Biological, psychosocial, and sociodemographic variables associated with depressive symptoms in persons with type 2 diabetes

Is there a Relation between Depression and Anxiety to Clinical Characteristics among Patients with T2D in Greece?

BACKGROUND

Diabetes is a chronic disease that may be related to various periods of an individual's life.

AIM

The aim of the present study is the investigation of the existence of depression and anxiety among patients suffering from type 2 diabetes as well as the factors that influence these variables (depression and anxiety).

MATERIALS AND METHODS

The Hospital Anxiety and Depression Scale (HADS) for mental health assessment was used in the context of the collection of the research data. The study involved 100 patients (42 men and 58 women) with an average age of 63.72 ± 9.84 years of life.

RESULT

The results showed that there was a positive correlation between HbA1c value and anxiety as well as HADS questionnaire total score, and a positive correlation between blood glucose value and anxiety as well as HADS questionnaire total score.

CONCLUSION

Both depression and anxiety of these patients are influenced by different clinical factors.

Life Satisfaction and Dental Visits in Adults Aged ≥50 Years and Living with Diabetes Mellitus: A Comparison between Urban and Rural Mexican

OBJECTIVE

To examine the association between low life satisfaction with past-year dental visits in a rural-urban national sample of 50-year-old Mexican adults with diabetes mellitus (DM).

METHODS

Data are drawn from the Mexican Health and Aging Study (MHAS), a cross-sectional study conducted in 2018 involving 3,592 older adults aged 50 years and older and living in urban and rural areas in Mexico. Life satisfaction was measured using the Satisfaction with Life Scale (SWLS) and past-year dental visits dichotomized as none and ≥1 dental visits. The Poisson regression analyses were used to assess the association, adjusting for confounders.

RESULTS

62.9% were women, mean age was 65.5 (±9.6), and 16.5% lived in a rural area, while the female subjects continue to present a higher probability of visiting a dentist (PR = 1.28 (95% CI 1.08-1.51)). In terms of age, the ≥70-year group presented 28% lower possibility of visiting a dentist (PR = 0.72 (95% CI 0.60-0.86)). The interaction showed that adults ≥50 years who reside in a rural area and have low life satisfaction were 40% less likely to have visited a dentist in the last year (PR = 0.60 (95% CI 0.37-0.98)) than adults ≥50 years who reside in an urban area and have high life satisfaction.

CONCLUSIONS

The present study highlights the association between low life satisfaction and past-year dental visits in rural populations. Therefore, rurality should be considered a possible confounder in analysis of life satisfaction in the older adult population.

Prevalence and associated factors of depression and anxiety among Chinese diabetic retinopathy patients: A cross-sectional study

The purposes of this study were to evaluate the mental health among patients with diabetic retinopathy (DR) and to explore its' influencing factors. A cross-sectional survey was conducted in Liaoning Province, China. A total of 200 patients volunteered to participate in the survey. Psycho-social variables included stress, self-efficacy, resilience, and social support. logistic regression analysis was used to explore the effect of psycho-social factors on depression and anxiety in DR patients. The prevalence of depression and anxiety was 25% and 13.5% among DR patients. Regression analysis showed that social support had a significant protective effect on depression (95%CI 0.931-0.997) and anxiety (95%CI 0.900-0.995). Stress had a significant acceleration of depression (95%CI 1.055-1.253) and anxiety (95%CI 1.120-1.457). Family history of diabetes (95%CI 1.856-18.057) and other chronic diseases (95%CI 1.485-12.508) were risk factors for anxiety. The high prevalence of depression (25.0%) and anxiety (13.5%) among DR patients should receive more attention in Chinese medical settings. Stress, social support, family history of diabetes and other chronic diseases seemed to be crucial in relation to depressive symptoms. Efficient interventions such as improving social support and decreasing stress with patients should be considered by health administrators aiming at alleviating depressive and anxiety among Chinese DR patients.

Comparative Analysis of Metabolic Syndrome Diagnostic Criteria and Its Effects on Prevalence in a Multiethnic Population

Background: Accurate prevalence measurement and diagnosis to prevent type 2 diabetes mellitus and cardiovascular disease cannot occur without consistent diagnostic criteria that can be applied to varying populations. Objective: The objective of this study was to determine the prevalence of metabolic syndrome in Caucasian, Filipino, Native Hawaiian, and Japanese populations utilizing different definitions. Methods: This study utilized cross-sectional study data from the Native Hawaiian/Multiethnic Health Research Project, collected from a population living in Kohala, Hawai'i. The National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPII), International Diabetes Federation (IDF), and World Health Organization (WHO) definitions were utilized, and each of the 1452 participants were evaluated on the criteria for metabolic syndrome based on all three definitions. Additionally, the average biomarker values associated with the diagnosis were taken for each ethnic group represented in the study and compared with Caucasians. Results: The overall prevalence of metabolic syndrome in this population varied from 22.31% to 39.05% using the different definitions. Ethnic disparities also occur, implying that certain populations are more prone to having severe abnormalities than others-shown when comparing the average biomarker values associated with metabolic syndrome diagnosis. Of all ethnic groups included in the study, Caucasians had the lowest prevalence of metabolic syndrome, while part-Hawaiians had the highest prevalence. Additionally, within the same ethnic group, the definitions yielded varying prevalence values. Conclusions: This implies that discrepancies exist among the criteria alone. Implications of this study revolve around not only the correct definition to apply to the population being studied but also the most accurate way to detect certain biomarker abnormalities to accurately assess the prevalence of metabolic syndrome in a multiethnic population.

The relationship between personality disorder, depression and eating disorder with treatment adherence in patients with type 2 diabetes; a cross-sectional study in diabetic patients in Iran

Purpose

Adherence to treatment is of great importance in patients with diabetes mellitus due to its necessity and benefits. The purpose of this study was to evaluate the relationship between personality disorder, depression and eating disorder with appropriate treatment acceptance and follow-up in patients with type 2 diabetes.

Methods

This cross-sectional study was performed in Imam Ali Medical Education Center in Karaj city of Alborz province of Iran. A total of 1320 patients were evaluated and were screened according to the inclusion criteria, including type 2 diabetes and those over 18 years of age. Finally, considering the exclusion criteria, 600 patients with type 2 diabetes were included in the study. Patients were divided into 4 groups. 150 patients with type 2 diabetes in the control group, 150 patients with type 2 diabetes with major depressive disorder, 150 patients with type 2 diabetes with personality disorder and 150 patients with type 2 diabetes and eating disorder were studied. Questionnaires used in the study included Hamilton Depression Rating Scale(HAM-D) for depression, Minnesota Multiphasic Personality Inventory II (MMPI II) questionnaire for personality disorders and Eating Disorder Diagnostic Scale(EDDS) for eating disorder. The Murisky questionnaire also assessed adherence to treatment in patients, which included 8 questions. Scores measure the degree of adherence to treatment.

Results

600 patients with type 2 diabetes were studied. Patients were divided into 4 groups (each group consisting of 150 patients) of control, depression, personality disorder and eating disorder. Mean age, sex, marital status and duration of diabetes were not significantly different in the study groups (P > 0.05). The mean Murisky score in patients with depression and personality disorder was significantly lower than the control group (P < 0.05) but the mean Murisky score in patients with eating disorder was not significantly different (P > 0.05). Patients with depression, paranoid, schizotypal, antisocial, borderline, avoidant and dependent personality disorder had less adherent to treatment than the control group.

Conclusions

Early psychiatric evaluation of patients with diabetes and identification of possible disorders can help improve diabetes control.

Association Between Genetic Risk for Type 2 Diabetes and Structural Brain Connectivity in Major Depressive Disorder

BACKGROUND

Major depressive disorder (MDD) and type 2 diabetes mellitus (T2D) are known to share clinical comorbidity and to have genetic overlap. Besides their shared genetics, both diseases seem to be associated with alterations in brain structural connectivity and impaired cognitive performance, but little is known about the mechanisms by which genetic risk of T2D might affect brain structure and function and if they do, how these effects could contribute to the disease course of MDD.

METHODS

This study explores the association of polygenic risk for T2D with structural brain connectome topology and cognitive performance in 434 nondiabetic patients with MDD and 539 healthy control subjects.

RESULTS

Polygenic risk score for T2D across MDD patients and healthy control subjects was found to be associated with reduced global fractional anisotropy, a marker of white matter microstructure, an effect found to be predominantly present in MDD-related fronto-temporo-parietal connections. A mediation analysis further suggests that this fractional anisotropy variation may mediate the association between polygenic risk score and cognitive performance.

CONCLUSIONS

Our findings provide preliminary evidence of a polygenic risk for T2D to be linked to brain structural connectivity and cognition in patients with MDD and healthy control subjects, even in the absence of a direct T2D diagnosis. This suggests an effect of T2D genetic risk on white matter integrity, which may mediate an association of genetic risk for diabetes and cognitive impairments.

Ethnic and Gender Differences in 10-Year Coronary Heart Disease Risk: a Cross-Sectional Study in Hawai'i

Background

Cardiovascular disease (CVD) is the leading cause of death in the US. In Hawai‘i, Filipinos and Native Hawaiians have the highest rates of CVD-related risk factors. CVD risk across these ethnic groups has not been examined. This cross-sectional study examines 10-year CVD risk as determined by the Framingham Risk Score (FRS) across ethnic groups in Hawai‘i, controlling for clinical, demographic, and psychosocial factors.

Methods

This study includes secondary data analysis of the Kohala Health Research Project dataset. All non-pregnant adults (≥ 18 years of age) who resided in the community of interest during the study period were eligible to participate with 1462 participants completing the clinical examination and surveys. This analysis included clinical, demographic, and psychosocial variables. Ethnic differences were examined using the chi-squared test and one-way ANOVA. Multiple linear regression on FRS was conducted and least square means of FRS were calculated.

Results

Data from 1146 individuals were analyzed. Participants were 44.4% Native Hawaiian, 15.4% Filipino, 15.3% Japanese, and 25% non-Hispanic White; 55.4% were female and had a mean age of 48.8 years. For males, the unadjusted Japanese mean FRS was significantly higher compared with the other ethnic groups. For females, Filipino and Japanese mean FRS were significantly higher compared with Native Hawaiians and non-Hispanic Whites. In the fully adjusted model, there were no ethnic group differences in FRS among males and Filipinos had significantly higher FRS compared with non-Hispanic White among females.

Conclusions

This cross-sectional community-based epidemiological study examined ethnic differences in CVD risk after adjusting for age, depression, social support, and acculturation. The results suggest that some ethnic differences in CVD risk persist even after controlling for confounders but that recalibration of risk assessment is necessary.

Cognitive illness representation and anxiety in older men and women with type 2 diabetes

AIM

In the elderly, type 2 diabetes is a frequent chronic condition that requires the attention of health care. As patient involvement is a prerequisite for treatment, it seems crucial to assess psychosocial aspects, including patient's cognitive component of attitude towards the condition, as early as upon diagnosis. The aim of this study was to examine whether the cognitive illness representation in older female and male patients with type 2 diabetes is differentiated. Considering disease duration, we determined the effect of cognitive illness representation on older diabetes emotional wellbeing.

METHODS

The study in 99 older adults with type 2 diabetes used Disease-Related Appraisals Scale (Skala Oceny Własnej Choroby; SOWCh) to assess cognitive illness representation and State-Trait Anxiety Inventory (STAI) to assess the severity of state anxiety.

RESULTS

In a subgroup with short-standing diagnosis, women scored significantly higher than men on subscales of Threat, Obstacle/Loss and Profit. In a subgroup with long-standing diagnosis, women scored significantly higher than men on the subscale of Threat and significantly lower than men on the subscale of Value. The associations between the individual dimensions of cognitive illness representation and anxiety were also determined. These correlations differed between sexes and stages of the disease.

CONCLUSION

Both at early and late stages of type 2 diabetes, women perceive their illness as a threat significantly more than men do. This appraisal persists throughout the entire duration of the illness. Men with long-standing diagnosis, attribute higher value to diabetes than women do, perceiving it as an opportunity to appreciate values they did not pay attention to before. Anxiety reported by older women and men can be explained to a significant extent by certain dimensions of their respective cognitive illness representation.

Glycaemic status and depressive symptoms among adults in Germany: results from the German Health Interview and Examination Survey for Adults (DEGS1)

AIMS

To examine the association between glycaemic status and depressive symptoms in a nationwide sample of the adult population in Germany.

METHODS

We conducted a cross-sectional analysis of data from 6385 participants aged 18-79 years in the nationwide German Health Interview and Examination Survey for Adults 2008-2011 (DEGS1). Glycaemic status was classified as follows: diagnosed diabetes (self-reported diagnosis or receiving antidiabetes medication); undiagnosed diabetes (HbA_1c ≥48 mmol/mol [≥6.5%]); prediabetes (HbA_1c 39-47 mmol/mol [5.7-6.4%]); or normoglycaemia (HbA_1c <39 mmol/mol [<5.7%]). Current depressive symptoms were measured using the Patient Health Questionnaire depression scale (PHQ-9) and defined as elevated depressive symptoms (PHQ-9 score ≥10 points; dichotomous variable) and severity of depressive symptoms (PHQ-9 score, range 0-27 points; continuous variable). Associations of glycaemic status and HbA_1c with both depressive symptoms variables were analysed using multivariable logistic (elevated depressive symptoms) and linear (severity of depressive symptoms) regression models.

RESULTS

Compared with normoglycaemia, diagnosed diabetes, but not prediabetes or undiagnosed diabetes, was associated with elevated depressive symptoms (odds ratio 1.55, 95% CI 1.00-2.41) and severity of depressive symptoms (β coefficient 0.71, 95% CI 0.23-1.19) in models adjusting for sociodemographics and health behaviours. Associations were similar among people with diagnosed diabetes taking and not taking antidiabetes medication. Among people without diagnosed diabetes, no associations between HbA_1c and depressive symptoms were found.

CONCLUSIONS

Diagnosed diabetes, but not prediabetes, undiagnosed diabetes or HbA_1c , was associated with depressive symptoms among adults in Germany. Studies examining psychosocial and biological mechanisms that may potentially explain relationships between diagnosed diabetes and depressive symptoms are needed.

Knowledge, Attitudes, Social Desirability, and Organizational Characteristics in Youth Mental Health Services

This project investigated the extent to which knowledge of evidence-based practices (EBPs) and organizational characteristics predicted attitudes toward EBPs, while controlling for social desirability and organization membership. Participants were 167 public sector youth practitioners. Hierarchical multiple regression analyses were conducted to determine which factors significantly predicted EBP attitudes. Findings suggested that social desirability, organization membership, and various organizational characteristics predicted EBP attitudes. Results are discussed as they relate to the importance of including social desirability in future research and identifying different factors that influence EBP attitudes across various organizations.

Psychological health and menopause-specific quality of life of Malaysian women with type 2 diabetes

Anxiety and depression are more common among females and those experiencing diabetes and menopause. Menopausal symptoms experienced by women can vary tremendously from population to population; therefore, there is a need to investigate these symptoms and associated risk factors in different communities. This study investigated the differences in psychological health and menopause-specific quality of life (MENQOL) between women with and without diabetes type 2 (T2DM) in Malaysia. Women with T2DM (n=320) were matched by age range to controls without T2DM (n=320). Data were collected from March 2012 to January 2013. Delusions Symptoms States Inventory (DSSI) instrument was used to identify symptoms of depression and anxiety. Women with diabetes had higher depressive (11.8% versus 8.4%) and anxiety (8.4% versus 6.6%) symptoms compared to women without diabetes. In both groups, the most common menopausal symptom was aches (muscles and joints). Women without diabetes had significantly higher scores for the sexual domain compared to women with diabetes (4.20 versus 3.21, p=0.001). The odds that a postmenopausal woman with diabetes was depressed or anxious on the DSSI scale increased significantly when the MENQOL score on the physical, vasomotor, and psychosocial domains increased by one unit. Both diabetes and psychological problems have negative impact on MENQOL. Our findings support the view of screening postmenopausal women with diabetes for depressive and anxiety, to improve overall quality of life.

Association of depression with type 2 diabetes and relevant factors

BACKGROUND

Based on the high prevalence of diabetes and depression in Rasht, we conducted a study to evaluate the prevalence of depression in type 2 diabetic patients, and its association with glycemic control, chronic complications, and some clinical and paraclinical parameters in this northern state of Iran.

MATERIALS AND METHODS

Beck depression inventory was used for evaluating depression on 90 type 2 diabetics and 90 healthy controls selected. Information on demographic and clinical and paraclinical characteristics was collected by interviews and from medical records.

RESULTS

This cross-sectional study was performed on 90 type 2 diabetic patients (63 female and 27 male with a mean age of 54.17 ± 10.57 years) and 90 healthy matched controls. Overall, depression was significantly more prevalent in case group [37.8% vs. 16%, odds ratio (OR) = 3.29, P = 0.001]. The prevalence of depression in diabetic women was significantly higher than nondiabetic ones (39.7% vs. 15%, P = 0.002). We could not find any significant correlation between depression and positive family history of depression, duration of diabetes, HBA1c level, and body mass index. The prevalence of depression was prominently more in diabetic patients with retinopathy than in those without this complication (55.6% vs. 24%, P = 0.015). Logistic regression analysis indicated that diabetes itself was the only significant determinant of having depression (OR = 3.29, P = 0.005, 95% confidence interval: 0.118-0.667).

CONCLUSION

There was a prominent prevalence of depression in type 2 diabetics overall. Depression was not correlated with duration of diabetes and glycemic control. There was a significant association between depression and retinopathy in diabetic patients. Diabetes itself was the only significant determinant of having depression after matching with other variables.

Ethnic and gender differences in ideal body size and related attitudes among Asians, Native Hawaiians, and Whites

Often overlooked explanations for the varied obesity rates across ethno-cultural groups include differences in attitudes toward excess weight, with certain populations assumed to have larger ideal body sizes (IBS). Past studies found ethnic and gender difference in IBS across and within different groups. This study examined the effects of ethnicity and gender, and their interaction, in accounting for differences in IBS and attitudes toward those ideals. Multiple regression analyses were used to better understand the effects of ethnicity and gender in accounting for differences in perceived IBS according to ethnic-specific and Western ideals and attitudes in 1,124 people of Native Hawaiian, Filipino, Japanese, and White ancestry. The analyses controlled for socio-demographics, body mass index, health-related behaviors, and psychosocial variables. The results indicated that Native Hawaiians selected larger ethnic IBS, Filipinos selected smaller ethnic IBS, and Native Hawaiians selected slightly smaller Western IBS than other ethnic groups. Overall, males selected larger IBS compared to females. Interaction analyses indicated that the relationship between ethnic IBS and attitude toward that IBS varied as a function of ethnicity, such that Native Hawaiians who selected a larger ethnic IBS held less favorable attitudes toward that IBS. The discrepancy between Native Hawaiians' selection of larger ethnic IBS as ideal and their less positive attitude toward that selection warrants more investigation. However, it does suggest that Native Hawaiians, on a personal level, do not prefer larger body sizes, which contradicts their perceptions of social norms. These findings have important implications for obesity interventions among Native Hawaiians.

A descriptive and comparative study from China on patients with type-2 diabetes with and without depressive symptoms

The aim of this study was to assess the prevalence of depressive symptoms for patients with type-2 diabetes at the population level in China and explore differences in demographic, socioeconomic, and disease-specific parameters between diabetic patients with and without depression. Self-rating depression scale was used to screen for depressive symptoms in 667 patients with type-2 diabetes from 4 communities in Beijing; their quality of life and social support was assessed using appropriate and validated tools. The results indicate that 44.23% of diabetic patients report depressive symptoms; patients with depressive symptoms had a significantly higher rate of diabetic complications, a lower quality of life and less social support than patients without depressive symptoms.

Psychiatric disorders presenting in the elderly with type 2 diabetes mellitus

Diabetes mellitus (DM) is one of the major health problems of the elderly. Developed countries face an epidemic of Type 2 DM. Healthcare providers should be aware of the frequent coexistence of psychiatric conditions in elderly patients with DM. Dementia, depression, and anxiety are commonly seen in addition to other psychiatric conditions. The relationship between diabetes and psychiatric disorders is complex. Evidence suggests that common mechanisms may play a role in both the pathogenesis of DM and several psychiatric illnesses. Possible mechanisms, diagnosis, and management options are reviewed and discussed. Common mechanisms of psychiatric illness involving brain-derived neurotrophic factor, insulin resistance, and inflammatory cytokines are throwing new light that these psychiatric illnesses could be due to the complications of Type 2 DM. Periodic screening should be done in DM patients to identify the psychiatric complications. Healthcare professionals should routinely screen for psychiatric complications of DM in addition to the microvascular and macrovascular complications of DM. It is important to screen all diabetic elderly patients for mental health issues as these may interfere with self-care and the overall management of DM. Recognition and management of psychiatric disorders will help to optimize the diabetes management. Good diabetes control can also reduce the mental health complications in these patients.

Screening tools used for measuring depression among people with Type 1 and Type 2 diabetes: a systematic review

BACKGROUND

Depression is common in patients with Type 1 or Type 2 diabetes, has a strong negative impact on the quality of life of patients and is associated with poor outcomes and higher mortality rates. Several guidelines encourage screening of patients with diabetes for depression. It is unclear which depression screening tools are currently being used in people with diabetes and which are most appropriate.

METHODS

A systematic review was conducted to examine which depression screening instruments are currently being used in diabetes research, and the operating characteristics of these tools in diabetes populations. Literature searches for the period January 1970 to October 2010 were conducted using MEDLINE, PSYCH-INFO, ASSIA, SCOPUS, ACADEMIC SEARCH COMPLETE, CINAHL and SCIENCE DIRECT.

RESULTS

Data are presented for the 234 published studies that were examined. The Beck Depression Inventory and the Centre for Epidemiologic Studies Depression Scale were the most popular screening tools (used in 24% and 21% of studies). Information on the cultural applicability of screening tools was mostly unavailable and, where reported, included only details of the language translation process. A small number of studies reported reliability data, most of which showed moderate-good sensitivity and specificity but a high rate of false positives.

CONCLUSIONS

Although a range of depression screening tools have been used in research, there remains few data on their reliability and validity. Information on the cultural applicability of these instruments is even scantier. Further research is required in order to determine the suitability of screening tools for use in clinical practice and to address the increasing problem of co-morbid diabetes and depression.

Does social support mediate the moderating effect of intrinsic religiosity on the relationship between physical health and depressive symptoms among Jews?

Previous research in the general population suggests that intrinsic religiosity moderates (mitigates) the effect of poor physical health on depression. However, few studies have focused specifically on the Jewish community. We therefore examined these variables in a cross-sectional sample of 89 Orthodox and 123 non-Orthodox Jews. Based on previous research suggesting that non-Orthodox Judaism values religious mental states (e.g., beliefs) less and a collectivist social religiosity more, as compared to Orthodox Judaism, we hypothesized that the moderating effect of intrinsic religiosity would mediated by social support among non-Orthodox but not Orthodox Jews. As predicted, results indicated that the relationship between physical health and depression was moderated by intrinsic religiosity in the sample as a whole. Furthermore, this effect was mediated by social support among non-Orthodox Jews, but not among the Orthodox. The importance of examining religious affiliation and potential mediators in research on spirituality and health is discussed.

The relation of medical conditions to depressive symptoms among Latinos: Leisure time physical activity as a mediator

Individuals with medical conditions report more depressive symptoms than those without such conditions. This study assessed whether physical activity (PA) plays a mediational role in the association between medical conditions and depressive symptoms among Latino adults. Adjusting for socioeconomic factors, those who reported having been diagnosed with diabetes, cardio-related disease, hypertension, high cholesterol, arthritis, or sleep problems endorsed more symptoms of depression. Vigorous PA mediated the relation between depressive symptoms and hypertension. In other words, people with hypertension who engaged in vigorous PA reported less depressive symptoms. PA may be a promising avenue for improving hypertension and depressive symptoms.

Factors associated with psychological and behavioral functioning in people with type 2 diabetes living in France

BACKGROUND

To identify demographic and clinical factors associated with psychological and behavioral functioning (PBF) in people with type 2 diabetes living in France.

METHODS

In March 2002, approximately 10,000 adults, who had been reimbursed for at least one hypoglycemic treatment or insulin dose during the last quarter of 2001, received a questionnaire about their health status and PBF (3,646 responders). For this analysis, the 3,090 persons with type 2 diabetes, aged 18-85 years old were selected.PBF was measured with the adapted version of the Diabetes Health Profile for people with type 2 diabetes. This permitted the calculation of three functional scores - psychological distress (PD), barriers to activity (BA), and disinhibited eating (DE) - from 0 (worst) to 100 (best).

RESULTS

Major negative associations were observed with PBF for microvascular complications (a difference of 6.7 in the BA score between persons with and without microvascular complications) and severe hypoglycemia (difference of 7.9 in the BA score), insulin treatment (-8.5 & -9.5 in the PD & BA scores respectively, as compared to treatment with oral hypoglycemic agents), non-adherence to treatment (-12.3 in the DE score for persons forgetting their weekly treatment), increasing weight (-8.5 & -9.7 in the PD & DE scores respectively, as compared to stable weight), at least one psychiatrist visit in 2001 (-8.9 in the DE score), and universal medical insurance coverage (-7.9 in the PD score) (due to low income).

CONCLUSION

Prevention and management of microvascular complications or adherence to treatment (modifiable factors) could be essential to preserving or improving PBF among people with type 2 diabetes. A specific approach to type 2 diabetes management may be required in groups with a low socioeconomic profile (particularly people with universal medical insurance coverage), or other non modifiable factors.

Association of increased QTc interval with the cardiometabolic syndrome

Recent studies indicate a high prevalence of increased QTc interval length in patients affected by the metabolic syndrome, but there is no data available to demonstrate the correlation of the QTc interval with severity of the cardiometabolic syndrome (CMS). The objective of this study was to estimate the association between increasing number of cardiometabolic abnormalities and increasing QTc interval length. Electrocardiograms were collected from 1420 participants in a cross-sectional study. The QTc interval lengths were corrected for heart rate using Bazett's formula. CMS was determined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) guidelines. Multiple linear regression models were used examining associations between increasing number of individual components of syndrome with QTc interval length. Participants with CMS had significantly longer QTc interval length, controlling for age, body mass index (BMI), sex, and ethnic group. Increasing number of CMS components was significantly associated with increased QTc interval length, even after adjusting for age, BMI, total cholesterol, fasting C peptide, and history of heart disease. These findings suggest that QTc interval length is increased in the presence of CMS and is linearly related to an increase in number of metabolic abnormalities.

The association between depression and health-related quality of life in people with type 2 diabetes: a systematic literature review

The relationships between co-morbid depression in people with diabetes and adverse outcomes including poor HbA(1c) control, adherence to medication and mortality have been examined and confirmed. However, as the awareness of the decrement to health-related quality of life (HRQOL) in people with diabetes and its clinical consequences grows, investigators have become increasingly interested in measuring HRQOL in clinical trials. Given that the psychological factors such as depression may contribute to diminished HRQOL, the present review sought to summarize the association between these variables in people with type 2 diabetes. Articles for a systematic review were obtained via a search performed using MEDLINE, EMBASE and PsycINFO (1980-2007).Fourteen articles fulfilled the inclusion criteria. Studies indicated that self-reported depressive symptoms markedly impaired HRQOL on several domains. However, depression was not related to all sub-domains of HRQOL in all studies, suggesting that the effects of depression on certain aspects of HRQOL may vary between clinical and demographic subgroups. Although a number of shortcomings identified in the current literature should be taken into account for future research, the importance of this review lies in the possibility it raises that the improvements in HRQOL and clinical practice may potentially be achieved by placing greater attention on the identification and management of depression.

Cardiometabolic health disparities in native Hawaiians and other Pacific Islanders

Elimination of health disparities in the United States is a national health priority. Cardiovascular disease, diabetes, and obesity are key features of what is now referred to as the "cardiometabolic syndrome," which disproportionately affects racial/ethnic minority populations, including Native Hawaiians and other Pacific Islanders (NHOPI). Few studies have adequately characterized the cardiometabolic syndrome in high-risk populations such as NHOPI. The authors systematically assessed the existing literature on cardiometabolic disorders among NHOPI to understand the best approaches to eliminating cardiometabolic health disparities in this population. Articles were identified from database searches performed in PubMed and MEDLINE from January 1998 to December 2008; 43 studies were included in the review. There is growing confirmatory evidence that NHOPI are one of the highest-risk populations for cardiometabolic diseases in the United States. Most studies found increased prevalences of diabetes, obesity, and cardiovascular risk factors among NHOPI. The few experimental intervention studies found positive results. Methodological issues included small sample sizes, sample bias, inappropriate racial/ethnic aggregation of NHOPI with Asians, and a limited number of intervention studies. Significant gaps remain in the understanding of cardiometabolic health disparities among NHOPI in the United States. More experimental intervention studies are needed to examine promising approaches to reversing the rising tide of cardiometabolic health disparities in NHOPI.

Depression and quality of life in patients with diabetes: a systematic review from the European depression in diabetes (EDID) research consortium

Diabetes patients are known to have a worse quality of life than individuals without diabetes. They also have an increased risk for depressive symptoms, which may have an additional negative effect on their quality of life. This systematic review summarizes the current knowledge on the association between depressive symptoms and quality of life in individuals with diabetes. A systematic literature search using MEDLINE, Psychinfo, Social SciSearch, SciSearch and EMBASE was conducted from January 1990 until September 2007. We identified studies that compared quality of life between diabetic individuals with and without depressive symptoms. Twenty studies were identified, including eighteen cross-sectional and two longitudinal studies. Quality of life was measured as generic, diabetes specific and domain specific quality of life. All studies reported a negative association between depressive symptoms and at least one aspect of quality of life in people with diabetes. Diabetic individuals with depressive symptoms also had a severely lower diabetes specific quality of life. Generic and domain specific quality of life were found to be mild to moderately lower in the presence of depressive symptoms. Therefore, increased awareness and monitoring for depression is needed within different diabetes care settings.

A longitudinal analysis of depressive symptoms among Asian and Pacific Islander mothers at-risk for child maltreatment

This longitudinal study examined racial differences in depressive symptoms at three time points among Asian, Native Hawaiian/Other Pacific Islander (NHOPI) and white mothers at-risk for child maltreatment (n = 616). The proportion of mothers with depressive symptoms ranged from 28 to 35% at all time points. Adjusted analyses revealed that Asian and NHOPI mothers were significantly more likely than white mothers to have depressive symptoms but this disparity was present only among families at mild/moderate risk for child maltreatment. Future research should identify ways to reduce this disparity and involve the Asian and NHOPI communities in prevention and treatment program design and implementation.

Cardiometabolic health disparities in native Hawaiians and other Pacific Islanders

Elimination of health disparities in the United States is a national health priority. Cardiovascular disease, diabetes, and obesity are key features of what is now referred to as the "cardiometabolic syndrome," which disproportionately affects racial/ethnic minority populations, including Native Hawaiians and other Pacific Islanders (NHOPI). Few studies have adequately characterized the cardiometabolic syndrome in high-risk populations such as NHOPI. The authors systematically assessed the existing literature on cardiometabolic disorders among NHOPI to understand the best approaches to eliminating cardiometabolic health disparities in this population. Articles were identified from database searches performed in PubMed and MEDLINE from January 1998 to December 2008; 43 studies were included in the review. There is growing confirmatory evidence that NHOPI are one of the highest-risk populations for cardiometabolic diseases in the United States. Most studies found increased prevalences of diabetes, obesity, and cardiovascular risk factors among NHOPI. The few experimental intervention studies found positive results. Methodological issues included small sample sizes, sample bias, inappropriate racial/ethnic aggregation of NHOPI with Asians, and a limited number of intervention studies. Significant gaps remain in the understanding of cardiometabolic health disparities among NHOPI in the United States. More experimental intervention studies are needed to examine promising approaches to reversing the rising tide of cardiometabolic health disparities in NHOPI.

Impaired glucose tolerance is associated with postganglionic sudomotor impairment

We compared quantitative sudomotor axon-reflex test responses in persons with normal and impaired glucose tolerance (IGT). Responses were significantly impaired in those with IGT, which may be indicative of early distal small fiber neuropathy.

Disparities in use of mental health and substance abuse services by Asian and Native Hawaiian/other Pacific Islander women

The purpose of this study was to determine if disparities exist in lifetime utilization of mental health/substance abuse services among Asian, Native Hawaiian/Other Pacific Islander (NHOPI) and white mothers. The study sample was comprised of mothers assessed to be at-risk (n = 491) and not at-risk (n = 218) for child maltreatment in the Hawaii Healthy Start Program study. Multiple logistic regression models were used to test the effects of predisposing, need, and enabling factors on utilization of services. Results revealed that, among mothers with depressive symptoms, compared with whites, Asians and NHOPI were significantly less likely to have received services. There were no significant racial differences in use of mental health/substance use services by other factors. These results suggest that racial disparities exist in utilization of mental health/substance abuse services among mothers with depressive symptoms. Future research is needed to identify barriers and facilitators to accessing needed services for Asian and NHOPI women.

Association between angiotensin-converting enzyme gene polymorphisms and QT duration in a multiethnic population in Hawaii

OBJECTIVES

Recent studies have suggested that heart-rate corrected QT interval (QTc) in normal populations may be influenced by genetic factors. We report findings of a study of the relationship between QTc, increased QTc (> 440 ms) and angiotensin-converting enzyme (ACE) genotype in a multiethnic, population-based study completed in rural Hawaii.

METHODS

Blood samples were obtained while fasting and after an oral glucose challenge from 1452 individuals between 1997 and 2000. The clinical examination included an electrocardiogram. Medical histories, behavioral and socio-demographic information were obtained during the interview. Ethnicity was estimated by self-report. The insertion/deletion (I/D) polymorphism in intron 16 of the ACE gene was determined by polymerase chain reaction (PCR) from a random sample of 588 participants. Multiple linear and logistic regression was used to test for associations between QTc and ACE gene polymorphisms.

RESULTS

The overall crude prevalence of increased QTc was 21.2%. The prevalence of increased QTc was lowest among those with ACE DD genotype, and highest among those with ACE insertion/insertion (II) genotype. The adjusted odds ratio for increased QTc was 2.29 (95% CI 1.02-5.12) and 3.61 (95% CI 1.60-8.13) for ID and II genotypes, respectively, compared to the DD genotype. The test for trend was highly significant (p < 0.001).

CONCLUSIONS

The ACE insertion allele was associated with increased prevalence of prolonged QTc independent of ethnicity, age, gender, and BMI. These findings may implicate the ACE gene as an important genetic risk factor for cardiovascular disease morbidity and mortality.

Quality of life, health status and clinical outcomes in Type 2 diabetes patients

This study examines relationships between patient reported outcomes (PROs) and clinical outcomes in Type 2 diabetes mellitus (T2DM). Patients at the outpatient clinics of a university hospital completed measures of generic health status (SF-12), diabetes-specific quality of life (Audit of Diabetes Dependent Quality of Life - ADDQoL), and depressive symptoms (Center for Epidemiologic Studies Depression - CES-D). Patient reported data were merged with a retrospective collection of clinical and utilization data, including HbA1C, from electronic medical records. A Charlson comorbidity score, diabetes complications score, BMI, and total number of ER and hospital visits were calculated. Usable response rate was 44.3% (n = 385). Patients were dichotomized into glycemic control levels based on the ADA recommended A1C level < 7.0, vs. >or= 7.0. The ADDQoL, PCS-12, and MCS-12 scores were separately examined as dependent variables using hierarchical regression models, with glycemic control as the primary explanatory variable, and controlling for demographics and clinical variables including comorbidities and complications. Glycemic control was not a significant predictor in any regression model. Obesity was a significant predictor leading to poorer PCS-12 and MCS-12 scores, while depressive symptoms significantly resulted in lower PCS-12, MCS-12 and ADDQoL scores. These and other factors related to self-management behaviors may contribute to a greater understanding of how to intervene with patients with T2DM. The use of such PROs alongside biomedical measures such as A1C is recommended.

Ethnic differences in the relationship between depressive symptoms and health-related quality of life in people with type 2 diabetes

OBJECTIVE

To examine ethnic differences in the relationship between depressive symptoms and specific aspects of heath-related quality of life in people with type 2 diabetes.

DESIGN

Cross-sectional data from 190 people with type 2 diabetes of Native Hawaiian (50%), Filipino (16%), Japanese (18%), and mixed-ethnic (16%) ancestries from the rural community of North Kōhala, Hawai'i were examined in this study. Depressive symptoms were measured with the Center for Epidemiological Studies-Depression (CES-D) scale. Health-related quality of life was measured with the Short Form-36 Health Survey (SF-36). Eight health-related quality of life constructs were examined: Physical Functioning, Role-Physical Functioning, Role-Emotional Functioning, Social Functioning, Bodily Pain, Vitality, General Health, and Health Transition.

RESULTS

Hierarchical regression analyses of the interaction between ethnicity and the SF-36 subscales of Physical Functioning, Role-Emotional Functioning, Bodily Pain, Vitality, and General Health indicated statistically significant associations with CES-D scores after controlling for sociodemographic factors, glycemic status, and social support.

CONCLUSION

Ethnicity moderated the relationship between depressive symptoms and the health-related quality of life aspects of physical and role-emotional functioning, bodily pain, vitality, and general health perception in people with type 2 diabetes. This relationship was strongest for Filipinos followed by Native Hawaiians and people of mixed-ethnic ancestries.

Prevalence and risk factors for prolonged QTc in a multiethnic cohort in rural Hawaii

BACKGROUND

Few studies have examined the biochemical risk factors for prolonged QTc, a predictor of mortality in numerous studies. We report on the prevalence and risk factors for prolonged QTc in a multiethnic population in rural Hawaii.

METHODS

Electrocardiograms were collected from 1415 participants in a cross-sectional survey. The QT interval lengths were corrected for heart rate using Bazett's formula. Linear and logistic regression models were used to examine associations between various cardiovascular risk factors with QTc.

RESULTS

Among the CVD risk factors examined, only age, gender, 2-h glucose, and systolic blood pressure (SBP) were independently associated with QTc interval length. Significant ethnic differences in prevalence were also observed, which persisted after controlling for other risk factors.

CONCLUSIONS

Significant associations between prolonged QTc and ethnic ancestry, but not cholesterol or triglyceride levels, suggest that genetic factors may play a more important role in determining QTc interval length than conventional biochemical and metabolic CVD risk factors.

Patient-reported assessments in diabetes care: clinical and research applications

Patient-reported assessments play an increasing role in diabetes care and research today. These assessments are used to evaluate new treatment regimens, explore attitudes, beliefs, and needs of diabetes populations, support inclusion of psychosocial aspects in daily care, and establish new patient-centered standards for quality-of-care improvement initiatives. Much work remains to be done to ensure that these activities will result in improved access to patient-centered diabetes care.