Prevalence of depression and association with all-cause and cardiovascular mortality among individuals with type 2 diabetes: a cohort study based on NHANES 2005-2018 data

The association between C-reactive protein-albumin-lymphocyte index and depression in adults with type 2 diabetes mellitus: A cross-sectional study from NHANES

OBJECTIVE

Inflammation and nutrition are interrelated, and both are related to depression. This study explored the association between the C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index, a novel immunonutrition scoring system, and depression in patients with type 2 diabetes mellitus (T2DM).

METHODS

We included 3517 patients with T2DM from the National Health and Nutrition Examination Survey 2005-2010 and 2015-2018. The Patient Health Questionnaire-9 was used to evaluate depression. The CALLY index was based on a comprehensive assessment of serum CRP, serum albumin, and the lymphocyte counts from whole blood. Weighted multivariate logistic regression models were used to examine the relationship between the CALLY index and depression. The restricted cubic spline was applied to explore the nonlinear relationship.

RESULTS

Compared with the non-depressed group, CALLY index and albumin in the depressed group were significantly reduced, while CRP and lymphocytes were significantly increased (P < 0.05). After adjusting for covariates, only the CALLY index significantly decreased (the highest quartile vs the lowest quartile, odds ratio = 0.58, 95 % confidence interval: 0.38-0.89, P = 0.014). The non-linear association between the CALLY index and depression was not significant (P for nonlinear=0.69). The results of subgroup analysis were basically consistent (P for interaction > 0.05).

CONCLUSION

The CALLY index was significantly negatively correlated with depression in American patients with diabetes and served as a potential marker for early identification.

Association of antidiabetic medications with depression risk and All-Cause mortality in type 2 Diabetes: A TriNetX-Based cohort study

AIMS

Individuals with type 2 diabetes face elevated risks of depression and all-cause mortality. This study aimed to compare the associations of different glucose-lowering drugs-metformin, GLP-1 receptor agonists (GLP-1 RA), DPP-4 inhibitors (DPP-4i), and SGLT-2 inhibitors (SGLT-2i)-with these risks.

METHODS

Using TriNetX, we conducted a retrospective cohort study of 359,787 patients with type 2 diabetes receiving monotherapy with the aforementioned drugs. Propensity score matching balanced baseline characteristics, and Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident depression and all-cause mortality. Additional subgroup analyses were performed stratified by sex and age.

RESULTS

We assessed the association between glucose-lowering therapies and the risk of depression and all-cause mortality over 1-, 3-, and 5-year follow-up periods. Compared to metformin, GLP-1 RA users were associated with a higher risk of depression (HR 1.54-1.84) and a modestly elevated risk of all-cause mortality at 1 and 3 years (HR 1.19 and 1.21, respectively), though this association was not observed at 5 years. Relative to SGLT-2 inhibitors (SGLT-2i), GLP-1 RA users demonstrated a higher risk of depression (HR 1.33-1.59) and all-cause mortality (HR 1.24-1.35). SGLT-2i use was associated with a lower risk of depression (HR 0.62-0.70) and all-cause mortality (HR 0.54-0.65) compared to DPP-4 inhibitors (DPP-4i). Notably, DPP-4i users exhibited the highest risk of both depression and all-cause mortality relative to metformin (HR 1.53-1.74 and HR 1.56-1.57, respectively).

CONCLUSION

SGLT-2i was associated with significant reductions in depression and mortality risks, highlighting its potential advantages for type 2 diabetes management. 1 Background.

Age Disparities in the Association Between Leisure-Time Physical Activity and Depression Among American Adults

BACKGROUND

This study aims to investigate the association between leisure-time physical activity (LTPA), age, and depressive symptoms.

METHODS

We included and analyzed data from 18,052 participants (age ≥ 20 years) from the cross-sectional National Health and Nutrition Examination Survey (NHANES) (2007-2014). Multivariable logistic regression was employed to assess the independent associations between physical activity and household income with depressive symptoms. Restricted cubic spline plots were utilized to analyze the non-linear relationship between LTPA and depression.

RESULTS

Among the 18,052 participants, 1,676 (9.28%) were defined as having depressive symptoms. We found: 1. Age exhibits a non-linear relationship with depression, with a turning point around 40 years. 2. Compared to those with no LTPA, individuals with higher levels of LTPA (Q3) in both younger and older age groups experienced the lowest risk of depression, with risk reductions of 53% (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.33-0.67) and 74% (OR 0.26, 95% CI 0.14-0.50), respectively. Conversely, in the middle-aged group, those with the highest level of LTPA (Q4) experienced the greatest reduction in depression risk, by 67% (OR 0.33, 95% CI 0.21-0.53). 3. A U-shaped relationship between LTPA and depression risk was observed in younger and older age groups.

CONCLUSION

The risk of depression peaks around the age of 40 in adults. For middle-aged individuals, greater engagement in LTPA is associated with reduced depression risk. Conversely, higher levels of LTPA in younger and older adults may not confer additional protective effects.

The effect of vitamin D supplementation on mental and functional health outcomes in African Americans with type 2 diabetes

In patients with type 2 diabetes (T2DM), depression increases the risk of poor glycemic control and decreases adherence to medications, exercise, and diet. Studies have shown an inverse relationship between plasma vitamin D (VD) level and depression risk. However, there are few interventional trials of African Americans (AAs), a demographic with higher prevalence of diabetes, depression, and VD deficiency. This randomized controlled trial evaluated the efficacy of vitamin D3 supplementation [4000 vs. 600 international units (IU)/day] for one year on mental and functional health outcomes in 75 adult AAs with T2DM with serum 25-hydroxy vitamin D (25(OH)D) level < 25 ng/mL. PHQ-9 and PROMIS questionnaires evaluated mental health outcomes, and 6-minute walk test estimated the ability to perform daily activities. At baseline, groups had similar levels of 25(OH)D, calcium, parathyroid hormone, hemoglobin A1c, and body mass index, and 25(OH)D levels correlated positively with a 6-minute walk distance. Surprisingly, both supplementation strategies increased 25(OH)D to > 30 ng/mL by 6 months with a plateau thereafter. Vitamin D3 4000 IU/day in AAs with T2DM did not produce significant difference in mental and functional health scores compared to 600 IU/day. Post-hoc analysis of those with baseline VD deficiency [25(OH)D < 20 ng/mL] demonstrated trends towards worsening pain interference and higher depression and fatigue scores throughout the study, plus consistently shorter 6-minute walk distances, most of which were independent of vitamin D supplementation group. These results suggest that VD deficient AAs with T2DM may be refractory to supplementation for improvement in mental and functional health outcomes.

Heavy alcohol consumption, depression, their comorbidity and risk of all-cause and cause-specific mortality: a prospective cohort study

BACKGROUND

Alcohol consumption and depression commonly co-occur, and most current research has focused on the associations between either alcohol consumption or depression alone with mortality risk. However, the association of the comorbidity of heavy alcohol consumption and depression on the risk of all-cause and cause-specific mortality remains unclear in the U.S.

POPULATION

AIM

The objective of our study was to analyze the risks of all-cause and cause-specific mortality in participants who have heavy alcohol consumption alone, depression alone, or both, by conducting a prospective cohort study with a sample in the National Health and Nutrition Examination Survey (NHANES) database.

METHOD

For this cohort study, we included 11,590 U.S. adults aged ≥ 20 years from a nationally representative sample. Data on depression and alcohol consumption were extracted from the NHANES conducted between 2005 and 2018, and mortality information was obtained from the NHANES Linked Mortality File through December 31, 2019. Drinking and depression were classified into four groups: only heavy alcohol consumption, only depression, both present, and neither present. By adjusting for confounding factors, we applied the Cox proportional hazards model to investigate the risk of all-cause mortality associated with alcohol consumption and depressive states, including cardiovascular disease (CVD), cancer, and other causes. The log-rank test and Kaplan-Meier (K-M) survival analysis were applied to investigate differences in survival probabilities. Additionally, we examined the correlation between heavy alcohol consumption and depression by assessing additive interaction using the synergy index (SI), the attributable proportion due to interaction (AP), and the relative excess risk due to interaction (RERI).

RESULTS

The adjusted HR (aHR) for all-cause mortality, as well as mortality due to CVD, cancer, and other causes, were highest among individuals with comorbid heavy alcohol consumption and depression (HR 2.68[95%CI 1.84,3.91]; 2.64 [95%CI 1.27, 5.48]; 2.55 [95%CI 1.22,5.35]; and 2.78[95%CI 1.64, 4.71]). However, the results of additive and multiplicative interactions indicated that the synergistic effect of heavy alcohol consumption and depression on all-cause and cause-specific mortality did not reach statistical significance.

CONCLUSIONS

Our findings confirmed that heavy alcohol consumption or depression was associated with an increased risk of all-cause and other-cause mortality. Although the synergistic effect of comorbid heavy alcohol consumption and depression on all-cause and cause-specific mortality did not reach statistical significance, the comorbidity of heavy alcohol consumption and depression was associated with the highest risk of all-cause and cause-specific mortality. This research could provide a foundation for further investigations into the mechanisms underlying the comorbidity of heavy alcohol consumption and depression, as well as interventions for depression among heavy alcohol consumers, with significant implications for public health and clinical practice.

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.

Association between frailty index and mortality in depressed patients: results from NHANES 2005-2018

This study investigated the relationship between the frailty index and all-cause and cause-specific mortality in patients with depression. We recruited 2,669 participants with depression from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018 and quantified their frailty status using a 53-item frailty index. Cox proportional hazards models were used to estimate hazard ratios (HR) and their 95% confidence intervals (CI). The median (IQR) frailty score was 0.3 (0.2, 0.4). During a median follow-up of 7.1 years, 342 all-cause deaths (including 85 cardiovascular deaths and 70 cancer deaths) were recorded. Compared to the lowest frailty index tertile, the adjusted HR (95% CI) for all-cause mortality in the highest tertile was 2.91 (1.97, 4.3), for cardiovascular mortality was 3.13 (1.37, 7.19), and for cancer mortality was 2.3 (1.05, 5.03). Each unit increase in the frailty index (log-transformed) was associated with a 241% increase in all-cause mortality (P < 0.001), a 233% increase in cardiovascular mortality (P < 0.001), and a 185% increase in cancer mortality (P < 0.001). These results were consistent across analyses stratified by age, gender, race, BMI, hypertension, and diabetes. This study suggests that the frailty index is positively associated with all-cause and cause-specific mortality in patients with depression. The frailty index could serve as a prognostic indicator, and frailty interventions should be an important part of managing patients with depression.

Individual and joint effects of diabetes and depression on incident cardiovascular diseases and all-cause mortality: Results from a population-based cohort study

AIMS

To assess the individual and joint effects of diabetes and depression on all-cause mortality and cardiovascular disease (CVD) in the middle-aged and elderly Chinese populations.

METHODS

9105 individuals without CVD from the China Health and Retirement Longitudinal Study (CHARLS) were included and followed up for 9 years. Participants were divided into four comparative groups: diabetes alone, depression alone, both conditions, and neither condition. Multivariate binary logistic regression models were performed to compare the risks of all-cause mortality and CVD among the four groups.

RESULTS

When compared to those without diabetes and depression, the multivariate adjusted odds ratios (aORs) for CVD in individuals who had diabetes only, depression only, and both diabetes and depression were 1.245 (95 % CI 1.023 to 1.515), 1.318 (95 % CI 1.171 to 1.485) and 1.722 (95 % CI 1.361 to 2.178), respectively. The aORs for all-cause mortality were 1.366 (95 % CI 1.035-1.804) for diabetes alone, 1.082 (95 % CI 0.916-1.279) for depression alone, and 1.590 (95 % CI 1.152-2.195) for both conditions when compared with those with neither condition.

CONCLUSIONS

Individuals with both diabetes and depression had greater risk of CVD and all-cause mortality when compared to those with diabetes or depression alone, or those without either condition.

A carefully planned resistance training program improves strength, fitness and depressive symptoms for a woman with type 2 diabetes

Summary

Depression in type 2 diabetes (T2D) is estimated at 50% vs 18% among US adults, and markers of inflammation, which are tightly linked to hyperglycemia, are 5- to 50-fold higher in adults with T2D. Although lifestyle modifications are recommended for managing diabetes, resistance training (RT) is not commonly considered. This case report examined the practicality of implementing a structured RT protocol in a highly sedentary woman with T2D and depressive symptomology and assessed changes in strength, fitness, depression, and inflammation. The 59-year-old participant (body mass index: 38.1 kg/m2) was diagnosed in 2015. She had hypertension and bronchial asthma, was highly sedentary, and was clinically depressed based on validated measures: The Center for Epidemiological Studies Depression (CES-D) questionnaire and the Profile of Mood States (POMS) questionnaire. She had quit smoking 6 months earlier. The estimated 1RM guided the exercise prescription that used progressive overload to improve strength and promote the accretion of lean body mass. All exercise sessions (~45 minutes duration; 3× weekly) were supervised by trained personnel. After 8 weeks, total strength improved 135%. Heart rate was reduced by 14%, and depression symptomology fell into normal ranges. Although RT improved strength, fitness, and depressive symptomology, RT did not improve HbA1c, HOMA-IR, or inflammation emphasizing the need for a comprehensive treatment strategy. Simple assessments can be performed to determine the fitness and mental health of individuals with T2D, and incorporating an exercise prescription to standard care to address these key health determinants will empower patients to actively engage in their health care.

Learning points

A progressive, individualized resistance training program is feasible and improves muscular strength, fitness level, and mental health in a high-risk individual with type 2 diabetes and multiple comorbidities. Flexibility with resistance training prescription to adapt to patient's needs and abilities contributes to exercise adherence and successful outcomes Physical activity assessment and exercise prescription should be a part of standard care for patients with diabetes.

Nurse-led follow-up care versus routine health education and follow-up in diabetes patients: An effectiveness analysis

Patients with diabetes have physical and psychological issues due to chronic illness. According to the guidelines of the Chinese Diabetes Society, after the diagnosis of patients with diabetes, they should receive routine health education, but this is the passive installation method of education. Nurses have made important contributions to the follow-up, education, and support of patients with diabetes and their families. The objective of this study was to evaluate the effectiveness of nurse-led follow-up care in routine health education and follow-up for patients with diabetes. Medical records of 721 patients with type 1 and type 2 diabetes were reviewed. Patients received nurse-led follow-up care including educational programs + Tai Chi exercises (patients received nurse-led follow-up care including educational programs for 6 months, n = 108), routine health education and follow-up + Tai Chi exercises (patients received routine health education and follow-up for 6 months, n = 205), or Tai Chi exercises only, but did not receive nurse-led follow-up care or routine health education and follow-up (patients received Tai Chi exercises only for 6 months, n = 408) for 6-months. The Zung Self-Rating Depression and Anxiety Scale and Summary of Diabetes Self-Care Activities were used to evaluate anxiety, depression, and self-care activities, respectively. Before the start of follow-up care (BFC), knowledge regarding diabetes and its threat was ≤1.75, anxiety and depression scores were ≥52 each, and self-care activities were ≤37. After 6 months of follow-up care, patients in the patients received nurse-led follow-up care including educational programs for 6 months improved their knowledge regarding diabetes and its threat, anxiety, depression, and self-care activities as compared to their before the start of follow-up care conditions and patients in the RF and patients received Tai Chi exercises only for 6 months at after 6 months of follow-up care conditions (P < .001 for all). Chinese type 1 or 2 diabetes patients had worse physical and psychological conditions and less knowledge regarding diabetes and its threat. Nurse-led aftercare, including educational programs with Tai Chi exercises for 6 months, decreased anxiety and depression and improved knowledge regarding diabetes and its threat and self-care activities in diabetic patients (Level of Evidence: IV; Technical Efficacy: Stage 5).

The association in diabetic retinopathy and stroke finding from NHANES evidence

PURPOSE

Diabetic retinopathy and stroke are both vascular pathologies, and this study intends to investigate the relationship between diabetic retinopathy and stroke.

METHODS

The NHANES database was used to find the relationship between diabetic retinopathy and stroke with 1948 individuals aged 40 years or older. The sensitivity of the data was verified by multiple interpolation, further analysis was done by subgroup analyses, and possible links were investigated with mediation studies.

RESULTS

Diabetes retinopathy was found to be closely associated with stroke, with the PDR group having a higher stroke incidence than the NPDR group. After controlling for covariates, there were still substantial differences in the risk of stroke among patients with NPDR and PDR. Overall, subgroup analysis revealed DR group showed an important distinction, compared to the non-DR (OR = 1.76, 95% CI 1.15-2.64). The results of the mediation research indicated that the connection between DR and stroke was mediated by the frailty index and hypertension.

CONCLUSION

This study demonstrated a statistically significant correlation between DR and stroke, which persisted even after DR staging and was more prevalent in PDR patients than in NPDR patients. Stroke prevention may benefit from DR health management.