Longitudinal associations between depression and diabetes complications: a systematic review and meta-analysis

Effectiveness of Low Intensity Mental Health Support via a Telehealth Enabled Network (LISTEN) for Adults With Diabetes Distress: A Parallel Group, Pragmatic Randomized Controlled Trial

OBJECTIVE

To assess the effectiveness of Low Intensity mental health Support via a Telehealth Enabled Network (LISTEN), facilitated by diabetes health professionals, for reducing diabetes distress among adults with type 1 or type 2 diabetes.

RESEARCH DESIGN AND METHODS

A two-arm, parallel group, pragmatic randomized controlled trial. Adults with diabetes distress (20-item Problem Areas in Diabetes [PAID] score ≥25, or ≥2 on three or more items) were recruited via the National Diabetes Services Scheme (NDSS) and randomized (1:1) via central randomization by computer to LISTEN (maximum four sessions of problem-solving therapy) or usual care (web-based resources about diabetes and emotional health). Participants completed self-report online surveys at baseline and at 8 and 26 weeks. The primary outcome was the change in diabetes distress (PAID) from baseline to 26 weeks. Secondary outcomes included psychological distress (10-item Kessler Psychological Distress Scale), general emotional well-being (World Health Organization 5-item Well-being Index) and coping self-efficacy at 8 and 26 weeks. Data were analyzed using intention-to-treat principles.

RESULTS

Participants (n = 429, 59% women, 40% men, 1% nonbinary; median age 54 [interquartile range 42.0-63.5]; 37% type 1 diabetes, 63% type 2 diabetes) were enrolled and randomized to the intervention (n = 216) or control group (n = 213). Over 26 weeks, there was a greater reduction in diabetes distress among the LISTEN group versus the control group (mean difference -7.2 [95% CI -11.6, -2.8]; P < 0.001; Cohen f2 = 0.03) and greater improvements in general emotional well-being and coping self-efficacy. No adverse events were reported.

CONCLUSIONS

LISTEN is an effective, low-intensity program, addressing the unmet needs of adults with type 1 and type 2 diabetes experiencing mild-to-moderate diabetes distress.

The impact of depression on healing outcomes in people with diabetes-related foot ulcers: A systematic review

This systematic review examined the impact of depression on healing outcomes among people with diabetes-related foot ulcers (DFUs). A comprehensive search of MEDLINE, APA PsycINFO, CINAHL, Embase, and The Cochrane Library was conducted from inception (1976) to 11 March 2024 to identify eligible studies. The Mixed Methods Appraisal Tool (MMAT) was used to assess study quality, and a narrative synthesis was conducted. We identified 1403 articles, of which 11 were included in the final analysis and included a total of 1392 participants with DFUs. The included studies used diagnostic interviews and screening tools to assess depression, and healing outcomes were described as healed ulcer, change in ulcer size, and/or changes in ulcer severity classification tool scores. Of the 11 studies, five studies (45.5 %) found that there was a significant negative impact (or association) of depression on healing outcomes of DFUs. On the other hand, six studies (54.5 %) showed there was no significant impact or association. Three studies were considered high quality, four studies medium quality, and four studies low quality. Depression may have a significant negative impact on healing outcomes in people with DFUs. However, the existing evidence is still unclear, and further high-quality studies are needed to investigate this impact.

Structural analysis of social behavior: Using cluster analysis to examine personality profile associated with diabetes onset

OBJECTIVE

In this study we tested whether some intrapsychic behaviors of structure of personality can be associated with the onset of Type 2 diabetes (T2-DM).

METHODS

T2-DM Patients (n. 257) and Healthy subjects (n = 258). Test: Social schedule (demographic variables); SASB-Form- Questionnaire A (describing intrapsychic behaviors of personality structure - 8 Clusters-Cl -).

RESULTS

From the logistic model emerged that in subjects with profile 2 "Low Affiliation and Autonomy" compared to profile 2 "Low Autonomy and Self-Care" considering age, education and living conditions effects, the association to the onset of diabetes increases (OR: 1.668). Subjects with profile 2 "Low Affiliation and Autonomy" show low assertiveness and autonomy (SASB-Cl 1); have a medium-low ability to accept and support themselves (medium-low-SASB-Cl 3,4); do not improve their leisure activities or interpersonal relationships because they are too scheduled by things to do (SASB-Cl 4, Cl5); have self-critical behavior (SASB-Cl 6 medium) and self-neglectful behavior - ignore illnesses at an emotional and physical level (Cl8). They occasionally incur in self-destructive behaviors (Cl 7). They may experience self-exhaustion and mild to moderate depression. These are the intrapsychic behaviors associated with onset of diabetes. Another variable associated with the onset of diabetes is high educational level.

CONCLUSIONS

These results suggest that certain personality traits have a great association with T2-DM onset. Furthermore the analysis of intrapsychic modalities in association with the onset of diabetes could constitute a further screening aimed at primary prevention.

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

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

Combined symptoms of diabetes distress, depression, and anxiety and their association with glycemic control in primary care patients with type 2 diabetes in Egypt

Introduction

Existing studies mostly focus on the separate impacts of diabetes distress, depression, and anxiety on glycemic control, leaving a gap in understanding their combined influence within primary care settings. This study aims to explore this interaction among patients with type 2 diabetes mellitus (T2DM) in Egyptian primary healthcare.

Methods

The study was conducted in rural primary healthcare settings in Egypt from September 2020 to June 2021, included 354 patients with T2DM. Sociodemographic, lifestyle, and clinical characteristics were assessed through patient interviews. Diabetes distress was measured using the 5-item Problem Areas in Diabetes Scale (PAID-5 scale), and symptoms of depression and anxiety were evaluated using the Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder 7 Scale (GAD-7), respectively. Glycated hemoglobin (HbA1c) measurements indicated glycemic control.

Results

Participants experienced varying mental health symptoms: 24.9% had one symptom, 8.2% had two, and 4.5% had all three (diabetes distress, depression, and anxiety symptoms). In multiple linear regression, not working status (β = -0.203, p = 0.015), dyslipidemia (β = 0.258, p = 0.021), increased BMI (β = 0.022, p < 0.001), and more mental health symptoms (β = 0.267, p < 0.001) predicted higher HbA1c levels. Ordinal regression found that higher educational levels (OR = 2.385, p = 0.021), sufficient income (OR = 2.360, p = 0.007), and higher HbA1c (OR = 3.103, p < 0.001) predicted more mental health symptoms.

Conclusion

Mental health symptoms were common, and there were reciprocal associations between elevated HbA1c levels and increased mental health symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-025-00793-2.

Clinical and radiographic peri-implant parameters in type-2 diabetic and non-diabetic individuals with major depressive disorder

The aim was to assess the clinical and radiographic peri-implant status among type-2 diabetic and non-diabetic individuals with major depressive disorders (MDD). Participants were divided into four groups; Group-1: patients with type-2 diabetes; Group-2: patients with MDD; Group-3: patients with type-2 diabetes and MDD; Group-4: healthy controls. Demographic data was collected, and medical history including most recent hemoglobin A1c (HbA1c) levels were retrieved from healthcare records. Peri-implant modified plaque and gingival indices (MPI and mGI) and peri-implant probing depth (PPD) were recorded; and crestal bone loss (CBL) was measured. Sample-size was estimated using data from a pilot investigation. Statistical analysis was performed using one way-analysis of variance and Bonferroni Post-hoc adjustment tests. P-vales below 0.05 were considered statistically significant. Thirty, 30, 30 and 30 individuals were included in groups 1, 2, 3 and 4. Mean HbA1c levels were higher in groups 1, 2 and 3 compared with Group-4 (P < 0.05). Thirty-seven, 40, 43 and 36 implants were present in groups 1, 2, 3 and 4, respectively. In groups 1, 2, 3 and 4, the implants were in function for a mean duration of 4.7 ± 2.4, 4.9 ± 1.8, 5.05 ± 1.7 and 10.6 ± 2.2 years, respectively. The mPI, mGI, PPD and CBL were significantly higher in groups 1, 2 and 3 than individuals in Group-4 (P < 0.05). There was significant correlation between peri-implant PD and HbA1c levels among individuals in Group-1 (P < 0.05). Peri-implant soft tissue and osseous statuses are compromised among patients with type-2 DM, and MDD regardless of whether these conditions occur individually or in combination. Clinical relevance: Peri-implant soft tissue and osseous statuses are compromised among patients with type-2 DM, and MDD regardless of whether these conditions occur individually or in combination.

Risk of mortality and complications in people with depressive disorder and diabetes mellitus: A 20-year population-based propensity score-matched cohort study

People with depression have increased premature mortality and elevated prevalence of diabetes-mellitus compared to general population. However, risk of mortality and diabetes-related complications among patients with depression and co-occurring diabetes is under-studied. This population-based propensity score-matched (1:10) cohort study identified 12,175 patients with pre-existing depression and incident-diabetes (depression-diabetes group) and 117,958 patients with incident-diabetes only (diabetes-only group) between 2002 and 2021 in Hong-Kong, using territory-wide medical-record database of public-healthcare services, to investigate whether depression increased the risk of overall mortality, complications and post-complication mortality in people with diabetes. Associations of depression with all-cause mortality, complication and post-complication all-cause mortality rates were examined by Cox proportional-hazards model. Complications were assessed by Diabetes-Complications-Severity-Index (DCSI). Associations of complications, in terms of DCSI scores (complication burden), specific types and two-way combinations of complications (complication patterns) with all-cause mortality rate in depression were also examined. Our results showed that depression-diabetes group exhibited increased all-cause mortality risk (adjusted hazards-ratio: 1.06 [95 %CI: 1.02-1.10]) relative to diabetes-only group, particularly among men and older age group, with significantly higher rate of experiencing neuropathy (1.44 [1.27-1.62]) and metabolic complications (1.30 [1.09-1.56]) and lower likelihood of peripheral-vascular complications, retinopathy and nephropathy, albeit comparable macrovascular and microvascular complication rates. The mortality-rate-ratio for patients with depression and diabetes was significantly higher than patients with diabetes-only at a low level of complication burden. In conclusion, depression patients with co-occurring diabetes are at increased risk of excess mortality. Further research is warranted to improve diabetes-related outcomes and reduce mortality gap in this vulnerable population.

Trends in prevalence and multimorbidity of metabolic, cardiovascular, and chronic kidney diseases among US adults with depression from 2005 to 2020

BACKGROUND

Comorbid depression and cardiometabolic diseases are prevalent and increase risk of mortality. However, trends in the prevalence and multimorbidity of cardiometabolic diseases in depression are unclear.

METHODS

Data of adults aged ≥20 years with depression from the National Health and Nutrition Examination Survey 2005-2020 were analyzed. Joinpoint regression analysis was used to estimate trends in the prevalence of dyslipidemia, hypertension, diabetes, chronic kidney disease, non-alcoholic fatty liver disease, and cardiovascular disease as well as having ≥3 of these diseases. Differences in the prevalence of these diseases in depression vs no depression were assessed using Poisson regressions after applying propensity score weighting.

RESULTS

A total of 3412 adults with depression were included. The prevalence of cardiometabolic diseases as well as having ≥3 diseases remained high and stable in the overall sample from 2005 to 2020 (P for trend >0.05). In 2017-2020, the prevalence ranged from 17.1 % (95 % CI, 12.7 %-21.5 %) for cardiovascular disease to 58.4 % (95 % CI, 50.4 %-66.3 %) for dyslipidemia; 40.7 % (95 % CI, 34.4 %-46.9 %) had ≥3 diseases. The prevalence of diabetes, cardiovascular disease, and having≥3 diseases was 23 %-85 % higher in adults with depression than those without.

LIMITATIONS

The utilization of self-reported data and/or one-time laboratory measurements may misclassify participants.

CONCLUSIONS

Prevalence of cardiometabolic diseases was high and multimorbidity was common in US adults with depression. Addressing the prevention, treatment, and management of cardiometabolic diseases in depression requires greater public health and clinical attention.

Pharmacologically treated depression, anxiety, and insomnia in individuals with type 2 diabetes: The role of diabetes duration, age, and age at diabetes onset. A Norwegian population-based registry study from the OMIT cohort

OBJECTIVE

To examine whether type 2 diabetes (T2D) duration ('0-4'; '≥5-9'; ≥10-19'; '≥20 years') was associated with use of medication for depression, anxiety, or insomnia, and if possible associations were modified by age, age at T2D onset, sex, and education.

METHODS

We used data from 55,083 adults with T2D in the national registry-based cohort study Outcomes & Multi-morbidity In T2D (2006-2019). Adjusted associations and effect modifications were estimated using binary logistic regressions with generalized estimation equations in the subgroups age (<60, ≥60 years), age at diabetes onset (<40, ≥40 years), sex (men, women), and education (primary, high school, university).

RESULTS

At initial registration, 12 % used medication for depression, 10 % for anxiety, and 16 % for insomnia. These prevalence estimates increased with diabetes duration in most subgroups. Individuals with early onset T2D had higher prevalence of depression than those with late onset, which increased with diabetes duration (per category change diabetes duration 0.7 % (95 % CI 0.2, 1.2), P for trend = 0.003). For anxiety and insomnia, a stronger association was found in those with early T2D onset compared to late onset (per category change 1.3 % (95 % CI 0.9, 1.8) and 1.9 (95 % CI 1.3, 2.4), P for interaction = 0.001; 0.01).

CONCLUSION

The prevalence of pharmacologically treated depression, anxiety, and insomnia increased with diabetes duration; this finding may imply that assessment of mental health disorders at the initial phase and along the diabetes trajectory are needed. As the prevalences advanced most prominently in people with early onset T2D, future studies should determine underlying mechanisms to test age-appropriate preventive interventions.

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

AIMS/HYPOTHESIS

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

METHODS

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

RESULTS

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

CONCLUSION/INTERPRETATION

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

TRIAL REGISTRATION

ClinicalTrials.gov NCT01794143.

The Interconnected Complexity of Diabetes and Depression

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

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Socioeconomic inequality in the outcomes of a psychological intervention for depression for South Africans with a co-occurring chronic disease: A decomposition analysis

Task-shared psychological interventions are effective for reducing the severity of depression symptoms, but differences in treatment outcome by socioeconomic status is uncertain. This study examines socioeconomic inequalities (SEI) in depression outcomes among people with HIV and/or diabetes who participated in a cluster randomised controlled trial in the Western Cape Province of South Africa. The trial took place at 24 primary care clinics randomised to deliver a task-shared psychological intervention or treatment as usual (TAU). The trial enrolled 1119 participants meeting criteria for probable depression. Depression symptom severity was evaluated at baseline and 24-month follow-up. Using a concentration index (CI), SEIs in depression were assessed for the intervention and TAU arms. Demographic and socioeconomic variables were used to decompose the CI to identify contributors to SEI. Results indicate poorer participants at the intervention arm have significantly worse 24-month outcomes than wealthier counterparts (CI = - 0.080; SE = 0.025). Race (34.2%), unemployment (17.4%) and food insecurity (15%) were the main contributing factors. While policymakers need to invest in psychological interventions to reduce the burden caused by depression, this study suggests treatment outcomes may be different across the socioeconomic spectrum. Decomposition of these findings points to structural constraints, such as unemployment, as the key contributors towards poorer treatment outcomes. These findings suggest a need to combine psychological interventions with structural interventions that address the broader socio-economic determinants of mental health.

A Narrative Review: Relationship Between Glycemic Variability and Emerging Complications of Diabetes Mellitus

A growing body of evidence emphasizes the role of glycemic variability (GV) in the development of conventional diabetes-related complications. Furthermore, advancements in diabetes management and increased life expectancy have led to the emergence of new complications, such as cancer, liver disease, fractures, infections, and cognitive dysfunction. GV is considered to exacerbate oxidative stress and inflammation, acting as a major mechanism underlying these complications. However, few reviews have synthesized the association between GV and these emerging complications or examined their underlying mechanisms. Hence, this narrative review provides a comprehensive discussion of the burden, risks, and mechanisms of GV in these complications, offering further evidence supporting GV as a potential therapeutic target for diabetes management.

Associations between biomarkers of inflammation and depressive symptoms-potential differences between diabetes types and symptom clusters of depression

Inflammation is a probable biological pathway underlying the relationship between diabetes and depression, but data on differences between diabetes types and symptom clusters of depression are scarce. Therefore, this cross-sectional study aimed to compare associations of a multimarker panel of biomarkers of inflammation with depressive symptoms and its symptom clusters between people with type 1 diabetes (T1D) and type 2 diabetes (T2D). This cross-sectional study combined data from five studies including 1260 participants (n = 706 T1D, n = 454 T2D). Depressive symptoms were assessed using the Center for Epidemiological Studies-Depression Scale (CES-D). Serum levels of 92 biomarkers of inflammation were quantified with proximity extension assay technology. After quality control, 76 biomarkers of inflammation remained for statistical analysis. Associations between biomarkers and depressive symptom scores and clusters (cognitive-affective, somatic, anhedonia) were estimated with multivariable linear regression models. Nine biomarkers were positively associated with depressive symptoms in the total sample (CCL11/eotaxin, CCL25, CDCP1, FGF-21, IL-8, IL-10RB, IL-18, MMP-10, TNFRSF9; all p < 0.05) without interaction by diabetes type. Associations differed for eight biomarkers (pinteraction < 0.05). TNFβ was inversely associated with depressive symptoms in T1D, whereas three biomarkers (GDNF, IL-18R1, LIF-R) were positively associated with depressive symptoms in T2D. For the remaining four biomarkers (CD6, CD244, FGF-5, IFNγ) associations were not significant in either subgroup. Biomarker associations were more pronounced with somatic and anhedonia than with cognitive-affective symptoms. These results indicate that different proinflammatory pathways may contribute to depression in T1D and T2D and that there may be a symptom specificity in the link between subclinical inflammation and depression.

Psychological interventions for depression in people with diabetes mellitus

OBJECTIVES

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

Depressive symptoms are not longitudinally associated with joint glycemic, blood pressure and cholesterol control among middle-aged and older adults with diabetes in USA

BACKGROUND

Depression co-occurs with diabetes at twice the rate, relative to the general population without diabetes but it is unknown whether depression is longitudinally associated with diabetes control in the general population.

PURPOSE

To characterize the longitudinal association between depressive symptoms and joint achievement of glycemic, blood pressure (BP), and cholesterol control (ABC control) among middle-aged and older adults (≥50 years) with diabetes in United States.

METHODS

Data of the nationally representative Health and Retirement Study 2006-2017 were pooled across study waves conducted every 2 years. Center for Epidemiological Studies Depression (CES-D8) scale was used to assess baseline depressive symptoms (≥3 points). Joint ABC control 4 years later was ascertained using HbA1c (<7.0% [53 mmol/mol] if <65 years, <7.5% [58 mmol/mol] if ≥65 years or <8.0% [64 mmol/mol] with comorbidities), BP (systolic < 140 and diastolic < 90 mm Hg), and non-HDL cholesterol (<130 mg/dL). Survey-weighted modified Poisson regressions were used to study the association (risk ratios [RR]) of depressive symptoms with ABC control.

RESULTS

The study sample consisted of 3 332 observations from 2 531 individuals (mean age: 64.4 years [SD: 8.8], 55.4% women). Depressive symptoms were neither associated with the achievement of joint ABC control (RR: 0.91 [95% CI, 0.76-1.09]) nor achievement of glycemic, BP or cholesterol control after adjusting for covariates. Findings were consistent across various subgroups defined by age, gender, baseline ABC control, medication use, and duration of diabetes.

CONCLUSIONS

Baseline depressive symptoms do not compromise future diabetes management. Care models should focus on both conditions independently to potentially improve overall health.

Association between major depressive disorder or depressive symptoms and the risk of vascular complications among patients with type 2 diabetes, and the mediating role of metabolic biomarkers: an analysis of the UK Biobank cohort

Background

Depression is a severe mental disorder commonly co-morbid with diabetes, but it remains to elucidate whether depression is associated with the risks of a wide range of vascular complications in people with type 2 diabetes mellitus (T2DM) and whether metabolic biomarkers may mediate this pathway.

Methods

We conducted this prospective analysis among the participants of the UK Biobank who were diagnosed with T2DM and free of vascular complications at baseline between March 13, 2006 and September 30, 2010. Major depressive disorder (MDD) was ascertained according to the hospital admission records and self-report of doctor-diagnosed conditions, while the presence of depressive symptoms was assessed using the Patient Health Questionnaire-2. Cox proportional hazards models were performed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of MDD and depressive symptoms with the risks of incident heart failure (HF); total and individual atherosclerotic cardiovascular disease (ASCVD) including coronary artery disease (CAD), ischemic stroke (IS), and peripheral artery disease (PAD); total and individual microvascular complications of diabetic kidney disease (DKD), diabetic retinopathy (DR), and diabetic neuropathy (DN). Mediation analyses were conducted to quantify the potential mediation effects of circulating metabolites (involved in insulin-resistance, lipid profile, liver function, renal function, and inflammation) in the association of MDD with the outcomes.

Findings

Of the total 23,856 patients with T2DM in the UK Biobank, 13,706 participants (61% males) were eligible and included in this study. During an average of 13 years of follow-up, 2927 (21.36%) ASCVD, 1070 (7.81%) HF, and 2579 (18.82%) microvascular complications occurred. The adjusted HR (95% CI) for MDD was 1.32 (1.09-1.61) with HF, 1.17 (1.03-1.32) with ASCVD, and 1.29 (1.14-1.46) with microvascular complications, while those for depressive symptoms were 1.47 (1.20-1.79), 1.25 (1.10-1.42) and 1.20 (1.05-1.37), respectively. The HRs ranged from 1.26 (1.09-1.44) to 1.96 (1.57-2.45) for MDD with individual complications and mortality, and from 1.26 (1.08-1.47) to 1.49 (1.16-1.93) for depressive symptoms. Up to 7.8% of adverse complications were attributable to MDD and 3.8% to depressive symptoms. A series of circulating metabolites involving lipid profile, renal function, and inflammation were observed to mediate the associations of MDD with vascular complications. The identified mediators jointly accounted for 7.29%-26.87% of the disparities in incident vascular complications between patients with and without MDD.

Interpretation

Our findings highlight the role of MDD and depressive symptoms in the development of vascular complications among people with T2DM, and suggest that the effect of improving mental health on vascular outcomes in patients with T2DM should be investigated in future work.

Funding

Three-Year Public Health Action Plan of Shanghai.

Exploring the DPP IV inhibitory potential: molecular docking and dynamic simulations of pyridine-3-carboxylic acid and pyrrolidine-2-carboxylic acid analogs

Diabetes mellitus remains a global challenge, with Type 2 Diabetes Mellitus (T2DM) prevalence increasing from 4% to 6.4% in the past 30 years. Presently oral hypoglycaemic agents like GLP-1 agonists, biguanides, sulphonylureas, glinides, and thiazolidinediones are employed in clinical practice. Very recently, novel targets including Dipeptidyl peptidase IV (DPP IV), PPAR, GIP, FFA1, and melatonin have been in the limelight for the development of novel treatment strategies. The present study focuses on the development of DPP IV inhibitors through computational approaches. DPP IV, also referred to as CD26 (cluster of differentiation 26) or adenosine deaminase complexing protein 2, is a protein that is encoded by the DPP IV gene in humans. This enzyme is involved in the metabolism of incretin hormones such as glucagon-like peptides (GLP-1). DPP IV inhibitors prevent the degradation of GLP-1, glucose-dependent insulinotropic peptide (GIP), thereby controlling the concentration of glucose in the blood. Considering the safety and efficacy of DPP IV inhibitors newer molecules were designed with better binding affinity with the protein as compared to existing Sitagliptin, and Vildagliptin-like drugs. Derivatives of nicotinic acid and proline were designed and studied using molecular docking and dynamic simulations. Docking results demonstrated that the NA-13 molecule possesses potent binding affinity with target protein 6B1E (-38.1498 kcal/mol) as compared to standard Sitagliptin (-33.3187 kcal/mol). MD simulation studies showcased that there are fewer variations of RMSD and RMSF for 6B1E-NA-13, 6B1E-P1, and 6B1E-P7 complexes, suggesting the potential of the designed DPP IV inhibitors in the management of T2DM.

National Incidence of Nurse Suicide and Associated Features

OBJECTIVES

The aim of this study was to estimate the national incidence of nurse suicide.

BACKGROUND

Nurses are at a higher risk of suicide than nonnurses; however, data have been limited since 2018.

METHODS

This study used a retrospective cohort design using 2017-2021 National Violent Death Reporting System suicides.

RESULTS

Female nurses had higher suicide rates than female nonnurses in 2018 (incidence rate ratio, 1.21 [95% confidence interval (CI), 1.05-1.39]), 2019 (1.41 [95% CI, 1.23-1.60]), 2020 (1.26 [95% CI, 1.08-1.45]), and 2021 (1.35 [95% CI, 1.17-1.55]), whereas male nurses were comparable with male nonnurses. Nurses had higher odds of mental health problems (adjusted odds ratio, 1.28 [95% CI, 1.13-1.46], P < .001), job problems (1.60 [95% CI, 1.33-1.92], P < .001), and use of poisoning (1.54 [95% CI, 1.37-1.74], P < .001). Nurses had higher odds of using opioids, cardiovascular/diabetic agents, and drugs not prescribed for home use.

CONCLUSION

Female nurses are at a higher risk of suicide than other females. Multimodal nurse suicide prevention strategies remain indicated.

Nurse-Led Telephone Program for Nonadherent to Treatment Type 2 Diabetics With Comorbid Depression: A Cost-Consequence and Budget Impact Analysis

Objective: To estimate the efficiency of a nurse-led telephone program for nonadherent to treatment Type 2 diabetics with comorbid depression (TELE-DD program). Design: Secondary analysis of cost-consequence and budget impact, utilizing data from a randomized clinical trial conducted in the primary healthcare setting. The target population consisted of Type 2 diabetic patients with comorbid depression who were nonadherent to their pharmacological treatment. Method: The average cost per controlled patient (glycated hemoglobin < 7%) and the incremental cost-effectiveness ratio were calculated. Similarly, the budgetary impact over 1 year of implementing this program in the region of reference of the randomized clinical trial was assessed. Results: The number of controlled patients is higher in the TELE-DD group at 6, 12, and 18 months. The average cost per controlled patient was higher in the TELE-DD group than in the control group at 6 months (€160.31 vs. €49.79), but lower at 12 (€150.09 vs. €179.59) and 18 months (€209.22 vs. €376.88). The incremental cost-effectiveness ratio at 6, 12, and 18 months was €254.47, €143.65, and €177.46, respectively. The budget impact analysis revealed that implementing the TELE-DD program would result in a reduction of €721,940.68 in expenditure for the funder in the first year of application. Conclusions: A nurse-led telephone program for nonadherent Type 2 diabetics with comorbid depression is an efficient option in the management of healthcare resources. These results highlight the role of nursing in chronic patient management and the efficient use of healthcare resources. Trial Registration: ClinicalTrials.gov Identifier: NCT04097483.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Antidepressant and antipsychotic prescribing in patients with type 2 diabetes in Scotland: A time-trend analysis from 2004 to 2021

AIMS

Prescribing of antidepressant and antipsychotic drugs in general populations has increased in the United Kingdom, but prescribing trends in people with type 2 diabetes (T2D) have not previously been investigated. The aim of this study was to describe time trends in annual prevalence of antidepressant and antipsychotic drug prescribing in adult patients with T2D.

METHODS

We conducted repeated annual cross-sectional analysesof a population-based diabetes registry with 99% coverage, derived from primary and secondary care data in Scotland, from 2004 to 2021. For each cross-sectional calendar year time period, we calculated the prevalence of antidepressant and antipsychotic drug prescribing, overall and by sociodemographic characteristics and drug subtype.

RESULTS

The number of patients with a T2D diagnosis in Scotland increased from 161 915 in 2004 to 309 288 in 2021. Prevalence of antidepressant and antipsychotic prescribing in patients with T2D increased markedly between 2004 and 2021 (from 20.0 per 100 person-years to 33.3 per 100 person-years and from 2.8 per 100 person-years to 4.7 per 100 person-years, respectively). We observed this pattern for all drug subtypes except for first-generation antipsychotics, prescribing of which remained largely stable. The degree of increase, as well as the overall prevalence of prescribing, differed by age, sex, socioeconomic status and subtype of drug class.

CONCLUSIONS

There has been a marked increase in the prevalence of antidepressant and antipsychotic prescribing in patients with T2D in Scotland. Further research should identify the reasons for this increase, including indication for use and the extent to which this reflects increases in incident prescribing rather than increased duration.

Anger Expression Styles, Cynical Hostility, and the Risk for the Development of Type 2 Diabetes or Diabetes-Related Heart Complications: Secondary Analysis of the Health and Retirement Study

OBJECTIVE

Limited research has examined associations between trait anger and hostility and incident type 2 diabetes (T2D) and diabetes-related heart complications. However, anger expression styles (i.e., anger-in, anger-out) have not been examined. The present study used secondary data to examine the associations between anger expression styles, cynical hostility, and the risk of developing T2D (objective 1) or diabetes-related heart complications (objective 2).

METHODS

Self-report data came from participants aged 50 to 75 years in the Health and Retirement Study. Anger-in (anger that is suppressed and directed toward oneself, anger-out (anger directed toward other people or the environment), and cynical hostility were measured at baseline (2006 or 2008). Follow-up data (i.e., diabetes status or diabetes-related heart complications status) were collected every 2 years thereafter until 2020. The objective 1 sample included 7898 participants without T2D at baseline, whereas the objective 2 sample included 1340 participants with T2D but without heart complications at baseline.

RESULTS

Only anger-in was significantly associated with incident T2D after controlling for sociodemographic characteristics (hazard ratio = 1.08, 95% confidence interval = 1.01-1.16), but the association did not hold after further adjustment for depressive symptoms. Only anger-out was significantly associated with incident diabetes-related heart complications after adjusting for sociodemographic characteristics, health-related covariates, and depressive symptoms (hazard ratio = 1.21, 95% confidence interval = 1.02-1.39).

CONCLUSIONS

Anger expression styles were differentially related to diabetes outcomes. These findings demonstrate the value of expanding the operationalization of anger beyond trait anger in this literature and encourage further investigation of anger expression styles.

Incidence of depression in patients with cardiovascular disease and type 2 diabetes: a nationwide cohort study

BACKGROUND

Estimating how type 2 diabetes (T2D) affects the rate of depression in cardiovascular disease (CVD) can help identify high-risk patients. The aim is to investigate how T2D affects the rate of depression according to specific subtypes of CVD.

METHODS

Incident CVD patients, free of psychiatric disease, with and without T2D, were included from nationwide registries between 2010 and 2020. We followed patients from CVD diagnosis until the first occurrence of depression, emigration, death, 5 years, or end of study (December 31, 2021). We used time-dependent Poisson regression to estimate the incidence rates and rate ratios (IRR) of depression following subtypes of CVD with and without T2D. The model included age, sex, comorbidities, calendar year, T2D duration, educational level, and living situation as covariates.

RESULTS

A total of 165,096 patients were included; 45,845 had a myocardial infarction (MI), 63,691 had a stroke, 19,959 had peripheral artery disease (PAD), 35,568 had heart failure (HF), and 979 were diagnosed with 2 or more CVD subtypes (= > 2 CVD's). Baseline T2D in each CVD subtype ranged from 11 to 17%. The crude incidence rate of depression per 1000 person-years (95% confidence intervals) was: MI + T2D: 131.1 (109.6;155.6), MI: 82.1 (65.3;101.9), stroke + T2D: 287.4 (255.1;322.6), stroke: 222.4(194.1;253.6), PAD + T2D: 173.6 (148.7;201.4), PAD:137.5 (115.5;162.5), HF + T2D: 244.3 (214.6;276.9), HF: 199.2 (172.5;228.9), =  > 2 CVD's + T2D: 427.7 (388.1;470.2), =  > 2 CVD's: 372.1 (335.2;411.9). The adjusted IRR of depression in MI, stroke, PAD, HF, and =  > 2 CVD's with T2D compared to those free of T2D was: 1.29 (1.23;1.35), 1.09 (1.06;1.12), 1.18 (1.13;1.24), 1.05 (1.02;1.09), and 1.04 (0.85;1.27) (p-value for interaction < 0.001).

CONCLUSION

The presence of T2D increased the rate of depression differently among CVD subtypes, most notable in patients with MI and PAD.

Improvement in symptoms of anxiety and depression in individuals with type 2 diabetes: retrospective analysis of an intensive lifestyle modification program

BACKGROUND

Type 2 diabetes (T2D) is a chronic metabolic disorder that has a notable influence on mental well-being, contributing to elevated morbidity and mortality rates. Depression and anxiety disorders are the most common mental health concerns among patients with T2D worldwide. Therefore, the present study aimed to assess the impact of an online intensive lifestyle intervention (ILI) on mental health outcomes (depression and anxiety) in patients with T2D in India.

MATERIALS AND METHODS

This retrospective pre-post analysis included adult patients (aged > 18 years) diagnosed with T2D who were enrolled in a diabetes management program in India between June 2021 and June 2023. The intervention consisted of lifestyle modifications such as a customized plant-based diet, regular physical activity, psychological support through group and individual therapy, and medical management. Data were extracted from the electronic database of the clinic, including anthropometry, medical history, biochemical parameters, symptoms of depression, and anxiety (assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorders-7 (GAD-7) scale) at the start and end of the six-month intervention period.

RESULTS

Of the 1061 eligible patients (177 with prediabetes), 40.3% were female. The mean age, duration of diabetes, and HbA1c levels were 52 ± 10.4 years, 9.8 ± 7.8 years, and 8 ± 1.7%, respectively. The prevalence of symptoms of depression and anxiety (ranging from mild to severe) was 46% and 44.3%, respectively, which reduced to 28.7% and 29.2%, respectively, post-intervention.

CONCLUSION

Integrated ILI successfully improved the symptoms of anxiety and depression, highlighting the importance of a multidisciplinary approach that includes diet, physical activity, psychological support, and medical management in enhancing mental health outcomes among patients with T2D. Future prospective studies are needed to explore the long-term effects of such interventions and develop effective strategies for promoting mental health in diverse populations.

TRIAL REGISTRATION

The study was approved by the Freedom from Diabetes Research Foundation Institutional Ethics Committee (approval number FFDRF/IEC/2024/7) and registered in the Clinical Trials Registry of India (CTRI/2024/03/064596, registered on March 21, 2024).

Antidepressant effect of carvedilol on streptozotocin-induced diabetic peripheral neuropathy mice by altering gut microbiota

RATIONALE

Although diabetic peripheral neuropathic pain (DPNP) and depression have been recognized for many years, their co-morbidity relationship and effective treatment choices remain uncertain.

OBJECTIVES

To evaluate the antidepressant effect of carvedilol on streptozotocin-induced DPNP mice, and the relationship with gut microbiota.

METHODS

The hyperalgesia and depressive behaviors of mice with comorbidity of DPNP and depression were confirmed by pain threshold of the mechanical sensitivity test (MST), immobility time of the tail suspension test (TST) and the forced swimming test (FST). The anti-depressive effect and fecal gut microbiota composition were studied in DPNP mice treated with carvedilol (10 mg/kg/day), and the relationships between them were analyzed by Spearman's correlation.

RESULTS

Depression was successfully induced in DPNP mice. Carvedilol can reverse the decreased mechanical pain threshold and relieve the depressive behaviors of DPNP mice, while increasing the abundance of Prevotella, Ruminococcus, Helicobacter and Desulfovibrio, and decreasing the abundance of Akkermansia and Allobaculum.

CONCLUSIONS

Carvedilol can alleviate the mechanical hyperalgesia and alter gut microbiota to ameliorate the depression-like behaviors which induced by DPNP.

Bidirectional relationship between diabetes mellitus and depression: Mechanisms and epidemiology

Diabetes mellitus and depression exhibit a complex bidirectional relationship that profoundly impacts patient health and quality of life. This review explores the physiological mechanisms, including inflammation, oxidative stress, and neuroendocrine dysregulation, that link these conditions. Psychosocial factors such as social support and lifestyle choices also contribute significantly. Epidemiological insights reveal a higher prevalence of depression among diabetics and an increased risk of diabetes in depressed individuals, influenced by demographic variables. Integrated management strategies combining mental health assessments and personalized treatments are essential. Future research should focus on longitudinal and multi-omics studies to deepen understanding and improve therapeutic outcomes.

Age differences in prosociality across the adult lifespan: A meta-analysis

Lifespan developmental theories and research suggest a positive effect of adult age on prosociality. However, this effect lacks consistency, with many studies excluding the period of midlife. This study summarized cross-sectional studies on adult age and prosociality, combining 120 (independent) samples (n = 103,829) in a lifespan meta-analysis approach. Linear and quadratic age effects on prosociality were analyzed, as well as comparisons between younger, middle-aged, and older adults. Prosociality was assessed via behavioral measures and self-reports. In both these domains, results indicated small linear age effects and higher prosociality in older compared to younger adults, supporting the hypothesis of increased prosociality in older age. Additionally, leveraging open data sets (64/120 independent samples), predominantly unpublished, we found some evidence for potential quadratic age effects on behavioral prosociality: Middle-aged adults exhibited higher behavioral and self-reported prosociality than younger adults, but no differences between middle-aged and older adults were observed. This meta-analysis offers new perspectives on age trajectories of prosociality, suggesting midlife as a potentially important phase of pronounced prosociality.

Analysis of health recommendations using longitudinal quality of life data: QoL@TbA - A transformer-based approach

Objective: Health recommendation systems suggest behavioral modifications to improve quality of life. However, current approaches do not facilitate the generation or examination of such recommendations considering the multifeature longitudinal evolution of behaviors. This paper proposes the use of a deep learning transformer-based model that allows the analysis of recommendations for behavior changes. Methods: We adapted a prediction approach, namely Behavior Sequence Transformer (BST), which analyzes temporal human routines and patterns, generating inductive outcomes. The evaluation relied on a case study that employed the behavioral history and profile of the English Longitudinal Study of Ageing (ELSA) participants (n = 2682), predicting their psychological mood (normal, pre-depressed, depressed) according to input recommendations for behavioral changes. Root mean squared error (RMSE) and learning curves were used to track the recommendation accuracy evolution and possible overfitting problems. Results: Experiments demonstrated lower RMSE values for the multifeature model (0.28/0.03) when compared to its single-feature versions (marital status, 0.59/0.001), (high pressure, 0.357/0.04), (diabetes, 0.36/0.01), (sleep quality, 0.57/0.02), (level of physical activity, 0.57/0.01). Conclusions: The results demonstrate the architecture's capability to analyze multifeatured longitudinal data, supporting the generation of suggestions for concurrent modifications across multiple input features. Moreover, these suggestions align with findings in specialized literature.

Treatment adherence and wellness, nutrition, and physical activity outcomes of diabetic patients with comorbid depression during the 18-month follow-up of the TELE-DD study

BACKGROUND

A good adherence to pharmacological treatment in chronic pathologies such as type 2 diabetes and clinical depression is essential to improve illness prognosis.

AIMS

The main goal of the TELE-DD study was to analyze the effectiveness of a telephone, psychoeducational, and individualized intervention carried out by nurses in patients with type 2 diabetes mellitus and comorbid clinical depression with prior nonadherence to pharmacological treatment. In this paper, we describe and analyze secondary outcomes of the trial intervention.

METHODS

A prospective cohort study was used to assess the effectiveness of a telephonic intervention (IG) in n = 191 participants with a similar control group (CG). Adherence to pharmacological treatment was assessed using the patient's self-perceived adherence questionnaire. In addition to clinical (HbAc1, HDL, LDL), physical (body mass index, blood pressure) and psychological measures (Patient Health Questionnaire-9 affective state), and psychosocial distress due to Diabetes Distress Scale Questionnaire at 3, 6, 12, and 18 months of follow-up were also analyzed.

RESULTS

The proportion of "Total Adherents" in the IG was higher throughout the study. This was particularly true at month 18 of the intervention. Self-perceived adherence rates increased by 27.1% in the IG and by 1.1% in the CG. Results of clinical and physical measures were higher in the IG than in the CG at month 18 of the intervention.

LINKING EVIDENCE TO ACTION

The interview based on positive reinforcement as well as individualized attention and flexibility in making telephone calls and dissemination of the intervention in the media closest to the patients were key to achieving good participation and collaboration as well as continuity in adherence to treatment and self-care.

Factors affecting the survival of prediabetic patients: comparison of Cox proportional hazards model and random survival forest method

BACKGROUND

The worldwide prevalence of type 2 diabetes mellitus in adults is experiencing a rapid increase. This study aimed to identify the factors affecting the survival of prediabetic patients using a comparison of the Cox proportional hazards model (CPH) and the Random survival forest (RSF).

METHOD

This prospective cohort study was performed on 746 prediabetics in southwest Iran. The demographic, lifestyle, and clinical data of the participants were recorded. The CPH and RSF models were used to determine the patients' survival. Furthermore, the concordance index (C-index) and time-dependent receiver operating characteristic (ROC) curve were employed to compare the performance of the Cox proportional hazards (CPH) model and the random survival forest (RSF) model.

RESULTS

The 5-year cumulative T2DM incidence was 12.73%. Based on the results of the CPH model, NAFLD (HR = 1.74, 95% CI: 1.06, 2.85), FBS (HR = 1.008, 95% CI: 1.005, 1.012) and increased abdominal fat (HR = 1.02, 95% CI: 1.01, 1.04) were directly associated with diabetes occurrence in prediabetic patients. The RSF model suggests that factors including FBS, waist circumference, depression, NAFLD, afternoon sleep, and female gender are the most important variables that predict diabetes. The C-index indicated that the RSF model has a higher percentage of agreement than the CPH model, and in the weighted Brier Score index, the RSF model had less error than the Kaplan-Meier and CPH model.

CONCLUSION

Our findings show that the incidence of diabetes was alarmingly high in Iran. The results suggested that several demographic and clinical factors are associated with diabetes occurrence in prediabetic patients. The high-risk population needs special measures for screening and care programs.

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

OBJECTIVE

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

RESEARCH DESIGN AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

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

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

Depression literacy, mental health literacy, and their relationship with psychological status and quality of life in patients with type 2 diabetes mellitus

Background

This study was conducted to measure depression literacy (D-Lit) and mental health literacy (MHL) and to investigate their relationship with psychological status and quality of life among Iranian patients with type 2 diabetes mellitus (T2DM).

Methods

This cross-sectional study was conducted in 2021 among 400 patients with T2DM in Iran. Samples were selected using proportional stratified sampling. Data collection tools comprised a demographic questionnaire, measures of MHL and D-Lit, the diabetes quality of life (DQOL) scale, and the DASS-21. After confirming the normality of the data using the Kolmogorov-Smirnov test, parametric statistical tests (such as one-way ANOVA, independent samples t-test, and Chi-Square) were used to investigate the relationship between the variables using SPSS v22 software. The results of continuous quantitative data are reported in the form of means and standard deviations, and qualitative data are reported in the form of absolute and relative frequencies.

Results

In this study, 10.25% of the participants (n = 41) had severe depression, while 36.75% (n = 147) experienced severe anxiety. The mean (standard deviation) of MHL was 80.92 (9.16) from 130 points. Of the participants, only 1.7% (n = 7) did not answer any questions correctly on the D-lit scale, and only 5.8% (n = 23) were able to answer 15 questions or more correctly on the D-lit. MHL had a significant negative correlation with depression (r = -0.236), anxiety (r = -0.243), and stress (r = -0.155) (P < 0.001). There was a positive and significant correlation between MHL and D-Lit (r = 0.186) (P < 0.001). D-Lit had a significant negative correlation with depression (r = -0.192), anxiety (r = -0.238), and stress (r = -0.156) (P < 0.001). There was a positive and significant correlation between the ability to recognize disorders (r = 0.163), knowledge of self-treatment (r = 0.154), and DQOL (P < 0.001). Depression (r = -0.251), anxiety (r = -0.257), and stress (r = -0.203) had a significant negative correlation with DQOL (P < 0.001).

Conclusion

MHL and D-Lit levels were found to be inadequate in patients with T2DM. These low levels of MHL and D-Lit among patients with T2DM were associated with higher levels of anxiety, depression, and stress, as well as a lower quality of life. Therefore, designing and implementing preventive programs to improve the mental health of patients with T2DM can help prevent mental disorders and ultimately improve their quality of life.

Korean National Burden of Disease: The Importance of Diabetes Management

Diagnosing the current health status and disease burden in a population is crucial for public health interventions. The ability to compare the burden of different diseases through a single measure, such as disability-adjusted life years has become feasible and continues to be produced and updated through the Global Burden of Diseases (GBD) study. However, the disease burden values of the GBD study do not accurately reflect the unique situation in a specific country with various circumstances. In response, the Korean National Burden of Disease (KNBD) study was conducted to estimate the disease burden in Koreans by considering Korea's cultural context and utilizing the available data sources at the national level. Both studies identified non-communicable diseases, such as diabetes mellitus (DM), as the primary cause of disease burden among Koreans. However, the extent of public health interventions currently being conducted by the central and local governments does not align with the severity of the disease burden. This review suggests that despite the high burden of DM in South Korea, the current policies may not fully address its impact, underscoring the need for expanded chronic disease management programs and a shift towards prevention-focused healthcare paradigms.

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

INTRODUCTION

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

RESEARCH DESIGN AND METHODS

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

ETHICS AND DISSEMINATION

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

TRIAL REGISTRATION NUMBER

CTRI/2022/10/046411.

Study of cognitive functions and their association with depression in type II diabetes mellitus

Introduction

Individuals with diabetes have higher risk of developing depression, cognitive impairment, and dementia compared to those who do not have diabetes. The present study aims to assess the level of cognitive functions and the presence of depression in diabetes patients and healthy controls. The study also explores the level of cognition among the normal control, diabetes without depression, and diabetes with depression.

Methods

In the present study, the presence of depression and the level of cognitive functions of 59 cases of diabetes mellitus type-2 were compared with an age- and gender-matched control group of 40 individuals. Clinical and demographic details were recorded on a semi-structured performa. Montreal Cognitive Assessment (MoCA) and Patient Health Questionnaire-9 (PHQ-9) were applied to both diabetes patients and healthy controls to assess the level of cognitive functions and the presence of depression, respectively.

Results

On applying odds ratio (OR), it was observed in the present study that there were 93.50% more chances [OR 1.935 with 95% confidence interval (CI) being 0.481-7.789] of depression among diabetic cases as compared to the control group. Similarly, the chance of MoCA score being less than 26 was twice among the diabetic group as compared to the control group (OR 2.208 with 95% CI being 0.702-6.946). On application of the Chi-square test, the association of depression was significant with HBA1C level, level of education, and presence of complications.

Conclusions

Patients with diabetes had almost double the risk of developing depression and poor cognitive functions as compared to the healthy control. High HbA1C level, level of education, and presence of complication in diabetes had a positive statistical association with depression. Thus, it is advisable to investigate patients with diabetes for the presence of depression and cognitive dysfunction by applying simple tools.

Psychosocial and clinical factors associated with depression among diabetic patients in Amhara region comprehensive specialized hospitals, Ethiopia, 2022; a multicenter prevalence study

Background

Depression commonly coexists with diabetes leads to complications and worsens the outcome. Even though the problem affects low- and middle-income countries including Ethiopia, only a few studies have been done to show the magnitude of the problem and factors associated with it. So, the study was conducted to fill those gaps.

Objective

The main objective of this study was to assess psychosocial and clinical factors associated with depression among diabetic patients in Amhara region comprehensive specialized hospitals, Ethiopia, 2022.

Methods

A hospital-based cross-sectional study was conducted in randomly selected hospitals of Amhara region from January 7 to February 10, 2022. A total of 426 diabetic patients who were on outpatient follow-up were selected using a multistage sampling technique. A p-value of ≤0.25 in the bivariable analysis was used to select variables for the multivariable analysis. A p-value < 0.05 within a 95% confidence interval was considered to be significantly associated factors.

Result

Out of 426 interviewed diabetes patients 203 (47.7%) had depression. Moderate physical activity (AOR = 0.50, 95% CI (0.29, 0.86)). low medication adherence (AOR = 2.10, 95% CI (1.22, 3.62)), medium medication adherence (AOR = 1.78, 95% CI (1.04, 3.06)), and high social support (AOR = 0.54, 95% CI (0.33, 0.91)) were significantly associated with depression among diabetic patients.

Conclusion

The overall prevalence of depression among diabetic patients was higher than in other developing countries. Hence, special attention to preventing depression and maintaining mental illness among patients with chronic illnesses, especially diabetes should be given.

The impact of major depressive disorder on glycaemic control in type 2 diabetes: a longitudinal cohort study using UK Biobank primary care records

BACKGROUND

This study evaluates longitudinal associations between glycaemic control, measured by mean and within-patient variability of glycated haemaglobin (HbA1c) levels, and major depressive disorder (MDD) in individuals with type 2 diabetes (T2D), focusing on the timings of these diagnoses.

METHODS

In UK Biobank, T2D was defined using self-report and linked health outcome data, then validated using polygenic scores. Repeated HbA1c measurements (mmol/mol) over the 10 years following T2D diagnosis were outcomes in mixed effects models, with disease duration included using restricted cubic splines. Four MDD exposures were considered: MDD diagnosis prior to T2D diagnosis (pre-T2D MDD), time between pre-T2D MDD diagnosis and T2D, new MDD diagnosis during follow-up (post-T2D MDD) and time since post-T2D MDD diagnosis. Models with and without covariate adjustment were considered.

RESULTS

T2D diagnostic criteria were robustly associated with T2D polygenic scores. In 11,837 T2D cases (6.9 years median follow-up), pre-T2D MDD was associated with a 0.92 increase in HbA1c (95% CI: [0.00, 1.84]), but earlier pre-T2D MDD diagnosis correlated with lower HbA1c. These pre-T2D MDD effects became non-significant after covariate adjustment. Post-T2D MDD individuals demonstrated increasing HbA1c with years since MDD diagnosis ( β = 0.51 , 95% CI: [0.17, 0.86]). Retrospectively, across study follow-up, within-patient variability in HbA1c was 1.16 (95% CI: 1.13-1.19) times higher in post-T2D MDD individuals.

CONCLUSIONS

The timing of MDD diagnosis is important for understanding glycaemic control in T2D. Poorer control was observed in MDD diagnosed post-T2D, highlighting the importance of depression screening in T2D, and closer monitoring for individuals who develop MDD after T2D.

Familial risk for depression is associated with reduced physical activity in young adults: evidence from a wrist-worn actigraphy study

Depression is characterized by reduced physical activity and sleep-wake cycle disturbances, often considered important features of the disease. While a few studies have suggested that self-reported reduced physical activity and sleep-wake cycle disturbances might both be linked to depression vulnerability, actigraphy-based measures in vulnerable samples remain largely unexplored. This study relied on actigraphy-based parameters to test whether these disturbances characterize depression vulnerability. Seven-day actigraphy data were collected from 20 (13 female) university students with a high vulnerability to depression, which was determined by the presence of a family history of the condition but no current symptoms, and 32 (21 female) controls with neither a family history of depression nor current depressive symptoms. Daily physical activity, namely gross motor activity, was quantified as average daily acceleration and time spent engaging in moderate-vigorous physical activity (MVPA). The sleep-wake cycle and circadian rhythms were assessed as total sleep duration per night (in hours), sleep within sleep period time (in hours), sleep efficiency (%), and relative amplitude (i.e., the difference between the activity during the day and the night, which reflects circadian rhythms amplitude). Results showed that individuals with a familial risk for depression exhibited reduced daily acceleration and time spent in MVPA relative to the control group, particularly on the weekend during their free time away from scheduled activities. On the other hand, the two groups were comparable in terms of sleep estimates. Taken together, reduced physical activity, but not sleep-wake disturbances, seem to be associated with vulnerability to depression and might be a viable target for identification and prevention efforts.

Prevalence and Predictors of Anxiety and Depression in Indian Patients with Type 2 Diabetes

Background

Numerous investigations indicate the presence of a reciprocal association between type 2 diabetes (T2D) and a range of mental health conditions. However, research on the factors that contribute to depression and anxiety in T2D patients in India is scarce.

Purpose

The present study aims to identify the prevalence and predictors of depression and anxiety in patients with T2D in India.

Methods

A cross-sectional study that included 2,730 patients with T2D was conducted at the Freedom from Diabetes Clinic in Pune, India. Anxiety and depression were measured by the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorders-7 (GAD-7) Scale. Binary logistic regression was applied to identify the factors predicting anxiety and depression.

Results

The prevalence of depression and anxiety were 20.3% and 17.3%, respectively. The major predictors of anxiety and depression were female gender, obesity, unmarried marital status, poor glycaemic control and the presence of comorbid conditions.

Conclusion

This study's findings highlight a significant prevalence of depression and anxiety among patients with T2D in India, with key predictors including gender, obesity, marital status, glycaemic control and comorbid conditions. These findings highlight the critical need for integrated mental health support in routine diabetes care to manage depression and anxiety.

The risk factors for mental health disorders in patients with type 2 diabetes: An umbrella review of systematic reviews with and without meta-analysis

Background

Patients with type 2 diabetes have a nearly twofold higher rate of diagnosed mental disorders than those without diabetes. The association between type 2 diabetes and mental disorders is well established in the literature and recognized as a bidirectional relationship. This study aims to conduct an umbrella review of risk and protective factors for mental health disorders in patients with type 2 diabetes and assess the credibility of the evidence for the association between each factor and mental health disorders.

Methods

A comprehensive search was conducted of Medline via PubMed, Web of Science, EMBASE, CINHAL, and PsycINFO from inception to November 17, 2022, to identify systematic reviews with and without meta-analyses examining associations of factors with mental health disorders in patients with type 2 diabetes. For each association, we recalculated the summary effect size and 95% confidence intervals using random-effects models. We also reported the 95% prediction interval and between-group heterogeneity.

Results

The study included 11 systematic reviews that met the inclusion criteria, comprising eight meta-analyses and three without meta-analyses. This involved approximately 489,930 participants and encompassed 26 unique factors. Six factors were rated as having suggestive evidence at the Class III level. These factors were obesity (n = 18,456, OR 1.75 [1.2 to 2.59], I2 97.7%), neuropathy (n = 3898, OR 2.01 [1.60 to 2.54], I2 44.5%), diabetes complications (n = 1769, OR 1.90 [1.53 to 2.36], I2 39.3%), peripheral blood concentrations of CRP (n = 1742, SMD 0.31 [0.16 to 0.45], I2 84.1%), female sex (n = 35,162, OR 1.36 [1.19 to 1.54], I2 64.5%), and social support (n = 3151, OR 2.02 [1.51 to 2.70], I2 87.2%).

Conclusions

Several factors associated with mental health disorders in patients with type 2 diabetes were identified with varying degrees of supporting evidence. Significantly, obesity, neuropathy, complications, peripheral blood CRP concentrations, female sex, and social support emerged with suggestive evidence. An investigation of these factors should be conducted to target interventions accordingly. It may be helpful to prioritize patients who have these risk factors as high-risk groups and to implement plans and policies to enhance support before mental health disorders occur.

Causal relationship between diabetes and depression: A bidirectional Mendelian randomization study

OBJECTIVE

This study explores the causal relationship between diabetes and depression using a two-sample Mendelian Randomization (TSMR) method.

METHODS

The study selected single nucleotide polymorphisms (SNPs) closely associated with diabetes and depression in European populations from the Genome-Wide Association Study (GWAS) database, to serve as instrumental variables (IVs). The main evaluation method was inverse variance weighted analysis (IVW), supplemented by verification using Weighted median, Weighted mode, and MR Egger methods. The Odds Ratio (OR) and 95 % Confidence Interval (CI) were used as the main evaluation indicators, along with sensitivity analysis.

RESULTS

This study found a negative correlation between diabetes and depression, suggesting that diabetes may reduce the risk of depression [IVW(FE): OR: 0.901, 95 % CI: 0.823 to 0.987; P = 0.025 < 0.05]. This finding was further confirmed by the Weighted median [OR: 0.844, 95 % CI: 0.730 to 0.974; P = 0.021 < 0.05] and Weighted mode method [OR: 0.766, 95 % CI: 0.637 to 0.921; P = 0.006 < 0.05]. However, the reverse showed no causal relationship between depression and diabetes (P > 0.05). Sensitivity analysis found no pleiotropy, and there were no large influences from individual SNPs on the result's robustness; the results are stable and reliable.

CONCLUSION

For the first time, this study using TSMR analysis found a negative correlation between diabetes and the risk of depression onset in European populations, suggesting that diabetes might reduce the risk of depression. But as the mechanisms are still unclear, these findings warrant further study.

Diabetic complications and risk of depression and anxiety among adults with type 2 diabetes

AIMS

To investigate if diabetic complications increase the risk of depression and/or anxiety among adults with type 2 diabetes.

METHODS

This register-based, prospective study included 265,799 adult individuals diagnosed with type 2 diabetes between 1997 and 2017 without a recent history of depression or anxiety. Diabetic complications included cardiovascular disease, amputation of lower extremities, neuropathy, nephropathy and retinopathy. Both diabetic complications and depression and anxiety were defined by hospital contacts and prescription-based medication. All individuals were followed from the date of type 2 diabetes diagnosis until the date of incident depression or anxiety, emigration, death or 31 December 2018, whichever occurred first.

RESULTS

The total risk time was 1,915,390 person-years. The incidence rate of depression and/or anxiety was 3368 per 100,000 person-years among individuals with diabetic complications and 1929 per 100,000 person-years among those without. Having or developing any diabetic complication was associated with an increased risk of depression and/or anxiety (HR 1.77, 95% CI 1.73-1.80). The risk for depression and/or anxiety was increased for all types of diabetic complications. The strongest association was found for amputation of lower extremities (HR 2.16, 95% CI 2.01-2.31) and the weakest for retinopathy (HR 1.13, 95% CI 1.09-1.17).

CONCLUSION

Individuals with type 2 diabetes and diabetic complications are at increased risk of depression and anxiety. This points towards the importance of an increased clinical focus on mental well-being among individuals with type 2 diabetes and complications.

Does Emotional Distress Predict Worse Glycemic Control Over Time? Results From the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)

OBJECTIVE

To evaluate whether baseline levels of depressive symptoms and diabetes-specific distress are associated with glycemic control in Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), a large randomized controlled trial comparing the metabolic effects of four common glucose-lowering medications when combined with metformin in individuals with type 2 diabetes mellitus (T2DM).

RESEARCH DESIGN AND METHODS

The primary and secondary outcomes were defined as an HbA1c value ≥7%, subsequently confirmed, and an HbA1c value >7.5%, subsequently confirmed, respectively. Separate Cox proportional hazards models assessed the association between baseline levels of each exposure of interest (depressive symptoms measured with the eight-item Patient Health Questionnaire and diabetes distress measured with the Diabetes Distress Scale) and the subsequent risk of metabolic outcomes.

RESULTS

This substudy included 1,739 participants (56% of whom were non-Hispanic White, 18% non-Hispanic Black, 17% Hispanic, and 68% male; mean [SD] age 58.0 [10.2] years, diabetes duration 4.2 [2.8] years, and HbA1c 7.5% [0.48%]). A total of 1,157 participants reached the primary outcome, with time to event of 2.1 years on average, while 738 participants reached the secondary outcome at 3 years on average. With adjustment for sex, race/ethnicity, treatment group, baseline age, duration of T2DM, BMI, and HbA1c, there were no significant associations between the depressive symptoms or diabetes distress and the subsequent risk of the primary or secondary outcomes.

CONCLUSIONS

The current findings suggest that, at least for individuals with diabetes of relatively short duration, baseline levels of emotional distress are not associated with glycemic control over time.

Differential Effects of Type 2 Diabetes Treatment Regimens on Diabetes Distress and Depressive Symptoms in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)

OBJECTIVE

We evaluated whether adding basal insulin to metformin in adults with early type 2 diabetes mellitus (T2DM) would increase emotional distress relative to other treatments.

RESEARCH DESIGN AND METHODS

The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) of adults with T2DM of <10 years' duration, HbA1c 6.8-8.5%, and taking metformin monotherapy randomly assigned participants to add insulin glargine U-100, sulfonylurea glimepiride, the glucagon-like peptide-1 receptor agonist liraglutide, or the dipeptidyl peptidase 4 inhibitor sitagliptin. The Emotional Distress Substudy enrolled 1,739 GRADE participants (mean [SD] age 58.0 [10.2] years, 32% female, 56% non-Hispanic White, 18% non-Hispanic Black, 17% Hispanic) and assessed diabetes distress and depressive symptoms every 6 months. Analyses examined differences at 1 year and over the 3-year follow-up.

RESULTS

Across treatments, diabetes distress (-0.24, P < 0.0001) and depressive symptoms (-0.67, P < 0.0001) decreased over 1 year. Diabetes distress was lower at 1 year for the glargine group than for the other groups combined (-0.10, P = 0.002). Diabetes distress was also lower for liraglutide than for glimepiride or sitagliptin (-0.10, P = 0.008). Over the 3-year follow-up, there were no significant group differences in total diabetes distress; interpersonal diabetes distress remained lower for those assigned to liraglutide. No significant differences were observed for depressive symptoms.

CONCLUSIONS

Contrary to expectations, this randomized trial found no evidence for a deleterious effect of basal insulin on emotional distress. Glargine lowered diabetes distress modestly at 1 year rather than increasing it. Liraglutide also reduced diabetes distress at 1 year. Results can inform treatment decisions for adults with early T2DM.

Prevalence and predictors of diabetes distress and depression in people with type 1 diabetes

Background

People living with diabetes often encounter psychosocial challenges, including diabetes distress and depression. Despite this, little research has focused on the co-occurrence of these conditions. This study aimed to explore the prevalence of depressive symptoms and diabetes distress in people with type 1 diabetes in Kuwait and to identify clinical and demographic factors associated with these conditions.

Methods

A total of 832 people with type 1 diabetes (females: 54.1%, mean age: 29 ± 8.5 years), were invited to participate in Dose Adjustment for Normal Eating (DAFNE) course. Diabetes distress was measured using the Problem Areas in Diabetes (PAID) scale and depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Depressive symptoms were defined as PHQ-9 scores ≥10. Data on biomedical outcomes, lifestyle factors, and sociodemographic information were collected.

Results

The prevalence rates of diabetes distress and depressive symptoms were 27.8% and 38.3%, respectively. Notably, 19.6% of people experienced both conditions. In the regression analysis, PAID scale and PHQ-9 scores were significantly associated, patients with higher score on depressive symptoms scale were more likely to suffer diabetes distress (B= 2.65, p < 0.001). Female sex (odds ratio [OR]= 2.2, 95% CI= 1.5, 3.2), higher hemoglobin A1c levels (OR= 1.6, 95% CI= 1.0, 2.5), obesity (OR= 1.7, 95% CI= 1.1, 2.8), inactivity (OR= 2.4, 95% CI= 1.6, 3.6), microvascular complications (OR= 2.8, 95% CI= 1.5, 5.4), and lipohypertrophy (OR= 1.7, 95% CI= 1.1, 2.5) were associated with greater odds for the co-occurrence of diabetes distress and depressive symptoms (p< 0.05 for all).

Conclusion

The majority of people with type 1 diabetes in Kuwait experience both diabetes distress and depressive symptoms. The strong correlation between diabetes distress and depressive symptoms suggests mutual predictability. The co-occurrence of both symptoms is associated with many sociodemographic and clinical factors.

Associations of comorbid depression with cardiovascular-renal events and all-cause mortality accounting for patient reported outcomes in individuals with type 2 diabetes: a 6-year prospective analysis of the Hong Kong Diabetes Register

Background

Psychosocial status and patient reported outcomes (PRO) [depression and health-related quality-of-life (HRQoL)] are major health determinants. We investigated the association between depression and clinical outcomes in Chinese patients with type 2 diabetes (T2D), adjusted for PRO.

Methods

Using prospective data from Hong Kong Diabetes Register (2013-2019), we estimated the hazard-ratio (HR, 95%CI) of depression (validated Patient Health Questionnaire 9 (PHQ-9) score≥7) with incident cardiovascular disease (CVD), ischemic heart disease (IHD), chronic kidney disease (CKD: eGFR<60 ml/min/1.73m2) and all-cause mortality in 4525 Chinese patients with T2D adjusted for patient characteristics, renal function, medications, self-care and HRQoL domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression measured by EQ-5D-3L) in linear-regression models.

Results

In this cohort without prior events [mean ± SD age:55.7 ± 10.6, 43.7% women, median (IQR) disease duration of 7.0 (2.0-13.0) years, HbA1c, 7.2% (6.6%-8.20%), 26.4% insulin-treated], 537(11.9%) patients had depressive symptoms and 1923 (42.5%) patients had some problems with HRQoL at baseline. After 5.6(IQR: 4.4-6.2) years, 141 patients (3.1%) died, 533(11.8%) developed CKD and 164(3.6%) developed CVD. In a fully-adjusted model (model 4) including self-care and HRQoL, the aHR of depression was 1.99 (95% confidence interval CI):1.25-3.18) for CVD, 2.29 (1.25-4.21) for IHD. Depression was associated with all-cause mortality in models 1-3 adjusted for demographics, clinical characteristics and self-care, but was attenuated after adjusting for HRQoL (model 4- 1.54; 95%CI: 0.91-2.60), though HR still indicated same direction with important magnitude. Patients who reported having regular exercise (3-4 times per week) had reduced aHR of CKD [0.61 (0.41-0.89)]. Item 4 of PHQ-9 (feeling tired, little energy) was independently associated with all-cause mortality with aHR of 1.66 (1.30-2.12).

Conclusion

Depression exhibits significant association with CVD, IHD, and all-cause mortality in patients with diabetes, adjusting for their HRQoL and health behaviors. Despite the association between depression and all-cause mortality attenuated after adjusting for HRQoL, the effect size remains substantial. The feeling of tiredness or having little energy, as assessed by item Q4 of the PHQ-9 questionnaire, was found to be significantly associated with an increased risk of all-cause mortality after covariate adjustments. Our findings emphasize the importance of incorporating psychiatric evaluations into holistic diabetes management.