Association between diabetes and depression: Sex and age differences

Depression and Diabetes in Workers Across the Life Span: Addressing the Health of America's Workforce-Behavioral Risk Factor Surveillance System, 2014-2018

OBJECTIVE

Diabetes affects nearly 12.2% of U.S. adults. Comorbid depressive symptoms among U.S. workers with diabetes are associated with increased unemployment and reduced work performance. This study examined the age-group-specific prevalence of depression among U.S. workers with self-reported diabetes and identified factors associated with depression.

METHODS

Data from the 2014-2018 Behavioral Risk Factor Surveillance System were used to examine the prevalence of depression among adult workers with diabetes in the United States. Relationships between depression prevalence and diabetes and demographic, physical, and behavioral risk factors were examined through bivariate and multivariable analyses. Age was categorized into four groups: 18-34, 35-54, 55-64, and ≥65 years.

RESULTS

The overall prevalence of self-reported depression among U.S. workers with diabetes was 17.4-30% higher than among those without diabetes. Workers with diabetes aged 18-34 years had the highest depression prevalence (28.7%) compared with other age-groups. Female workers with diabetes were significantly more likely than male workers to report depression in all age-groups. Young adult workers with diabetes who had another chronic disease were nearly three times more likely to report depression than those without another chronic condition. There were no overlapping patterns of prevalence of diabetes and depression by state.

CONCLUSION

Workers with diabetes are at an increased risk of depression, which can affect their overall health and productivity. These findings indicate that, among those with diabetes, young adult workers and women are most likely to have depression. Employee wellness programs may address the specific needs of individuals with diabetes and depression.

Mental Health among Spanish Adults with Diabetes: Findings from a Population-Based Case-Controlled Study

Background: The purpose of this study was to assess and compare the prevalence of self-reported mental disorders, psychological distress, and psychotropic drug consumption among people with diabetes mellitus (DM) and matched non-DM controls. Methods: A case–controlled study using data from the Spanish National Health Interview Survey was conducted in 2017. We identified 2116 DM adults (aged ≥35 years). Non-DM controls were matched 1:1 by age, sex, and province of residence. Results: Prevalence of mental disorders (25.0% vs. 19.2%; p < 0.001), psychological distress (29% vs. 19.5%; p < 0.001), and consumption of psychiatric medications (29.7% vs. 23.5%; p < 0.001) among DM cases were higher than those among matched non-DM controls. The DM patient variables associated with experiencing a mental disorder, psychological distress, and consumption of psychiatric medications were: being a woman, worse self-rated health, and a visit to a psychologist within the last year. Older age (≥80 years) was associated with a lower probability of reporting mental disorders and psychological distress among DM cases. Not practicing physical exercise was significantly associated with experiencing psychological distress. Conclusions: Adults with DM included in our investigation have a significantly higher prevalence of mental disorders, psychological distress, and consumption of psychiatric medications than non-DM controls. It is necessary to implement screening strategies and psychological interventions to improve the mental health of DM patients in Spain, focusing especially on women and those aged 35 to 59 years.

Risk of Depression among Early Onset Type 2 Diabetes Mellitus Patients

<b><i>Methodology:</i></b> Biochemically confirmed type 2 diabetes mellitus (T2DM) patients (<i>n</i> = 1,114) were recruited from the outpatient department of 2 tertiary care hospitals in Dhaka, Bangladesh. Face-to-face interview was conducted using a semi-structured questionnaire containing sociodemographic parameters and relevant information about depression and diabetes. Biochemical test results and treatment-related information were taken from patients’ records. The Hospital Anxiety and Depression Scale (HADS) was used to screen all patients for psychiatric manifestation. Those diagnosed by HADS were subsequently reassessed using structured clinical interview for DSM-5 Disorders – Clinician Version. T2DM diagnosed at age &#x3c;40 years were considered as early onset T2DM. Association between age of onset category and depression was assessed using multivariable mixed-effect logistic regression adjusting for random variation of the area of residence and plausible confounders. <b><i>Results:</i></b> Around a third of the participants (32.5%) were diagnosed with T2DM before the age of 40 years. Early onset T2DM patients were found to have 57% increase in the risk of developing depression (OR 1.57; 95% CI 1.13–2.28; <i>p</i> = 0.011) in comparison to those with usual onset T2DM (≥40 years). Among other factors a positive family history for diabetes (OR 1.33; 95% CI 1.03–1.78; <i>p</i> = 0.038), poor glycemic control (OR 1.31; 95% CI 1.03–1.68; <i>p</i> = 0.028), presence of 1, or more diabetic complications (OR 1.37; 95% CI 1.03–1.78; <i>p</i> = 0.011) also showed increased risk of depression. <b><i>Conclusion:</i></b> Early onset T2DM patients are at greater risk of developing depression. The finding is likely to help in setting preventive strategies aiming to reduce the presence of concomitant depression symptoms among diabetes.

Burden of Uncontrolled Hyperglycemia and Its Association with Patients Characteristics and Socioeconomic Status in Philadelphia, USA

Purpose: To examine the burden of uncontrolled hyperglycemia in patients with diabetes mellitus (DM) and their characteristics in a large urban city.

Methods: A randomized sample of 4993 patients with DM ≥18 years old who received routine health care in a large university teaching hospital in the city of Philadelphia was analyzed. Uncontrolled hyperglycemia was classified as blood hemoglobin A1c >8%. The associations of uncontrolled hyperglycemia with sociodemographic and cardiovascular factors were analyzed using univariate and multivariate analysis methods.

Results: The results show that patients 18–54 years had the highest prevalence of uncontrolled hyperglycemia (36.0%), followed by those at age 55–64 (30.9%), 65–74 (22.9%), and ≥75 (20.6%) years (p<0.0001). Unadjusted hyperglycemia was significantly associated with patients with increased total cholesterol to high-density lipoprotein ratio (odds ratio [OR]=1.59, 95% confidence interval [CI]: 1.33–1.90, p<0.001), and with prevalent coronary heart disease (OR=1.39, 95% CI: 1.16–1.67, p=0.001). Patients living in neighborhoods with lower socioeconomic status (SES) had significantly higher uncontrolled hyperglycemia rates across the city (r=0.52, R²=0.27, p=0.03).

Conclusions: Findings of this study is one of the first studies to address that younger adults had higher rates of uncontrolled hyperglycemia. Further attention should be paid to the challenges of controlling DM in younger adults and patients who live in neighborhoods with lower SES.

Depressive Symptoms are Associated with High Levels of Serum Low-Density Lipoprotein Cholesterol in Older Adults with Type 2 Diabetes Mellitus

Fundamento

O Diabetes Mellitus Tipo 2 (DMT2) é comum nos idosos, que também apresentam um nível elevado de fatores de risco para doenças cardiovasculares (DCVs), tais como dislipidemia. Entretanto, o papel da depressão nos pacientes com DMT2 e sua relação com fatores de risco para DCV são pouco estudados.

Objetivo

O objetivo do presente estudo foi investigar a relação entre sintomas depressivos (SDs) e fatores de risco cardiovascular conhecidos em idosos comunitários portadores de DMT2.

Métodos

Trata-se de um estudo transversal, no qual foram incluídos 85 idosos comunitários com DMT2. Os SDs foram avaliados através da Escala de Depressão Geriátrica de Yesavage, em versão reduzida (GDS-15). Os seguintes fatores de risco cardiovascular foram avaliados: pressão arterial sistólica (PAS) e diastólica (PAD), glicose plasmática em jejum (GPJ), perfil lipídico (triglicerídeos séricos (TG), colesterol total sérico (CT), colesterol sérico de lipoproteína de baixa densidade (LDL-C) e colesterol sérico de lipoproteína de baixa densidade (HDL-C)) e índice de massa corporal (IMC). A análise de regressão múltipla de Poisson foi utilizada para avaliar a associação entre os SDs e cada fator de risco cardiovascular ajustado por sexo, idade, tempo em atividades físicas moderadas e status funcional. O nível de significância adotado para a análise foi de 5%.

Resultados

Dentre todos os fatores de risco analisados, apenas o aumento de LDL-C apresentou uma correlação com níveis elevados de SD (RP=1,005; IC95% 1,002-1,008). Foi observada uma associação significativa entre os níveis de HDL-C (RP=0,99; IC95% 0,98-0,99) e a PAS (RP=1,009; IC95% 1,004-1,014).

Conclusão

Nos idosos com DMT2, a presença de SD foi associada a níveis de LDL-C, HDL-C e PAS, mesmo após o ajuste por sexo, idade, nível de atividade física e capacidade funcional. (Arq Bras Cardiol. 2020; 115(3):462-467)

Initial Glycemic Control and Care Among Younger Adults Diagnosed With Type 2 Diabetes

OBJECTIVE

The prevalence of type 2 diabetes is increasing among adults under age 45. Onset of type 2 diabetes at a younger age increases an individual's risk for diabetes-related complications. Given the lasting benefits conferred by early glycemic control, we compared glycemic control and initial care between adults with younger onset (21-44 years) and mid-age onset (45-64 years) of type 2 diabetes.

RESEARCH DESIGN AND METHODS

Using data from a large, integrated health care system, we identified 32,137 adults (aged 21-64 years) with incident diabetes (first HbA_1c ≥6.5% [≥48 mmol/mol]). We excluded anyone with evidence of prior type 2 diabetes, gestational diabetes mellitus, or type 1 diabetes. We used generalized linear mixed models, adjusting for demographic and clinical variables, to examine differences in glycemic control and care at 1 year.

RESULTS

Of identified individuals, 26.4% had younger-onset and 73.6% had mid-age-onset type 2 diabetes. Adults with younger onset had higher initial mean HbA_1c values (8.9% [74 mmol/mol]) than adults with onset in mid-age (8.4% [68 mmol/mol]) (P < 0.0001) and lower odds of achieving an HbA_1c <7% (<53 mmol/mol) 1 year after the diagnosis (adjusted odds ratio [aOR] 0.70 [95% CI 0.66-0.74]), even after accounting for HbA_1c at diagnosis. Adults with younger onset had lower odds of in-person primary care contact (aOR 0.82 [95% CI 0.76-0.89]) than those with onset during mid-age, but they did not differ in telephone contact (1.05 [0.99-1.10]). Adults with younger onset had higher odds of starting metformin (aOR 1.20 [95% CI 1.12-1.29]) but lower odds of adhering to that medication (0.74 [0.69-0.80]).

CONCLUSIONS

Adults with onset of type 2 diabetes at a younger age were less likely to achieve glycemic control at 1 year following diagnosis, suggesting the need for tailored care approaches to improve outcomes for this high-risk patient population.

Depression among Peruvian adults with hypertension and diabetes: Analysis of a national survey

BACKGROUND AND AIMS

Hypertension and diabetes are global health problems with an incidence that is rapidly increasing worldwide. Depression is the most frequent mental health co-morbidity and is considered an important risk factor for the development of both diseases. This study aimed to determine the prevalence and factors associated with depression among Peruvian adults with hypertension and diabetes.

METHODS

We performed a secondary analysis of the 2017 Peru Demographic and Family Health Survey, using data from 10,566 adults aged 40 and older. The main outcome was depression assessed with the Patient Health Questionnaire-9 (PHQ-9). Other important variables were the diagnosis of hypertension or diabetes, sex, age, level of education, geographical region, wealth index, daily smoking, harmful alcohol consumption and physical disability.

RESULTS

The overall prevalence of depression was 23.15% (CI 95%: 21.42%-24.88%) and among adults with hypertension and diabetes it was 34.96% (CI 95%: 29.33%-40.59%) and 35.56% (CI 95%: 24.49%-46.63%), respectively. Whereas the prevalence of depression among adults with type 2 diabetes mellitus (T2DM) was higher in the physical disability group (PRa: 1.28; CI 95%: 1.12-1.45), the prevalence of depression among adults with hypertension was higher in the female group (PRa: 1.36; CI 95%: 1.20-1.54) and among those with harmful alcohol consumption (PRa: 1.50; CI 95%: 1.01-2.24).

CONCLUSION

Peru has a considerable burden of depression in the hypertensive and diabetic populations. While the variables positively associated with depression in hypertensive adults were female gender and harmful alcohol consumption, in adults with diabetes it was the presence of physical disability.

Frequency of Depression in Patients with Type 2 Diabetes Mellitus and its Relationship with Glycemic Control and Diabetic Microvascular Complications

Introduction

Various clinical studies have reported that clinical depression is a common co-morbidity in patients with type 2 diabetes mellitus. Depression can badly affect the lifestyle of diabetic patients and impair the proper management of diabetes mellitus. Therefore, there exists a need to identify risk factors of depression in diabetic patients especially in relation to various clinical parameters, glycemic control and diabetic microvascular complications.

Materials and methods

It was a cross-sectional study conducted in a tertiary care hospital in Pakistan from August 2018 to April 2019. We recruited type 2 diabetic patients and measured their various clinical and hematological parameters. We evaluated depression using Patient Health Questionnaire (PHQ-9) and evaluated its relationship with glycemic control, duration of diabetes, fasting lipid profile and presence of various diabetic microvascular complications.

Results

There were 100 subjects in the study having a mean age 58.3 ± 12.4 (range: 36 - 71) years with a male to female ratio of 1:1.2. The mean duration of type 2 diabetes mellitus was 11.2 ± 9.2 years. The mean PHQ-9 score of the study population was 10.2 ± 8.1. The frequency of depression was found to be 40.0%. Depression was most frequently found in women and in patients between 40 to 60 years of age (60.0%). Depression was more common in patients with dyslipidemia (p-value = 0.0015). Patients with diabetic retinopathy, diabetic nephropathy and diabetic neuropathy were 3.8 times, 4.2 times and 2.1 times more likely to have clinical depression than the patients without these complications. Patients with glycated hemoglobin (HbA1c) worse than 7.5% had a significantly higher rate of depression than those whose HbA1c ranged from 6.5 - 7.5 % (p-value = 0.0028). Duration of diabetes mellitus did not significantly affect the frequency of depression in diabetic patients.

Conclusion

Depression is common in a large number of diabetic patients. Female gender, dyslipidemia, diabetic microvascular complications and impaired glycemic control are significantly associated with depression in diabetic patients.

Depression in type 1 diabetes and risk of dementia

OBJECTIVE

Depression afflicts 14% of individuals with type 1 diabetes (T1D). Depression is a robust risk factor for dementia but it is unknown if this holds true for individuals with T1D, who recently started living to an age conferring dementia risk. We examined if depression is a dementia risk factor among elderly individuals with T1D.

METHODS

3,742 individuals with T1D age ≥50 were followed for dementia from 1/1/96-9/30/2015. Depression, dementia, and comorbidities were abstracted from electronic medical records. Cox proportional hazard models estimated the association between depression and dementia adjusting for demographics, glycosylated hemoglobin, severe dysglycemic epidsodes, stroke, heart disease, nephropathy, and end stage renal disease. The cumulative incidence of dementia by depression was estimated conditional on survival dementia-free to age 55.

RESULTS

Five percent (N = 182) were diagnosed with dementia and 20% had baseline depression. Depression was associated with a 72% increase in dementia (fully adjusted HR = 1.72; 95% CI:1.12-2.65). The 25-year cumulative incidence of dementia was more than double for those with versus without depression (27% vs. 12%).

CONCLUSIONS

For people with T1D, depression significantly increases dementia risk. Given the pervasiveness of depression in T1D, this has major implications for successful aging in this population recently living to old age.

Younger Adults Initiating Hemodialysis: Antidepressant Use for Depression Associated With Higher Health Care Utilization

OBJECTIVE

To examine associations between antidepressant use and health care utilization in young adults beginning maintenance hemodialysis (HD) therapy.

PATIENTS AND METHODS

Antidepressant use, hospitalizations, and emergency department (ED) visits were examined in young adults (N=130; age, 18-44 years) initiating HD (from January 1, 2001, through December 31, 2013) at a midwestern US institution. Primary outcomes included hospitalizations and ED visits during the first year.

RESULTS

Depression diagnosis was common (47; 36.2%) at HD initiation, yet only 28 patients (21.5%) in the cohort were receiving antidepressant therapy. The antidepressant use group was more likely to have diabetes mellitus (18 [64.3%] vs 33 [32.4%]), coronary artery disease (8 [28.6%] vs 12 [11.8%]), and heart failure (9 [32.1%] vs 15 [14.7%]) (P<.05 for all) than the untreated group. Overall, 68 (52.3%) had 1 or more hospitalizations and 33 (25.4%) had 1 or more ED visits in the first year. The risk of hospitalization during the first year was higher in the antidepressant use group (hazard ratio, 2.35; 95% CI, 1.39-3.96; P=.001), which persisted after adjustment for diabetes, coronary artery disease, and heart failure (hazard ratio, 1.94; 95% CI, 1.22-3.10; P=.006). Emergency department visit rates were similar between the groups.

CONCLUSION

Depression and antidepressant use for mood indication are common in young adult incident patients initiating HD and and are associated with higher hospitalization rates during the first year. Further research should determine whether antidepressants are a marker for other comorbidities or whether treated depression affects the increased health care use in these individuals.

Influence of Health Status on the Association Between Diabetes and Depression Among Adults in Europe: Findings From the SHARE International Survey

OBJECTIVE

The association between diabetes and depression, a common health comorbidity in people with diabetes, has been recognized but not well understood. The purpose of this study was to explore the association between diabetes and depression in a large international sample of adults, adjusting for demographics, socioeconomic status, behavioral risks, and current health status.

METHODS

The association between diabetes and depression was assessed in a sample of 57,004 Europeans ≥50 years of age from 15 European countries using data from the fifth wave of SHARE (the Survey of Health, Ageing, and Retirement in Europe). Multiple logistic regression models of the association between diabetes and depression were conducted, adjusting for potential confounders.

RESULTS

Analyses showed that, despite diabetes being associated with depression in crude and partially adjusted models, further adjustment for self-perceived health made the association between diabetes and depression no longer statistically significant (odds ratio 1.0, 95% CI 0.9-1.0).

CONCLUSION

Adjustment for a variety of demographic, socioeconomic, behavioral risk, and health status variables reduced the estimated association between diabetes and depression until it was no longer significant. Further research should explore the specific symptoms of distress characterized in people with diabetes.

Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms

In 2 meta-analyses on gender differences in depression in nationally representative samples, we advance previous work by including studies of depression diagnoses and symptoms to (a) estimate the magnitude of the gender difference in depression across a wide array of nations and ages; (b) use a developmental perspective to elucidate patterns of gender differences across the life span; and (c) incorporate additional theory-driven moderators (e.g., gender equity). For major depression diagnoses and depression symptoms, respectively, we meta-analyzed data from 65 and 95 articles and their corresponding national data sets, representing data from 1,716,195 and 1,922,064 people in over 90 different nations. Overall, odds ratio (OR) = 1.95, 95% confidence interval (CI) [1.88, 2.03], and d = 0.27 [0.26, 0.29]. Age was the strongest predictor of effect size. The gender difference for diagnoses emerged earlier than previously thought, with OR = 2.37 at age 12. For both meta-analyses, the gender difference peaked in adolescence (OR = 3.02 for ages 13-15, and d = 0.47 for age 16) but then declined and remained stable in adulthood. Cross-national analyses indicated that larger gender differences were found in nations with greater gender equity, for major depression, but not depression symptoms. The gender difference in depression represents a health disparity, especially in adolescence, yet the magnitude of the difference indicates that depression in men should not be overlooked. (PsycINFO Database Record

Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms

In 2 meta-analyses on gender differences in depression in nationally representative samples, we advance previous work by including studies of depression diagnoses and symptoms to (a) estimate the magnitude of the gender difference in depression across a wide array of nations and ages; (b) use a developmental perspective to elucidate patterns of gender differences across the life span; and (c) incorporate additional theory-driven moderators (e.g., gender equity). For major depression diagnoses and depression symptoms, respectively, we meta-analyzed data from 65 and 95 articles and their corresponding national data sets, representing data from 1,716,195 and 1,922,064 people in over 90 different nations. Overall, odds ratio (OR) = 1.95, 95% confidence interval (CI) [1.88, 2.03], and d = 0.27 [0.26, 0.29]. Age was the strongest predictor of effect size. The gender difference for diagnoses emerged earlier than previously thought, with OR = 2.37 at age 12. For both meta-analyses, the gender difference peaked in adolescence (OR = 3.02 for ages 13-15, and d = 0.47 for age 16) but then declined and remained stable in adulthood. Cross-national analyses indicated that larger gender differences were found in nations with greater gender equity, for major depression, but not depression symptoms. The gender difference in depression represents a health disparity, especially in adolescence, yet the magnitude of the difference indicates that depression in men should not be overlooked. (PsycINFO Database Record

Depression and anxiety among hypertensive and diabetic primary health care patients. Could patients' perception of their diseases control be used as a screening tool?

OBJECTIVES

To measure the frequency and identify risk factors of depression and anxiety among diabetic and hypertensive primary health care (PHC) patients. Also to assess whether patients' perception of their chronic diseases control and sleep disturbance could serve as screening tools for depression and anxiety. Methods: This cross-sectional study of 368 PHC patients was conducted in AlKhobar city, Kingdom of Saudi Arabia between April and May 2015. Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 were used as diagnostic tools for depression and anxiety. Results: Frequencies, cross-tabulations and logistic regression tests were performed. Patient's perception of chronic diseases control was significantly associated with the presence of depression and anxiety, while it was not seen in the tested disease control (glycated hemoglobin less than 7% and blood pressure less than 140/90 mm Hg). Sleep disturbance has a high specificity (98.9%) in screening for depression. Overall prevalence of depression or anxiety was 57.3% and detected cases was 23%. Depression comprise 48.7% (39.8% mild, 7.1% moderate, 1.8% severe). Anxiety comprise 38.4% (25.1% mild, 8.8% moderate, 4.4% severe). Co-existence of both disorders was 29.5%. Sleep disturbance, weight change, and low income had an independent significant effect on depression and anxiety. Conclusion: Having no sleep disturbance can rule out 98.9% of depression and anxiety cases.  Patient's feelings should be considered in chronic diseases health care plans. Depression or anxiety among diabetic and hypertensive patients have a high morbidity, but with low detection rate.

Association between depression and diabetes amongst adults in Bangladesh: a hospital based case-control study

Methods

A matched case–control study was conducted among 591 consecutive patients with diabetes attending a tertiary hospital in Dhaka and 591 controls matched for age, sex and area of residence without diabetes not related with the index–case. Depression was measured using the Patient Health Questionnaire–9. Multivariate logistic regression was performed to examine the association between depression and diabetes.

Results

The mean age (±standard deviation) of the participants was 50.4 ± 11.4 years, with a male to female ratio of 43:57. The prevalence of depression was 45.2% and 19.8% among cases and controls, respectively. In the multivariate analysis, mild as well as moderate to severe depression were significantly associated with diabetes and independent of sociodemographic factors and co–morbidity (adjusted odds ratio (OR) = 2.0, 95% confidence interval (CI) = 1.4–2.9 and adjusted OR = 6.4, 95% CI = 3.4–12.3; P < 0.001 for both).

Conclusion

The high prevalence and strong association of depression in individuals with diabetes in Bangladesh suggests that depression should be routinely screened for patients with diabetes at the clinics and that management strategies adequate for resource–poor settings need to be developed. Further research to determine the pathophysiological role of depression in the development of diabetes is merited.

The association between depression, quality of life, and the health care expenditure of patients with diabetes mellitus in Uganda

BACKGROUND

Depression is one of the commonest neuropsychiatric disorders in patients with diabetes mellitus (DM) and is associated with poor glycaemic control, vascular complications, a low quality of life and increased health care expenditure. Co-morbid DM and depression remains poorly identified and inadequately treated in sub-Saharan Africa.

METHODS

We conducted a cross-sectional survey of 437 patients with DM at 3 DM clinics in Uganda. Participants were assessed for depression, blood sugar levels, diabetic neuropathy, quality of life, and health care expenditures.

RESULTS

The prevalence of depression was 34.8%. Depressed participants were more likely to be suicidal [OR=3.81, (CI 2.87-5.04)], younger [OR=3.98 CI (1.20-13.23)], un-employed [OR=1.99(CI 1.04-3.81)], and having lost a spouse [OR=2.36 (CI 1.29-4.31)]. Overall quality of life was poor [OR=0.67 (CI 0.47-0.96)], they scored poorer in the physical [OR=0.97, (CI 0.95-0.99)], psychological [OR=1.05 (CI 1.03-1.07)], and environmental [OR=0.97, (CI 0.95-0.99)] domains. They had an increased likelihood of incurring direct out-of-pocket payments for health care services [OR=1.56 (CI 1.03-2.36)], and were more likely to be impoverished [OR=1.52 (CI 1.01-2.28)].

LIMITATION

The cross sectional nature of this study makes it difficult to examine causation. More studies are required in order to better understand the associations and impact of the factors examined above on patient outcomes.

CONCLUSIONS

Depression is highly prevalent among patients with DM in Uganda, and is associated with a number of adverse outcomes. A holistic approach that focuses on the depression management among patients with diabetes is recommended.

Trends in the prevalence of depression in hospitalized patients with type 2 diabetes in Spain: analysis of hospital discharge data from 2001 to 2011

BACKGROUND

This study aims to describe trends in the prevalence of depression among hospitalized patients with type 2 diabetes in Spain, 2001-2011.

METHODS

We selected patients with a discharge diagnosis of type 2 diabetes using national hospital discharge data. Discharges were grouped by depression status. Prevalence of depression globally and according to primary diagnoses based on the Charlson comorbidity index (CCI) were analyzed. We calculated length of stay (LOHS) and in-hospital mortality (IHM). Multivariate analysis was adjusted by age, year and comorbidity.

RESULTS

From 2001 to 2011, 4,723,338 discharges with type 2 diabetes were identified (4.93% with depression). Prevalence of depression in diabetic patients increased from 3.54% in 2001 to 5.80% in 2011 (p<0.05). The prevalence of depression was significantly higher in women than in men in each year studied and increased from 5.22% in 2001 to 9.24% in 2011 (p<0.01). The highest prevalence was observed in the youngest age group (35-59 years). The median LOHS decreased significantly over this period. Men with diabetes and depression had higher IHM than women in all the years studied (p<0.05). Older age and greater comorbidity were significantly associated with a higher risk of dying, among diabetic patients with concomitant depression.

CONCLUSIONS

Prevalence of depression increased significantly among hospitalized diabetic patients from 2001 to 2011 even if the health profile and LOHS have improved over this period. Programs targeted at preventing depression among persons with diabetes should be reinforced in Spain.

Stressful life events are associated with insulin resistance among Chinese immigrant women in the United States

BACKGROUND

Chinese immigrants experience increased chronic disease risk following migration to the US. Although the impact of lifestyle changes (e.g., diet) on disease risk has been extensively studied, associations of psychosocial stress and disease risk have attracted less attention. Thus, the objective of the present study was to examine associations between stress and insulin resistance in foreign-born Chinese American women.

METHODS

From October, 2005 to April, 2008, 423 women recruited from southeastern Pennsylvania completed questionnaires reporting stressful life events. Blood samples were analyzed for fasting insulin and fasting glucose levels, which were used to estimate insulin resistance according to the homeostasis model assessment (HOMA_IR).

RESULTS

In logistic regression analyses, a greater number of negative life events was associated with insulin resistance (OR=1.17, 95% CI=1.02-1.34), controlling for age, level of acculturation, marital status, body mass index, and waist circumference. Similarly, greater negative life event impact ratings were also associated with insulin resistance (OR=1.08, 95% CI=1.01-1.16) controlling for relevant covariates.

CONCLUSIONS

This is one of the first studies to examine associations between psychosocial stress and insulin resistance in Chinese immigrant women. These findings contribute to a growing body of literature on stress and diabetes risk in an immigrant population.

Prevalence of depression in adults with type 2 diabetes in the Basque Country: relationship with glycaemic control and health care costs

Background

The aim of the study was to estimate the prevalence of depression in the population diagnosed with diabetes type 2 and to test the hypothesis that the presence of depression in such cases was associated with a) worse glycaemic control, and b) higher healthcare costs.

Methods

We conducted a cross-sectional analysis, from 1st September 2010 to 31st August 2011, among patients with type 2 diabetes aged 35 years and over in the Basque Country. It was identified how many of them had also depression. The database included administrative individual level information on age, sex, healthcare costs, other comorbidities, and values of glycaemic control (HbA_1c). Deprivation index variable was used as socioeconomic measure and, to observe the coexistent pathologies, all the patients diagnoses were categorized by Adjusted Clinical Groups. We used a measure of association, a logistic and a linear regression for analysis.

Results

12.392 (9.8%) of type 2 diabetes patients were diagnosed with depression, being the prevalence 5.2% for males and 15.1% for females. This comorbidity was higher among the most deprived population. There was no association between the presence of depression and glycaemic control. We estimated that the comorbidity average cost per patient/year was 516€ higher than in patients with just type 2 diabetes (P < 0.001) adjusted by the other covariates.

Conclusions

We did not find any relationship between depression and glycaemic control in patients with type 2 diabetes. However, the comorbidity was associated with significantly high healthcare costs compared to that of type 2 diabetes occurring alone, after adjusting by other illness. Thus, there is a need of more precise recognition, screening and monitoring of depression among diabetic population. Evidence-based treatment for depression should be included in type 2 diabetes clinical guidelines.

Association of depression and anxiety with diabetes mellitus type 2 concerning some sociological factors

BACKGROUND

Diabetes is a metabolic disorder with a high worldwide prevalence. It has been reported that diabetic patients are more prone to depression and anxiety.

OBJECTIVES

This study aimed to evaluate the prevalence of depression and anxiety among diabetic patients with regards to some factors such as age, gender, level of education and occupational status.

MATERIALS AND METHODS

One hundred and eighty four diabetic patients have participated in this study. To assess the severity of depression and anxiety Beck depression inventory and Beck anxiety inventory questionnaire were used respectively. Binary logistic regressions were used to analyze the data.

RESULTS

The results of the present study have shown that 70.7% of the diabetic patients were suffered from depression. Besides, 69.6% of them were diagnosed with anxiety. According to the result, diabetes related depression is affected by sex (OR: 2.767), age (OR: 2.222), level of education (OR: 4.145) and job status (OR: 3.901). It has been also resulted that gender (OR: 2.274), age (OR: 2.706) and Job Status (OR: 2.441) are the effective factors leading to anxiety.

CONCLUSIONS

Depression and anxiety have higher prevalence among diabetic patients and some sociological factors such as age, gender, job and education are related to these psychological disorders.

Contributors to depressive symptoms among Korean immigrants with type 2 diabetes

BACKGROUND

Patients with diabetes have a higher prevalence of depression than the general population. Korean immigrants with type 2 diabetes are understudied.

OBJECTIVES

The aim of this study was to identify the prevalence and correlates of depressive symptoms in Korean immigrants.

METHODS

In this cross-sectional descriptive study, a community sample of 164 Korean immigrant adults with type 2 diabetes were assessed for depressive symptoms using the Center for Epidemiological Studies Depression scale. Predictors of depression were grouped into three categories: demographic (age, gender, education, English proficiency), clinical (duration of diabetes, comorbidities, insulin use), and psychosocial (general health, diabetes-related quality of life [QOL], family support).

RESULTS

Approximately 56% of participants had Center for Epidemiological Studies Depression Scale scores of ≥16. Higher levels of depression were associated with greater impact of diabetes on QOL (b = 5.68, p = .001), worse overall health (b = -0.09, p = .012), and less family support (b = -4.02, p = .042). The relationship between depression and diabetes impact on QOL was stronger for men than women (b = 6.67, p = .020).

DISCUSSION

Depressive symptoms are common among Korean immigrants with type 2 diabetes. Assessing diabetes-related QOL, general health, and family support may be of value in better understanding depressive symptoms among this population. Among Korean immigrant men with type 2 diabetes, specific attention should be paid to diabetes-related QOL.

Population-based cohort analyses of the bidirectional relationship between type 2 diabetes and depression

OBJECTIVE

This study addresses the strength of association for the bidirectional relationship between type 2 diabetes and depression.

RESEARCH DESIGN AND METHODS

We used two cohort studies with the same source of database to determine the link between depression and type 2 diabetes. The data analyzed included a random sample of 1 million beneficiaries selected from the National Health Insurance claims in 2000. The analysis of diabetes predicting the depression onset consisted of 16,957 diabetic patients and the same number of sex- and age-matched nondiabetic control subjects. The analysis of depression predicting diabetes onset included 5,847 depressive patients and 5,847 sex- and age-matched nondepressive control subjects. The follow-up period was between 2000 and 2006, and onset of end points was identified from ambulatory care claims. The Cox proportional hazards regression model adjusted for potential confounders was used to estimate relative hazards.

RESULTS

The first cohort analysis noted an incidence density (ID) of 7.03 per 1,000 person-years (PY) and 5.04 per 1,000 PY for depression in diabetic and nondiabetic subjects, respectively, representing a covariate-adjusted hazard ratio (HR) of 1.43 (95% CI 1.16-1.77). The second cohort analysis noted an ID of 27.59 per 1,000 PY and 9.22 per 1,000 PY for diabetes in depressive and nondepressive subjects, respectively. The covariate-adjusted HR was stronger at 2.02 (1.80-2.27) for incident diabetes associated with baseline depression.

CONCLUSIONS

The two cohort studies provided evidence for the bidirectional relationship between diabetes and depression, with a stronger association noted for the depression predicting onset of diabetes.

Gender-specific care of diabetes

Diabetic men have benefited in the last 30 years from a significant improvement in total and cardiovascular mortality, whereas diabetic women have had no improvement at all. Moreover, recent research focused on the role of sex hormones in glucose homeostasis, and might account for different pathophysiologic mechanisms in the development of diabetes-related complications. Thus, care of diabetic women is a challenge that requires particular attention. The available data regarding gender-specific care of diabetes mellitus are uneven, rich in some domains but very poor in others. The large prospective trials performed in the last 20 years have assumed that the natural history of diabetes mellitus in men and women, as well as the efficiency of glucose-lowering therapies and management of hyperglycemic-related complications, could be attributable without distinction to men and women. We propose in this paper to analyze the published medical literature according to the specific management of diabetes mellitus in women, and to try to distinguish some particular features. We found important distinctions between diabetic men and women regarding the patterns of abnormalities of glucose regulation, epidemiology, development of diabetes-related complications, ischemic heart disease, morbidity and mortality, impact of cardiovascular risk factors, development of the metabolic syndrome, depression and osteoporosis, as well as the impact of lifestyle modifications or primary and secondary preventions on cardiovascular risk factors, and finally medical therapeutics. Moreover, special considerations were given to some particular aspects of the medical life in diabetic women, such as the features of gestational diabetes mellitus and the management of pregnancy in pregestational diabetic women, use of contraception, hormone-replacement therapy and polycystic ovary syndrome.

Rosiglitazone treatment reversed depression- but not psychosis-like behavior of db/db diabetic mice

The objective of the present study was to examine the effect of long-term management of insulin resistance and hyperglycemia on neurobehavioral deficits in db/db mice. In this study, 5-week-old db/db and lean control mice were fed with rosiglitazone (20 mg/kg/day) mixed or standard chow for a duration of 5 weeks. Mice were monitored weekly for blood glucose concentration. Five weeks after the onset of treatment, they were subjected to the forced swim test (FST), pre-pulse inhibition (PPI), open field test (OFT) and fear-potentiated startle (FPS) test to examine for depression, psychosis-like behavior, locomotor activity and emotional learning, respectively. Rosiglitazone normalized hyperglycemia and improved glucose tolerance. Rosiglitazone significantly reduced immobility time in the FST in db/db mice, suggesting an antidepressant-like effect. However, rosiglitazone failed to reverse disruption of PPI in db/db mice, indicating its ineffectiveness against psychosis-like behavior. In the OFT, rosiglitazone did not affect the activity of db/db mice, suggesting its antidepressant-like effect was independent of changes in locomotor activity. In the FPS test, db/db mice showed impaired emotional learning and rosiglitazone failed to correct it. In conclusion, long-term blood glucose management in type-2 diabetics may help to limit the co-occurrence of depression but not the psychotic symptoms and ability to cope with stress.

Urbanization and prevalence of depression in diabetes

OBJECTIVES

To depict recent secular trend (2001-2005) in prevalence of depression among diabetic population in Taiwan, and to explore the influences of urbanization on the prevalence of depression.

STUDY DESIGN

A descriptive correlation study design relating urbanization and prevalence of depression.

METHODS

Annual prevalence of depression was calculated as the ratio of number of individuals with depression (ICD-9-CM: 296, 309, or 311) to the size of diabetic population (ICD-9-CM: 250), which were ascertained from ambulatory care claim data of Taiwan's National Health Insurance between 2001 and 2005. Multivariate Poisson regression analysis was used to assess the secular trend in the prevalence of comorbid depression, and to appraise the influence of urbanization on prevalence of depression in diabetic patients.

RESULTS

The prevalence of depression among diabetic population increased annually from 22.6/10(3) in 2001 to 27.0/10(3) in 2005 with a significantly and linearly rising trend (β = 0.0461, p < 0.0001). Diabetic population living in urban areas showed the largest increase in prevalence (6.3/10(3)), followed by those from rural areas (5.6/10(3)). Compared to the diabetic patients residing in rural areas, those living in urban areas (RR = 1.28, 95% CI = 1.25-1.31) and those from satellite towns (RR = 1.22, 95% CI = 1.19-1.25) both had significantly increased adjusted RR.

CONCLUSIONS

There is a significant increasing trend in prevalence of depression among diabetic population in recent years in Taiwan. Diabetic patients from urban areas not only had the greatest prevalence of depression but also showed the largest increase in prevalence during the study period, which highlights a need for managing depression in urban diabetes.

Patient age: a neglected factor when considering disease management in adults with type 2 diabetes

OBJECTIVE

The average age at diagnosis for type 2 diabetes is decreasing. However, because age is most often controlled for in clinical research, little is known regarding how adult age is associated with diabetes disease-related variables.

METHODS

In a community based study with type 2 diabetes patients (N=506), after adjusting for potentially confounding variables, we examined associations between patients' age and: stress, depression, diabetes-related distress, self-efficacy, diet, exercise, and glycemic control. We then explored to what extent age interacts with these variables in their association with glycemic control.

RESULTS

Younger age was independently associated with: greater chronic stress and negative life events, higher levels of diabetes-related distress, higher depressed affect, eating healthier foods and exercising less frequently, lower diabetes self-efficacy, and higher HbA1c. Interactions showed that younger patients with high stress and/or low self-efficacy were more likely to have higher HbA1c levels than older patients.

CONCLUSIONS

Results suggest younger adult patients with type 2 diabetes represent a unique patient subgroup with specific needs and health risks based on their developmental stage and life context.

PRACTICE IMPLICATIONS

Treatment programs need to target younger adult patients and may need to utilize different media or modalities (e.g., social media) to reach this group.

Diabetes mellitus and risk of subsequent depression: a longitudinal study

BACKGROUND

Findings of previous studies on the association between diabetes and the risk of depression are contradictory. Furthermore, much less is known concerning the association among young adults.

OBJECTIVE

To investigate whether diabetes is associated with an increased risk of subsequent development of depression, with emphasis on age-specific variations.

DESIGN

A cohort study.

SETTING

Claims data of one million subjects randomly selected from 23 million people covered by the Taiwan National Health Insurance program.

PARTICIPANTS

From the claims data, we identified 14,048 patients aged ≥ 20 years with newly diagnosed diabetes in 2000-2002 and randomly selected 55,608 non-diabetic subjects for comparison, that were frequency-matched by calendar year, age, and gender. Incidence rates of depression to the end of 2007 were identified, and risks were compared between the two groups.

RESULTS

The incidence of depression was 1.80-times higher in the diabetic group than in nondiabetic subjects over a median follow-up of 6.5 years (adjusted hazard ratio [HR]=1.46, 95% confidence interval [CI]: 1.24-1.71). Age-specific HRs for incidence of depression in relation to diabetes were not statistically different between the patient subgroups aged 20-39, 40-49, 50-59, 60-69 and ≥ 70 years (p value for age-diabetes interaction=0.33). Stratified analyses showed that the association was much stronger for subjects without comorbid cardiovascular disease than for those with this comorbidity. Insulin treatment was associated with a 43% reduced risk of depression in diabetic patients.

CONCLUSIONS

In this population-based study, diabetic patients were at a higher risk for subsequent depression. Adequate treatment reduced the risk.

Young adult African American patients with type 2 diabetes: a high risk patient sub-group with few supports for good diabetes management

This study examined age differences in support, BMI, and HbA1c among African American patients with type 2 diabetes. Participants were 158 African American adults with type 2 diabetes. Average HbA1c was 1% higher among patients aged 20-49 than patients 60-77, and double the number of younger patients had a BMI ≥35 than older patients. Younger patients reported less trust in their physician and greater disagreement with recommendations. They reported relying less on partners, greater unresolved conflict with partners around diabetes, and less church involvement. The association between age and HbA1c was partially mediated by patients' trust of their physician.

Treatment patterns and resource use among patients with comorbid diabetes mellitus and major depressive disorder

OBJECTIVE

To descriptively analyze patient characteristics, treatment patterns, and medical resource use of individuals with diabetes mellitus (DM) with and without comorbid major depressive disorder (MDD).

RESEARCH DESIGN AND METHODS

Using an administrative claims database, commercially insured adults diagnosed with DM were studied over the calendar years 2005 and 2006. Demographic characteristics, comorbid illnesses, medication use, resource utilization, and costs were examined descriptively among patients with DM both with and without comorbid MDD.

RESULTS

Patients with DM and MDD were found to have a high resource burden, compared to patients with DM without MDD. Specifically, these patients were found to be more likely to be diagnosed with other comorbid medical conditions, to use multiple medications, and to use more healthcare services such as inpatient visits, emergency admissions, and outpatient visits. Consistent with these findings, costs for these patients were found to be $19,707 per year, compared to $11,237 for patients with DM without comorbid MDD.

LIMITATIONS

The study utilizes data from an administrative claims database of insured individuals and hence, results may not be generalizable. Furthermore, the analysis is unable to examine clinical severity or indirect costs.

CONCLUSION

Compared to patients with DM and no comorbid MDD, patients with DM and MDD tend to have a larger burden of disease and to use more healthcare resources.

Diabesity: an overview of a rising epidemic

'Diabesity' is the term for diabetes occurring in the context of obesity. In this review, we will overview the latest epidemiological data available describing the rising prevalence, health impact and economic impact of diabesity. We will also outline the measures required to slowdown this newly evolving epidemic. The global prevalence of diabetes in 2010 was 284 million people worldwide constituting around 6.4% of the world population, which is higher than was projected in earlier studies. Furthermore, the projections for 2030 show the prevalence to reach 439 million individuals comprising ~7.7% of the world population. The burden of diabetes on the world economy has been rising steadily in the last decade to reach $376 billion in 2010 and is expected to reach $490 billion in 2030. Diabesity represents a substantial economic burden as reflected by diabetes and obesity consuming 14 and 5.7% of the USA's total health expenditure, respectively, representing the highest known expenditure on diabesity worldwide. When costs associated with being overweight were also included, the upper limit of obesity expenditure rises to 9.1% of the USA's total healthcare expenditure. The highest recorded expenditure on diabetes alone was in Saudi Arabia consuming 21% of the country's total health expenditure, with no data available about the health expenditure on obesity. The health impact of diabesity is substantial to include long-term diabetic complications, reduction in health-related functioning, reduction of quality of life and reduced overall life expectancy. Long-term complications include myocardial infarction, cerebrovascular stroke and end-stage renal disease. Also recent advances have found that there is an association between chronic stress, depression and sleeping troubles to both diabetes and obesity. This century is the unprecedented diabetogenic era in human history. It is thus urgent to take steps including screening, prevention and early management in an attempt to control this evolving epidemic of diabesity.

Age and sex differences in hospitalizations associated with diabetes

AIM

To evaluate national trends in hospitalizations and hospital charges associated with diabetes over a recent 14-year period.

METHODS

We evaluated hospital discharges with a primary or secondary diagnosis of diabetes (250.xx)in the Nationwide Inpatient Sample (1993-2006). Outcomes included population-adjusted estimates of hospital discharges and hospital charges (2006 $U.S.).

RESULTS

Overall, discharges associated with diabetes increased 65.3% (1,384/100,000 in 1993, 2,288/100,000 in 2006) over the 14-year period (p < 0.001 test for trend). The largest increase in hospitalizations occurred among adults 30-39 years of age, representing a 102% increase. Among young adults, increases among women were ∼1.3 times greater compared with men, for the 20-29 year (63% vs. 46%) and 30-39 year (118% vs. 85%) age groups, even after excluding pregnancy-related hospitalizations. Overall, women had higher rates of hospitalizations associated with diabetes compared with men, but there was evidence of an age by sex interaction, with higher rates of hospitalizations among women in the younger age groups and among men in the older age groups. Annual inflation-adjusted total charges for hospitalizations with diabetes increased 220% over the period.

CONCLUSIONS

Large increases in diabetes hospitalizations occurring among adults aged 30-39 years and young women signal a shift in the hospital burden of diabetes.

Association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan

BACKGROUND

The combination of depression with type 2 diabetes is a public health problem. If diabetes is managed in its initial phase, the morbidity and mortality due to this combination may be prevented at an early stage. Therefore, we aimed to determine the association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan.

METHODS

From July 2006 to September 2007, a matched case control study (n = 592) was conducted in Civil Hospital, Karachi. Incident cases of type 2 diabetes (n = 296) diagnosed within one month were recruited from diabetic Out Patient Department (OPD) of Civil Hospital, Karachi. They were matched on age and sex with controls (n = 296), who were attendants sitting in the medical out patient department of the same hospital, recruited on the basis of absence of classical symptoms of polyuria and polydipsia along with random blood glucose level of <200 mg/dl measured by a glucometer. Depression was identified by the Siddiqui Shah Depression Scale. Conditional logistic regression was applied to examine the association of depression and other independent variables with newly diagnosed type 2 diabetes at 95% C.I. and P < 0.05.

RESULTS

The study comprised of 592 subjects with 432(73%) males and 160(27%) females. Depression was significantly associated with newly diagnosed type 2 diabetes having mild level (mOR: 3.86; 95%CI: 2.22,6.71) and moderate to severe level (mOR: 3.41; 95%CI: 2.07,5.61). History of (h/o) gestational diabetes (mOR: 2.83; 95%CI: 1.05,7.64), family h/o diabetes (mOR: 1.59; 95%CI: 1.04,2.43), nuclear family (mOR: 1.75; 95%CI: 1.14,2.69), BMI (mOR: 1.62; 95%CI: 1.01,2.60 for obese and mOR: 2.12; 95%CI: 1.19,3.79 for overweight vs healthy to underweight) were also significantly associated with outcome, adjusting for age, sex, marital status, h/o smoking and h/o high BP.

CONCLUSIONS

Diabetics should be screened simultaneously for depression and concomitant preventive strategies for gestational diabetes, nuclear family and high BMI should also be used to prevent mortality/morbidity among patients between 25 to 60 years of age.

The prevalence of depression in white-European and South-Asian people with impaired glucose regulation and screen-detected type 2 diabetes mellitus

BACKGROUND

There is a clear relationship between depression and diabetes. However, the directionality of the relationship remains unclear and very little research has considered a multi-ethnic population. The aim of this study was to determine the prevalence of depression in a White-European (WE) and South-Asian (SA) population attending a community diabetes screening programme, and to explore the association of depression with screen-detected Type 2 diabetes mellitus (T2DM) and impaired glucose regulation (IGR).

METHODOLOGY/PRINCIPAL FINDINGS

Participants were recruited from general practices in Leicestershire (United Kingdom) between August 2004 and December 2007. 4682 WE (40-75 years) and 1327 SA participants (25-75 years) underwent an Oral Glucose Tolerance Test, detailed history, anthropometric measurements and completed the World Health Organisation-Five (WHO-5) Wellbeing Index. Depression was defined by a WHO-5 wellbeing score < or =13. Unadjusted prevalence of depression for people in the total sample with T2DM and IGR was 21.3% (21.6% in WE, 20.6% in SA, p = 0.75) and 26.0% (25.3% in WE, 28.9% in SA, p = 0.65) respectively. For people with normal glucose tolerance, the prevalence was 25.1% (24.9% in WE, 26.4% in SA, p = 0.86). Age-adjusted prevalences were higher for females than males. Odds ratios adjusted for age, gender, and ethnicity, showed no significant increase in prevalent depression for people with T2DM (OR = 0.95, 95%CI 0.62 to 1.45) or IGR (OR = 1.17, 95%CI 0.96 to 1.42).

CONCLUSIONS

Prior to the knowledge of diagnosis, depression was not significantly more prevalent in people with screen detected T2DM or IGR. Differences in prevalent depression between WE and SA people were also not identified. In this multi-ethnic population, female gender was significantly associated with depression.

Gender-specific care of diabetes mellitus: particular considerations in the management of diabetic women

In the past 30 years, the all-cause mortality and cardiovascular mortality rates for women with diabetes mellitus (DM), in contrast to men, have not declined. Furthermore, the difference between all-cause mortality rates in women with DM and those without DM has more than doubled. This urgently needs addressing. This review will analyse published medical literature relating to the specific management of DM in women and try to identify areas where gender affects care. We have identified specific gender differences in the pathophysiology of glucose homeostasis disorder, diabetes-related complications and any female gender-specific features of women with diabetes, such as contraception and the menopause. These gender-specific features of DM may offer a route to improved care for women and new therapeutic possibilities.

Social Support Mediating between Coping by Emotional Expression and Depression

The present purpose was to investigate the effects of social support on the relationship between coping by expressing emotions and depression in women. Japanese undergraduate students ( N = 218) completed four self-report questionnaires: the dispositional and situational versions of the Emotional Coping Questionnaire which measures the mode of expression as being either to self as in a diary or to others as in telling a friend, the Social Support Scale to evaluate received support, and the Center for Epidemiologic Studies–Depression Scale. Analysis showed that expression of emotions to self in both dispositional and situational coping had significant positive correlations with depression, especially for women who scored high on depression, and expression of emotions to others in both dispositional and situational coping were significantly positively correlated with social support. However, no significant mediation effects of social support in emotional expression and depression were found. Limitations and topics for research are discussed.

High prevalence rates of diabetes and hypertension among refugee psychiatric patients

There is increasing evidence that immigrants and traumatized individuals have elevated prevalence of medical disease. This study focuses on 459 Vietnamese, Cambodian, Somali, and Bosnian refugee psychiatric patients to determine the prevalence of hypertension and diabetes. The prevalence of hypertension was 42% and of diabetes was 15.5%. This was significantly higher than the US norms, especially in the groups younger than 65. Diabetes and hypertension were higher in the high-trauma versus low-trauma groups. However, in the subsample with body mass index (BMI) measurements subjected to logistic regression, only BMI was related to diabetes, and BMI and age were related to hypertension. Immigrant status, presence of psychiatric disorder, history of psychological trauma, and obesity probably all contributed to the high prevalence rate. With 2.5 million refugees in the country, there is a strong public health concern for cardiovascular disease in this group.