive symptoms and diabetes distress) and medication adherence in Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), a large randomized controlled trial comparing four glucose-lowering medications added to metformin in adults with relatively recent-onset type 2 diabetes mellitus (T2DM).

RESEARCH DESIGN AND METHODS

The Emotional Distress Substudy assessed medication adherence, depressive symptoms, and diabetes distress in 1,739 GRADE participants via self-completed questionnaires administered biannually up to 3 years. We examined baseline depressive symptoms and diabetes distress as predictors of medication adherence over 36 months. Bidirectional visit-to-visit relationships were also examined. Treatment satisfaction, beliefs about medication, diabetes care self-efficacy, and perceived control over diabetes were evaluated as mediators of longitudinal associations.

RESULTS

At baseline, mean ± SD age of participants (56% of whom were White, 17% Hispanic/Latino, 18% Black, and 66% male) was 58.0 ± 10.2 years, diabetes duration 4.2 ± 2.8 years, HbA1c 7.5% ± 0.5%, and medication adherence 89.9% ± 11.1%. Higher baseline depressive symptoms and diabetes distress were independently associated with lower adherence over 36 months (P < 0.001). Higher depressive symptoms and diabetes distress at one visit predicted lower adherence at the subsequent 6-month visit (P < 0.0001) but not vice versa. Treatment assignment did not moderate relationships. Patient-reported concerns about diabetes medications mediated the largest percentage (11.9%-15.5%) of the longitudinal link between emotional distress and adherence.

CONCLUSIONS

Depressive symptoms and diabetes distress both predict lower adherence to glucose-lowering medications over time among adults with T2DM. Addressing emotional distress and concerns about anticipated negative effects of taking these treatments may be important to support diabetes treatment adherence.

The psychosocial burdens of living with diabetes

AIM

To better understand the prevalence of self-reported psychosocial burdens and the unmet needs identified by people with diabetes in relation to routine diabetes visits.

METHODS

An English language, online survey was distributed via social media, key stakeholder networks, charity and advocacy groups to adults with type 1 diabetes or type 2 diabetes. Survey items were designed by members of the FDA RESCUE Collaborative Community Governing Committee prior to pilot testing with potential participants. Descriptive statistical analyses were conducted, as well as thematic analyses on free-text responses using NVivo v14.

RESULTS

Four hundred and seventy-eight participants completed the survey: 373 (78%) had type 1 diabetes, 346 (73%) identified as a woman and 433 (91%) were white. Most participants had experienced self-reported (rather than diagnosed) anxiety and depression (n = 323 and n = 313, respectively), as well as fear of low blood sugars (n = 294), low mood (n = 290) and diabetes-related distress (n = 257). Sixty-eight percent reported that diabetes had negatively affected self-esteem, 62% reported the feelings of loneliness, but 93% reported that friends/family/work colleagues were supportive when needed. Two hundred and seventy-two percent (57%) reported that their diabetes team had never raised the topic of mental health. The overwhelming majority stated that the best thing their diabetes team could do to help was to simply ask about mental well-being, listen with empathy and without judgement, and practice skills to understand psychosocial issues in diabetes.

CONCLUSION

Integrating psychosocial discussions and support within routine healthcare visits is crucial to improve outcomes for people with diabetes. Such a biopsychosocial model of healthcare has long been advocated by regulatory bodies.

Real-world data of a digitally enabled, time-restricted eating weight management program in public sector workers living with overweight and obesity in the United Kingdom: A service evaluation of the Roczen program

Introduction

The health of the United Kingdom workforce is key; approximately 186 million days are lost to sickness each year. Obesity and type 2 diabetes (T2D) remain major global health challenges. The aim of this retrospective service evaluation was to assess the impact of a digitally enabled, time-restricted eating (TRE) intervention (Roczen Program, Reset Health Ltd) on weight and other health-related outcomes.

Methods

This service evaluation was conducted in people living with overweight/obesity, with 89% referred from public sector employers. Participants were placed on a TRE, low-carbohydrate, moderate protein plan delivered by clinicians and mentors with regular follow up, dietary guidance, goal setting, feedback, and social support.

Results

A total of 660 members enrolled and retention was 41% at 12 months. The majority were female (73.2%), 58.9% were of White ethnicity, with a mean (SD) age of 47.5 years (10.1), and a body mass index of 35.0 kg/m2 (5.7). Data were available for 82 members at 12-month. At 12-month, members mean actual and percentage weight loss was -9.0 kg (7.0; p < 0.001) and -9.2% (6.7, p < 0.001) respectively and waist circumference reduced by -10.3 cm (10.7 p < 0.001), with 45.1% of members achieving ≥10% weight loss. Glycated hemoglobin was significantly improved at 6 months in people living with T2D (-11 mmol/mol [5.7] p = 0.012). Binge eating score significantly reduced (-4.4 [7.0] p = 0.006), despite cognitive restraint increasing (0.37 [0.6] p = 0.006).

Conclusion

Our service evaluation showed that the Roczen program led to clinically meaningful improvements in body weight, health-related outcomes and eating behaviors that were sustained at 12-month.

Diabetes and gender incongruence: frequent mental health issues but comparable metabolic control - a DPV registry study

Context

The condition when a person's gender identity does not match the sex assigned at birth is called gender incongruence (GI). Numbers of GI people seeking medical care increased tremendously over the last decade. Diabetes mellitus is a severe and lifelong disease. GI combined with diabetes may potentiate into a burdensome package for affected people.

Objective

The study aimed to characterize people with GI and diabetes from an extensive standardized registry, the Prospective Diabetes Follow-up Registry (DPV), and to identify potential metabolic and psychological burdens.

Methods

We compared demographic and clinical registry data of persons with type 1 or type 2 diabetes and GI to those without GI and used propensity score matching (1:4) with age, diabetes duration and treatment year as covariates.

Results

75 persons with GI, 49 with type 1 and 26 with type 2 diabetes were identified. HbA1c values were similar in matched persons with type 1 or 2 diabetes and GI compared to those without GI. Lipid profiles showed no difference, neither in type 1 nor in type 2 diabetes. Diastolic blood pressure was higher in the type 1 and GI group than in those without, whereas systolic blood pressure showed comparable results in all groups. Depression and anxiety were significantly higher in GI people (type 1 and 2). Non-suicidal self-injurious behaviour was more common in type 1 and GI, as was suicidality in type 2 with GI.

Conclusion

Mental health issues are frequent in people with diabetes and GI and need to be specially addressed in this population.