Behavioral and clinical factors associated with depression among individuals with diabetes

Towards standardization of person-reported outcomes (PROs) in pediatric diabetes research: A consensus report

BACKGROUND

Diabetes ranks among the most common chronic conditions in childhood and adolescence. It is unique among chronic conditions, in that clinical outcomes are intimately tied to how the child or adolescent living with diabetes and their parents or carers react to and implement good clinical practice guidance. It is widely recognized that the individual's perspective about the impact of trying to manage the disease together with the burden of self-management should be addressed to achieve optimal health outcomes. Standardized, rigorous assessment of behavioural and mental health outcomes is crucial to aid understanding of person-reported outcomes alongside, and in interaction with, physical health outcomes. Whilst tempting to conceptualize person-reported outcomes as a focus on perceived quality of life, the reality is that health-related quality of life is multi-dimensional and covers indicators of physical or functional health status, psychological well-being and social well- being.

METHODS

In this context, this Consensus Statement has been developed by a collection of experts in diabetes to summarize the central themes and lessons derived in the assessment and use of person-reported outcome measures in relation to children and adolescents and their parents/carers, helping to provide a platform for future standardization of these measures for research studies and routine clinical use.

RESULTS

This consensus statement provides an exploration of person-reported outcomes and how to routinely assess and incorporate into clincial research.

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.

The prevalence of depression among patients with diabetic foot ulcers at King Khalid University Hospital, Riyadh, Saudi Arabia

Background and Aim

The prevalence rates of depression and anxiety among diabetic patients with diabetic foot ulcers (DFU) vary from one study to the other. We aimed to determine the prevalence of depression and the associated risk factors among patients with DFU.

Methods

We conducted a cross-sectional study using a self-reported questionnaire on adult patients aged 18 years old and above with DFU at our institution. We used the 9-item Patient Health Questionnaire to evaluate the presence of depressive symptoms.

Results

A total of 75 patients, 56 (74.7%) males and 19 (25.3%) females, participated in the study; 33 (44.0%) were more than 60 years old. The prevalence of moderate to severe depression among our patients was 35 (46.7%). Patients who had DFU for more than 1 year had a higher proportion of moderate to severe depression (P = 0.032). There were no significant differences in the proportion of patients who had depression according to age groups (P = 0.456), gender (P = 0.095), level of education (P = 0.145), employment (P = 0.514), type of diabetes (P = 0.561), duration of diabetes (P = 0.704), level of HbA1c (P = 0.525), smoking history (P = 0.163), and previous history of DFU (P = 0.713). Logistic regression analysis showed that patients who had DFU for more than 1 year were three times more at risk to have moderate to severe depression (P = 0.049).

Conclusion

Patients with DFU have a high frequency of moderate to severe depression regardless of age, gender, or other sociodemographic characteristics, with patients with long-standing DFU having triple the risk of depression as those with freshly diagnosed DFU. Diabetic persons should be thoroughly assessed to reduce the diabetes result, and preventative actions and patient education about DFU are crucial.

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.

Food Insecurity and Diabetes Insulin Adherence Among Older Adults

Older adults in the United States continue to be impacted by food insecurity. Diabetes is on the rise in older adults and insulin therapy is often recommended as treatment. However, less is known about the relationship between food insecurity and insulin adherence among older adults. The current study utilized secondary data analysis methods to examine the 2021 National Health Interview Survey to explore the relationship between food insecurity and insulin adherence among adults aged 55 and older who are living with diabetes. Results of multivariable logistic regression suggest that participants experiencing food insecurity were more likely to take less insulin than needed and delay buying insulin in the past 12 months compared to participants who were food secure. Homeownership was inversely associated with taking less insulin than needed. Higher income-to-poverty ratio was also inversely associated with skipping insulin doses, taking less insulin than needed, and delaying the purchase of insulin. Our results showed that other racialized/ethnic groups (i.e., American Indian, Alaskan Native, Asian, biracial, and multiracial persons) compared to White were less likely to skip an insulin dose and take less insulin than needed. Suggesting food insecurity should be considered when insulin therapy is recommended for older adults with diabetes.

Risk of Depression according to Cumulative Exposure to a Low-Household Income Status in Individuals with Type 2 Diabetes Mellitus: A Nationwide Population- Based Study

BACKGRUOUND

We aimed to identify the risk of incident depression according to cumulative exposure to a low-household income status in individuals with type 2 diabetes mellitus (T2DM).

METHODS

For this retrospective longitudinal population-based cohort study, we used Korean National Health Insurance Service data from 2002 to 2018. Risk of depression was assessed according to cumulative exposure to low-household income status (defined as Medical Aid registration) during the previous 5 years among adults (aged ≥20 years) with T2DM and without baseline depression who underwent health examinations from 2009 to 2012 (n=2,027,317).

RESULTS

During an average 6.23 years of follow-up, 401,175 incident depression cases occurred. Advance in cumulative number of years registered for medical aid during the previous 5 years from baseline was associated with an increased risk of depression in a dose-dependent manner (hazard ratio [HR], 1.44 [95% confidence interval (CI), 1.38 to 1.50]; HR, 1.40 [95% CI, 1.35 to 1.46]; HR, 1.42, [95% CI, 1.37 to 1.48]; HR, 1.46, [95% CI, 1.40 to 1.53]; HR, 1.69, [95% CI, 1.63 to 1.74] in groups with 1 to 5 exposed years, respectively). Insulin users exposed for 5 years to a low-household income state had the highest risk of depression among groups categorized by insulin use and duration of low-household income status.

CONCLUSION

Cumulative duration of low-household income status, defined as medical aid registration, was associated with an increased risk of depression in a dose-response manner in individuals with T2DM.

Program ACTIVE II: 6- and 12-month outcomes of a treatment approach for major depressive disorder in adults with type 2 diabetes

AIMS

To evaluate the long-term effects of behavioral treatments on glycemic and psychological outcomes for patients with major depressive disorder (MDD) and type 2 diabetes (T2D).

METHODS

Program ACTIVE II was a multicenter randomized controlled comparative effectiveness trial of cognitive behavioral therapy (CBT), exercise (EXER), combination treatment (CBT + EXER) and usual care (UC) for adults with MDD and T2D.

RESULTS

Primary outcomes: change in A1c and depressive symptoms at 6- (N = 87) and 12-months (N = 75) from baseline. In those with a baseline A1c ≥7.0 %, CBT + EXER showed lasting A1c benefit at 6- (-1.2 %; SE: 0.6; p = 0.032) and 12-months (-1.4 %; SE: 0.6; p = 0.025) compared to UC. All groups had clinically significant improvements in depressive symptoms. At 6 months, CBT + EXER had significant improvements in diabetes-related distress regimen burden (p = 0.005); and social support (CIRS, p = 0.043) compared to UC.

CONCLUSIONS

The Program ACTIVE II CBT + EXER intervention demonstrated a sustained improvement in A1c for a subgroup of study participants with a baseline A1c ≥7.0 %. However, this finding should be considered preliminary because of small sample size. All 3 behavioral intervention groups demonstrated improvements in psychosocial outcomes one-year post-intervention. These findings point to the enduring benefits of community-based interventions to extend the availability of depression treatment for T2D patients.

Depressive symptoms and daily living dependence in older adults with type 2 diabetes mellitus: the mediating role of positive and negative perceived stress

BACKGROUND

Higher stress is associated with higher levels of depression and instrumental-activities-of-daily-living (IADL) dependence, and depression is strongly associated with specific IADL disabilities. Accordingly, the aim of this study was to investigate the mediating effect of perceived stress on the association between depression and IADL dependence among older adults with diabetes mellitus (DM).

METHODS

We examined baseline data collected from a longitudinal study that recruited 110 patients with DM aged ≥ 65 years from the endocrinology outpatient clinic of a district hospital. The instruments used for our measurement processes comprised a demographic data sheet and Chinese versions of the Perceived Stress Scale (PSS), the short form of the Geriatric Depression Scale (GDS-S), and the Lawton IADL Scale. We assessed the mediating effects of positive perceived stress (PPS) and negative perceived stress (NPS) after controlling for five covariates by using a regression-based model run through the SPSS macro PROCESS.

RESULTS

We observed negative correlations between GDS-S scores and PPS and between PPS and IADL dependence; we noted positive correlations between GDS-S scores and NPS and between NPS and IADL dependence (all P < 0.01). The indirect effect is coefficient = 0.12, [95% confidence interval = (0.0, 0.33)], suggesting that PPS achieves a mediating effect between depressive symptoms and IADL dependence. However, the NPS does not achieve a mediating effect in the relationship between depressive symptoms and IADL dependence (coefficient = 0.06, 95% CI = - 0.03, 0.15).

CONCLUSIONS

Personal PPS mediates the association between depression and IADL dependence in older adults with DM. This finding suggests that providing patients with psychological education to promote their PPS may help prevent their functional decline.

Exploring the association between depression and diabetes among type 1 and type 2 diabetic mellitus patients: A cross-sectional study in Gujarat, India

Background

Depression and anxiety are common among patients with diabetes mellitus and it affects the control of diabetes negatively. Depression is the third leading reason for the most disability-adjusted life years. Once depression coexists with diabetes mellitus, it is related to major health consequences and ends up in poor health outcomes.

Aim

The study aimed to estimate the prevalence of depression in diabetes mellitus people and to find an association of depressive symptoms with sociodemographic and clinical predictors among patients with diabetes mellitus attending follow-ups at the general public hospital, in western Gujarat.

Materials and Methods

It is an institutional-based cross-sectional study conducted among people living with diabetes mellitus at Tertiary Hospitals, Urban Health Training Center, and Rural Health Training Center. The study period was from January 2023 to May 2023. Data were collected using a structured questionnaire. Depression was assessed by the Patient Health Questionnaire 9. The collected data were cleaned, edited, entered into MS Excel (2006), and analyzed using SPSS software (version 26). A P value of <0.05 was considered statistically significant.

Results

A total of 380 study participants were included in this study. Among 380 participants, 282 (74%) were having depressive symptoms. Of 282, 61 (21.6%) have mild depressive symptoms, 106 (37.5%) have moderate symptoms, 111 (39%) have moderately severe symptoms, and four (1.4%) have severe symptoms. Of 380 participants, 221 (58%) have clinical depression (moderate, moderately severe, and severe symptoms). Variables significantly associated with depression were marital status, number of family members, socio-economic status, type of diabetes mellitus, treatment given, presence of comorbidities, and duration of diabetes more than 5 years.

Conclusion

The present study has shown a considerably higher amount of depression in diabetic participants. So, healthcare professionals should consider screening for depression using the Patient Health Questionnaire 9 or other validated tools in all diabetic patients, especially in those who are at a higher risk.

Affective and Cognitive Impairments in Rodent Models of Diabetes

Diabetes and related acute and long-term complications have a profound impact on cognitive, emotional, and social behavior, suggesting that the central nervous system (CNS) is a crucial substrate for diabetic complications. When anxiety, depression, and cognitive deficits occur in diabetic patients, the symptoms and complications related to the disease worsen, contributing to lower quality of life while increasing health care costs and mortality. Experimental models of diabetes in rodents are a fundamental and valuable tool for improving our understanding of the mechanisms underlying the close and reciprocal link between diabetes and CNS alterations, including the development of affective and cognitive disorders. Such models must reproduce the different components of this pathological condition in humans and, therefore, must be associated with affective and cognitive behavioral alterations. Beyond tight glycemic control, there are currently no specific therapies for neuropsychiatric comorbidities associated with diabetes; animal models are, therefore, essential for the development of adequate therapies. To our knowledge, there is currently no review article that summarizes changes in affective and cognitive behavior in the most common models of diabetes in rodents. Therefore, in this review, we have reported the main evidence on the alterations of affective and cognitive behavior in the different models of diabetes in rodents, the main mechanisms underlying these comorbidities, and the applicable therapeutic strategy.

Depression and self-care in diabetes; adjustment for misclassification bias: application of predictive weighting method

OBJECTIVE

This study aimed to investigate the association between depression and self-care in diabetic patients potentially influenced by biases in depression measurement using weighting the positive and negative predictive values.

METHODS

In this cross-sectional study, 1050 patients informedly consented to participate in the study. Using a WHO-5 well-being index, the participants were examined for depressive mood as exposure. The sensitivity and specificity of this index in a systematic review study were 0.86 and 0.81, respectively. Self-care (that is outcome) was assessed using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. To correct the misclassification bias of exposure, the predictive weighting method was used in the multivariable logistic regression model adjusted for covariates. Bootstrap sample with replacement and simulation was used to deal with random error.

RESULTS

The mean age of patients was 42.8 ± 7.5 years. In this study, 70.1% of diabetic patients (n = 720) were depressed based on the questionnaire score and only 52.7% (n = 541) of them had appropriate self-care behaviors. Our study revealed a close relationship between self-care and covariates such as gender, depression, having comorbidities, abdominal obesity, economic status and education. The odds ratio of the association between depressive mood and lack of self-care in primary multivariable logistic regression was 2.21 (95% CI: 1.62-3.00, p < 0.001) and after misclassification bias adjusting, it was equal to 3.4 (95% CI: 1.7-6.6, p < 0.001). The OR percentage of bias was - 0.55.

CONCLUSION

After adjusting for depression misclassification bias and random error, the observed association between depression and self-care was stronger. According to our findings, psychiatric interventions, and counseling and education along with self-care interventions are necessary for these patients. Special attention should be paid to male, low economic classes, less educated and those having a history of comorbidities along with psychological assessment when improving the care and progress of treatment in diabetic patients is expected. Future studies are needed to clarify the role of other psychological disorders on self-care of diabetics.

The association between screen time and depression symptoms severity among adults with diabetes: A cross-sectional study

OBJECTIVE

To investigate the association between time spent on screen-based sedentary behavior (SBSB) and depression symptom severity (DSS) among adults with type 2 diabetes.

METHODS

A cross-sectional study employing secondary data collected by Qatar Biobank (QBB) on 2386 adults with type 2 diabetes aged ≥ 18 years. Self-reported data on DSS measured using the Patient Health Quationnaire-9 and daily time spent on SBSB per week was used.

RESULTS

After adjusting for covariates, including physical activity and sleep duration, subjects who spent 2-4 h or > 4 h a day on SBSB watching TV or other devices other than computers during weekdays had increased odds of higher DSS than subjects who spent < 1 h by 44% (95% Confidence interval (CI) 13-83%) and 52% (95% CI 17-96%), respectively. Subjects who spent > 4 h a day on SBSB using computers during weekdays had increased odds of higher DSS by 115% (95% CI 56-196%) than subjects who spent < 1 h. Similar associations were observed between time spent on SBSB using the mentioned devices during weekends and DSS.

CONCLUSION

Increase in time spent on SBSB is independently associated with increased DSS among adults with type 2 diabetes regardless of the equipment used or timing of the week.

Psychiatric morbidities among patients with type-2 diabetes mellitus attending outpatient department in a rural area of North India

Background

Both diabetes mellitus and psychiatric morbidities are widely prevalent diseases which show a discerning upward trend globally. Coexistence of diabetes and psychiatric morbidities usually manifests as impaired quality of life and poor treatment adherence.

Objectives

The study aimed to estimate the prevalence of psychiatric morbidities among rural diabetic patients and to determine their association with different variables.

Methodology

The present cross-sectional study was conducted in CHC of Rural Health Block attached with PG Department of Community Medicine GMC (Government Medical College) Jammu. The eligible diabetic patients attending medical outpatient department services were enrolled using a consecutive sampling method. DAS scale was used to assess psychiatric morbidity among the study subjects.

Results

The findings revealed that the prevalence of psychiatric morbidity in the study participants was 38.9%, 68.5% and 25.64% for depression, anxiety and stress, respectively. Psychiatric morbidities were slightly higher in female patients and were significantly associated with age, marital status, sedentary lifestyle, history of substance abuse, duration of diabetes, presence of complications and underlying morbidities (P < 0.05).

Conclusions

The prevalence of anxiety and depression among rural diabetic patients was found to be quite high. Diabetic patients need thorough screening for psychiatric evaluation, and there is an urgent need for psychiatric counselling at regular intervals.

Association between Serum Irisin and Leptin Levels and Risk of Depressive Symptoms in the Diabetic Elderly Population

BACKGROUND

Adipokines are considered to be involved in the pathogenesis of diabetes and depression. The associations of serum levels of leptin and irisin with depressive symptoms were investigated in elderly patients with type 2 diabetes (T2DM).

METHODS

189 elderly diabetics were assessed with the 30-item Geriatric Depression Scale (GDS-30), and 57 patients with depressive symptoms and 132 controls were selected. Blood biochemical parameters, including serum irisin and leptin, were measured.

RESULTS

Serum irisin levels were decreased and leptin concentrations were significantly higher in T2DM patients with depressive symptoms compared to controls. In all subjects, the irisin level was inversely correlated with the leptin level and the GDS-30 score, whereas the leptin level was highly correlated with BMI and the GDS-30 score. Higher levels of leptin and lower concentrations of irisin are, among other factors, variables indicative of predictive capacity for depressive symptoms in elderly patients with T2DM.

CONCLUSIONS

The results indicated that irisin and leptin levels may be used as diagnostic markers of depressive symptoms in diabetic, elderly patients and as potential therapeutic targets for the treatment. Further prospective and more extensive studies are needed to clarify the role of these adipokines in the common pathogenesis of depression and diabetes.

The AGE-RAGE Axis and the Pathophysiology of Multimorbidity in COPD

Chronic obstructive pulmonary disease (COPD) is a disease of the airways and lungs due to an enhanced inflammatory response, commonly caused by cigarette smoking. Patients with COPD are often multimorbid, as they commonly suffer from multiple chronic (inflammatory) conditions. This intensifies the burden of individual diseases, negatively affects quality of life, and complicates disease management. COPD and comorbidities share genetic and lifestyle-related risk factors and pathobiological mechanisms, including chronic inflammation and oxidative stress. The receptor for advanced glycation end products (RAGE) is an important driver of chronic inflammation. Advanced glycation end products (AGEs) are RAGE ligands that accumulate due to aging, inflammation, oxidative stress, and carbohydrate metabolism. AGEs cause further inflammation and oxidative stress through RAGE, but also through RAGE-independent mechanisms. This review describes the complexity of RAGE signaling and the causes of AGE accumulation, followed by a comprehensive overview of alterations reported on AGEs and RAGE in COPD and in important co-morbidities. Furthermore, it describes the mechanisms by which AGEs and RAGE contribute to the pathophysiology of individual disease conditions and how they execute crosstalk between organ systems. A section on therapeutic strategies that target AGEs and RAGE and could alleviate patients from multimorbid conditions using single therapeutics concludes this review.

Insulin resistance, age and depression's impact on cognition in middle-aged adults from the PREVENT cohort

BACKGROUND

Alzheimer's disease (AD), type 2 diabetes mellitus (characterised by insulin resistance) and depression are significant challenges facing public health. Research has demonstrated common comorbidities among these three conditions, typically focusing on two of them at a time.

OBJECTIVE

The goal of this study, however, was to assess the inter-relationships between the three conditions, focusing on mid-life (defined as age 40-59) risk before the emergence of dementia caused by AD.

METHODS

In the current study, we used cross-sectional data from 665 participants from the cohort study, PREVENT.

FINDINGS

Using structural equation modelling, we showed that (1) insulin resistance predicts executive dysfunction in older but not younger adults in mid-life, that (2) insulin resistance predicts self-reported depression in both older and younger middle-aged adults and that (3) depression predicts deficits in visuospatial memory in older but not younger adults in mid-life.

CONCLUSIONS

Together, we demonstrate the inter-relations between three common non-communicable diseases in middle-aged adults.

CLINICAL IMPLICATIONS

We emphasise the need for combined interventions and the use of resources to help adults in mid-life to modify risk factors for cognitive impairment, such as depression and diabetes.

Depression and determinants among diabetes mellitus patients in Ethiopia, a systematic review and meta-analysis

INTRODUCTION

Primary studies have estimated the prevalence of depression and its determinants among diabetes patients. However, studies synthesizing this primary evidence are limited. Hence, this systematic review aimed to determine the prevalence of depression and identify determinants of depression among diabetes in Ethiopia.

METHODS

This systematic review and meta-analysis included a search of PubMed, Google Scholar, Scopus, Science Direct, PsycINFO, and Cochrane library. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Data were pooled using a random-effects model. Forest plots, and Egger's regression test were all used to check for publication bias. Heterogeneity (I)² was computed. Subgroup analysis was done by region, publication year, and depression screening instrument. In addition, the pooled odds ratio for determinants was calculated.

RESULTS

Sixteen studies, including 5808 participants were analyzed. The prevalence of depression in diabetes was estimated to be 34.61% (95% CI: 27.31-41.91). According to subgroup analysis by study region, publication year, and screening instrument, the highest prevalence was observed in Addis Ababa (41.98%), studies published before 2020 (37.91%), and studies that used Hospital Anxiety and Depression Scale (HADS-D) (42.42%,) respectively. Older age > 50 years (AOR = 2.96; 95% CI: 1.71-5.11), being women (AOR = 2.31; 95% CI: 1.57, 3.4), longer duration with diabetes (above 5 years) (AOR = 1.98; 95% CI: 1.03-3.8), and limited social support (AOR = 2.37; 95% CI: 1.68-3.34), were the determinants of depression in diabetic patients.

CONCLUSION

The results of this study suggest that the prevalence of depression in diabetes is substantial. This result underscores the importance of paying particular attention to prevent depression among diabetes. Being older, not attending formal education, longer duration with diabetes, having comorbidity, and low adherence to diabetes management were all associated. These variables may help clinicians identify patients at high risk of depression. Future studies focusing on the causal association between depression and diabetes are highly recommended.

Fluorescent advanced glycation end products in type 2 diabetes and its association with diabetes duration, hemoglobin A1c, and diabetic complications

Background

Fluorescent advanced glycation end products (fAGEs) are generated through the Maillard reaction between reducing sugars and amino compounds. fAGEs accumulation in human bodies have been confirmed to be related to many chronic diseases. To date, the correlations between serum fAGEs levels and clinical parameters or carotid intima media thickness (CIMT) in patients with T2DM remain unclear. Thus, this study aimed to investigate the relationship between serum AGEs levels and clinical parameters or CIMT in patients with T2DM.

Method

A total of 131 patients with diabetes and 30 healthy controls were enrolled. Patients were divided into three groups according to diabetes duration, including ≤5, 5-10, and ≥10 years. Serum fAGEs, protein oxidation products, clinical parameters, and CIMT were determined.

Results

The result showed that levels of fAGEs and protein oxidation products increased with the increasing duration of diabetics. Pearson correlation coefficients of fAGEs versus hemoglobin A1c (HbA1c) were >0.5 in patients with diabetes duration ≥10 years. A continued increase in fAGEs might cause the increase of HbA1c, urinary albumin/creatinine ratio (UACR) and CIMT in patients with T2DM.

Conclusion

Our study suggested that levels of fAGEs could be considered as an indicator for duration of diabetics and carotid atherosclerosis. Diabetes duration and smoking might have a synergistic effect on the increment of fAGEs levels, as evidence by the results of correlation analysis in patients with long-duration diabetics (≥10 years) and smoking. The determination of fAGEs might be helpful to advance our knowledge on the overall risk of complications in patients with T2DM.

Factors affecting depression and anxiety in diabetic patients: A cross sectional study from a tertiary care hospital in Eastern India

BACKGROUND

Diabetes is one of the most common chronic disease in the world and its prevalence in India is rising day by day. Diabetic patients often suffer from depression and anxiety which has a negative impact on patients resulting in non-adherence to medication, rapid disease progression and overall poor prognosis. India is the land of diversity and so are the causes of depression and anxiety in the people from different parts of the country. The study done in the current population has revealed certain indicators of both depression and anxiety that were not significant in previous studies. These new findings point towards the changing scenario and the need for more precise steps for improving the quality of life of diabetics.

AIMS

The study aims to determine the prevalence of depressive symptoms and anxiety among diabetic patients and the factors associated with them.

METHODS

A prospective cohort study was conducted with 305 participants among which 152 were diabetic while 153 were non diabetic patients. Depression and anxiety of the patients was measured through PHQ-9 scale and GAD-7 scale respectively. Factors associated with prevalence of depression and anxiety in the diabetic population was analysed.

RESULTS

The prevalence of depressive symptoms (39.5% versus 12.4%) and anxiety (36.2% versus 14.4%) were significantly higher in diabetic patients as compared to non-diabetic participants. Low-income, urban residence, unmarried status, insulin therapy, presence of retinopathy, and ischemic heart disease were significantly associated with depression among diabetic group of patients. Similarly the major predictors of anxiety were marital status, literacy and diabetic complications like neuropathy, retinopathy and ischemic heart disease.

CONCLUSION

Our study shows depression and anxiety are highly prevalent among diabetic patients. All diabetic patients while seeking clinical contact should be screened for depression and anxiety especially those patients with predisposing risk factors.

Smoking and diabetes interplay: A comprehensive review and joint statement

Evidence shows that smoking increases the risk of pre-diabetes and diabetes in the general population. Among persons with diabetes, smoking has been found to increase the risk of all-cause mortality and aggravate chronic diabetic complications and glycemic control. The current paper, which is a joint position statement by the French-Speaking Society on Tobacco (Société Francophone de Tabacologie) and the French-Speaking Society of Diabetes (Société Francophone du Diabète), summarizes the data available on the association between smoking and diabetes and on the impact of smoking and smoking cessation among individuals with type 1, type 2, and gestational diabetes mellitus. It also provides evidence-based information about the pharmacological and behavioral strategies for smoking cessation in these patients.

Hyperinsulinemia Associated Depression

Hyperinsulinemia promotes fat accumulation, causing obesity. Being an inflammatory state, obesity can induce further inflammation and is a risk factor for HPA (hypothalamic pituitary axis) dysregulation through hypercortisolism-related hyperglycemia. In another hypothesis, the sympathetic nervous system (SNS) plays a significant role in the regulation of hormone secretion from the pancreas such as an increase in catecholamines and glucagon as well as a decrease in plasma insulin levels, a disruption on SNS activity increases insulin levels, and induces glycogenolysis in the liver and lipolysis in adipose tissue during hypoglycemia. Hyperglycemia-hyperinsulinemia exacerbates inflammation and increases the oxidative stress along with regulating the levels of norepinephrine in the brain sympathetic system. Increased inflammatory cytokines have also been shown to disrupt neurotransmitter metabolism and synaptic plasticity which play a role in the development of depression via inhibiting serotonin, dopamine, melatonin, and glutamate signaling. An increased level of plasma insulin over time in the absence of exercising causes accumulation of lipid droplets in hepatocytes and striated muscles thus preventing the movement of glucose transporters shown to result in an increase in insulin resistance due to obesity and further culminates into depression. Further hyperinsulinemia-hyperglycemia condition arising due to exogenous insulin supplementation for diabetes management may also lead to physiological hyperinsulinemia associated depression. Triple therapy with SSRI, bupropion, and cognitive behavioral therapy aids in improving glycemic control, lowering fasting blood glucose, decreasing the chances of relapse, as well as decreasing cortisol levels to improve cognition and the underlying depression. Restoring the gut microbiota has also been shown to restore insulin sensitivity and reduce anxiety and depression symptoms in patients.

The prevalence of depression and its associated factors among patients with diabetes mellitus attending a tertiary clinic in Gaborone, Botswana

Background

Depression is one of the commonest co-existing medical conditions among patients with diabetes mellitus (DM). A bidirectional relationship between depression and DM exists, complicating glycaemic control leading to an increase in diabetic complications. There is a dearth of information regarding the prevalence of depression and associated factors among patients with DM in Botswana.

Aim

This study aimed to determine the prevalence of depression and associated factors among patients with DM. The study also assessed the association between depression and glycaemic control.

Setting

A tertiary diabetic referral clinic in Gaborone, Botswana.

Method

A sample of 260 randomly selected patients with DM was recruited in this cross-sectional study. Socio-demographic and clinical characteristics of the patients were collected using a case report form. Depression was evaluated using the Patient Health Questionnaire (PHQ)-9 scale. Multivariate regression analysis was used to determine factors significantly associated with depression.

Results

The mean age (standard deviation [s.d.]) of study participants was 58.4 (11.8) years, and the majority, 160/260 (61.5%), were females. The prevalence of depression was 30.4% and significantly associated with female sex (adjusted odds ratio [AOR] = 5.529, p-value = 0.004), three or more diabetes-related hospitalisations (AOR = 3.886, p-value = 0.049) and inversely associated with systolic blood pressure (SBP) ≥ 140 mmHg (AOR = 0.11, p-value = 0.001).

Conclusion

Depression is a common problem among patients with DM in our setting. Routine screening of depression in diabetic patients to enable early detection and treatment is recommended.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Prevalence of Depression Among Patients With Type 2 Diabetes at King Abdullah Medical City

Introduction Diabetes is one of the most common endocrine diseases worldwide. Type 2 diabetes and depression are commonly comorbid, high-prevalence, chronic disorders. Individuals with diabetes mellitus may have concurrent mental health disorders and are shown to have poorer disease outcomes. However, the evidence for clinical correlation is still unclear. Objectives To find the prevalence of depression among patients with type 2 diabetes at King Abdullah Medical City (KAMC). Materials and methods A cross-sectional observational study was conducted at KAMC in Makkah, the Kingdom of Saudi Arabia. Study participants were 267 people with type 2 diabetes (aged between 18-70 years). Those who had preexisting depression or drank alcohol, pregnant women, and postpartum women were excluded from the study. Participants' clinical and demographic data and depression assessment were obtained on phone through an interview and using the Arabic version of the Patient Health Questionnaire-9 (PHQ-9), respectively. Glycated hemoglobin (HbA1c) test results of participants were collected electronically. Results The participants' mean age was 57.88 ± 8.71 years, and 64.4% were males. Only 15.4% were current smokers and 16.9% were ex-smokers. The most common medical condition was hypertension (65.2%) and the majority (92.1%) had uncontrolled HbA1c with a mean value of 8.37 ± 1.92. Among the studied patients, 73% suffered from different degrees of depression; 36%, 19.9%, 8.6%, 5.2%, and 3.4% of the participants were suffering from minimal, mild, moderate, moderately severe, and severe depression, respectively. Only neuropathy was a significant risk factor of depression (odds ratio=2.87, 95% confidence interval=1.18-6.97, p=0.02). Conclusion Depressive symptoms are common in patients with uncontrolled type 2 diabetes who also suffer from neuropathy and retinopathy. Hypertension, cardiovascular diseases, and unhealthy diet had a significant correlation with depression.

Antidepressants and the risk of myocardial infarction among patients with diabetes: A population-based cohort study

OBJECTIVE

To investigate the impact of antidepressants (ATDs) on the risk of myocardial infarction (MI) among patients with diabetes mellitus (DM).

METHODS

This was a retrospective population-based cohort study that used data obtained from the National Health Insurance Research Database in Taiwan. The study cohort included diabetic patients who were older than 50 years from 1997 to 2010. We then randomly assigned individuals to the matched cohort at a 1:1 ratio according to their demographic data. Both study and matched cohorts were followed up to compare the risk of MI between patients with and without ATD use from 2000 until the end of 2013. Multivariate Cox proportional hazards models were used to evaluate the relationship between ATD treatment and the occurrence of MI.

RESULTS

After adjustment for confounders, patients with ATD use of more than 180 days had a lower risk of MI than those without ATD use in the matched cohort (adjusted hazard ratio [HR] = 0.68, 95% confidence interval [CI], 0.66-0.71). The adjusted HRs of MI were 0.77 (95% CI, 0.73-0.81) and 0.56 (95% CI, 052.-0.60) in patients with DM and ATD use of 180 > cDDD ≥ 28 and cDDD ≥ 180, respectively. When the duration of ATD treatment was 180 days or longer, MI risk was significantly reduced (after adjustment) for all classes of ATD except bupropion.

CONCLUSIONS

Most ATDs, but not bupropion, were associated with significantly reduced risk of MI among the DM population.

Depression and anxiety among individuals with medical conditions during the COVID-19 pandemic: Findings from a nationwide survey in Bangladesh

BACKGROUND

Coronavirus disease 2019 (COVID-19) disproportionately impacts individuals with medical conditions, including with respect to their mental health. The present study investigated depression and anxiety and their correlates among individuals with medical conditions in Bangladesh.

METHODS

Subjects were recruited to participate in an internet-based survey. Data were collected from November 2020 to January 2021 using convenience sampling by a semi-structured questionnaire through online platforms. Multiple regression analyses were performed to determine associations applying Bonferroni correction (p < 0.004). The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) measured depression and anxiety, respectively.

RESULTS

Nine-hundred-and-seventy-one participants (50.1% male; mean age = 42.29 ± 15.86 years; age range = 18-80 years) with medical conditions were included in final analyses. The most frequently reported conditions were diabetes, hypertension, obesity, heart disease, asthma, and anemia. Estimates of moderate to severe depression and anxiety were 38.9% and 35.2%, respectively. The mean depression and anxiety scores were significantly higher among participants who reported having hypertension, obesity, heart disease, asthma, anemia, cancer and chronic obstructive pulmonary disease (COPD). Using Bonferroni correction (p < 0.004), depression was associated with being female and a student, having poorer quality of life, poorer health status and greater numbers of co-morbidities, not engaging in physical exercise and tobacco smoking. Anxiety was associated with being female and a student, having lower socioeconomic status, poorer quality of life, poorer health status and greater numbers of co-morbidities, less sleep and tobacco smoking.

CONCLUSIONS

Depression and anxiety are prevalent among individuals with medical conditions and correlate with sociodemographic, quality-of-life and smoking measures. Interventions targeting vulnerable groups should be employed and investigated.

Suboptimal diabetic control and psychological burden after the triple disaster in Japan: the Fukushima Health Management Survey

INTRODUCTION

A triple disaster struck eastern Japan in March 2011. We investigated the psychological distress and post-traumatic stress disorder (PTSD) symptoms caused by the disaster in people without or with diabetes mellitus.

RESEARCH DESIGN AND METHODS

This cross-sectional analysis examined the 16 097 evacuees (1820 (11.3%) with and 14 277 (88.7%) without diabetes mellitus) included in the Fukushima Health Management Survey. Non-specific mental health distress was assessed using the Kessler-6 Scale, and traumatic symptoms were evaluated using the PTSD Checklist. Logistic regression analyses were used to estimate the OR and 95% CI associated with symptoms, adjusted for diabetes-related and disaster-related factors.

RESULTS

In the age-adjusted and sex-adjusted logistic models, suboptimal diabetic control (hemoglobin A1c (HbA1c) ≥7%) was associated with both psychological distress and possible PTSD. In the same models, current smoking, evacuation, and sleep dissatisfaction were associated with psychological distress and possible PTSD. In the multivariate-adjusted logistic models, HbA1c ≥7% was associated with psychological distress, independent of job change, evacuation, or sleep dissatisfaction.

CONCLUSION

After the triple disaster, non-specific mental health distress was associated with suboptimal diabetic control. Thus, patients with diabetes, especially those with suboptimal diabetic control, may be vulnerable to postdisaster psychological burden.

Factors Associated with Depressive Symptoms in Korean Adults with Diabetes Mellitus: A Cross-Sectional Study

Depressive symptoms in adults with diabetes are influenced by sociodemographic status, health-related behaviors, and comorbid diseases. This study aimed to examine the factors related to depressive symptoms in Korean adults with diabetes, using data from the Korea National Health and Nutrition Examination Surveys for 2014, 2016, and 2018. A total of 1529 Korean adults with diabetes were selected as subjects for the analysis. The age group of the participants was 19-80 years, with a mean age of 63.34 ± 0.68 years. The depressive symptoms and severity were assessed using the Korean version of the Patient Health Questionnaire-9. Descriptive statistics, chi-squared tests, and univariate and multivariable logistic regression analyses were used by applying a complex sample analysis method. The findings showed that 9.6% of Korean adults with diabetes exhibited moderate to severe depressive symptoms, which gradually decreased during 2014-2018. The most significant independent factors of depressive symptoms were living without a spouse, unemployment, low household income, fair or poor subjective health conditions, high perceived stress, a diabetes duration of over 20 years, and stroke. In females, living without a spouse, low household income, poor subjective health condition, high perceived stress, stroke, and coronary heart disease were significantly associated with depressive symptoms. In males, living without a spouse, unemployment, poor subjective health condition, high perceived stress, and hypertension were significantly associated with depressive symptoms. These findings highlight the importance of regular screening for depressive symptoms in patients with diabetes as the prevalence of depressive symptoms in people with diabetes may be higher than those in the general population. Future studies should also examine the development and effectiveness of psychosocial intervention programs to decrease depressive symptoms in patients with diabetes, considering cost-effective and time-saving approaches.

High Prevalence of Depressive Symptoms in Patients With Type 1 and Type 2 Diabetes in Developing Countries: Results From the International Diabetes Management Practices Study

OBJECTIVE

Depression is common in people with diabetes, but data from developing countries are scarce. We evaluated the prevalence and risk factors for depressive symptoms in patients with diabetes using data from the International Diabetes Management Practices Study (IDMPS).

RESEARCH DESIGN AND METHODS

IDMPS is an ongoing multinational, cross-sectional study investigating quality of care in patients with diabetes in real-world settings. Data from wave 5 (2011), including 21 countries, were analyzed using the 9-item Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. Logistic regression analyses were conducted to identify risk factors of depressive symptoms.

RESULTS

Of 9,865 patients eligible for analysis, 2,280 had type 1 and 7,585 had type 2 diabetes (treatment: oral glucose-lowering drugs [OGLD] only, n = 4,729; OGLDs plus insulin, n = 1,892; insulin only, n = 964). Depressive symptoms (PHQ-9 score ≥5) were reported in 30.7% of those with type 1 diabetes. In patients with type 2 diabetes, the respective figures were 29.0% for OGLDs-only, 36.6% for OGLDs-plus-insulin, and 46.7% for insulin-only subgroups. Moderate depressive symptoms (PHQ-9 score 10-19) were observed in 8-16% of patients with type 1 or type 2 diabetes. Female sex, complications, and low socioeconomic status were independently associated with depressive symptoms. In type 1 diabetes and in the type 2 diabetes OGLDs-only group, depression was associated with poor glycemic control.

CONCLUSIONS

Depressive symptoms are common in patients with diabetes from developing countries, calling for routine screening, especially in high-risk groups, to reduce the double burden of diabetes and depression and their negative interaction.

Do Youth Want Psychosocial Screenings in Diabetes Clinic? Profiles of Acceptability

AIMS

Psychosocial screenings are recommended and increasingly common in pediatric subspecialty clinics, though little is known about their acceptability. This study seeks to uncover profiles of acceptability and assess demographic and clinical correlates among adolescents with diabetes.

METHODS

A sample of 124 adolescents (57.7% female) ages 12-21 years (M = 16.2 ± 2.3) completed screenings during routine diabetes appointments. K-means clustering of responses to acceptability items derived profiles; Analysis of Variance (ANOVA) and Chi-square tests assessed correlates.

RESULTS

Adolescents with the most common profile (72.6%) placed high importance on medical providers' awareness of their emotions and reported no difficulties/discomfort with the screener. These youth had moderate depressive symptoms, low diabetes distress, and low A1c. Those who fit a less common profile (18.5%) were uncomfortable with the screener and had the highest depressive symptoms and lowest A1c. Youth who fit a smaller profile (6.5%) endorsed technical difficulties and had high depressive symptoms and lowest diabetes distress. The smallest profile (2.4%, N = 3) had difficulty understanding and experienced discomfort with the screening and had the lowest depressive symptoms and the highest diabetes distress and A1c. These differences in depressive symptoms (F = 3.54, p = .017), A1c values (F = 4.03, p = .009), and diabetes distress (F = 3.27, p = .036) were significant though differences in age, gender, and diabetes duration were not.

CONCLUSIONS

Most youth responded favorably to in-clinic psychosocial screenings. Youth who were less satisfied were at increased risk for psychosocial and medical complications. Findings highlight areas of need, such as enhanced support with and an emphasized rationale for screenings, which may improve patient experience in subspecialty care.

Risk factors for severity of depression in participants with chronic medical conditions in rural primary health care settings in India

Background

Depression and chronic medical disorders are strongly linked. There are limited studies addressing the correlates of the severity of depression in patients with co-morbid disorders in primary care settings. This study aimed to identify the socio-demographic and disease-specific risk factors associated with the severity of depression at baseline among patients participating in a randomized controlled trial (HOPE study).

Methods

Participants were part of a randomized controlled trial in 49 primary care health centers in rural India. We included adults (≥ 30 years) with at least mild Depression or Anxiety Disorder and at least one Cardiovascular disorder or Type 2 Diabetes mellitus. They were assessed for the severity of depression using the PHQ-9, severity of anxiety, social support, number of co-morbid chronic medical illnesses, anthropometric measurements, HbA1c, and lipid profile.

Results

Proportionately there were more women in the moderate category of depression than men. Ordinal logistic regression showed co-morbid anxiety and a lower level of education significantly increased the odds of more severe depression, while more social support was significantly negatively associated with depression severity in women. In men, anxiety was positively associated with greater depression severity; while reporting more social support was negatively associated with depression.

Limitations

This is a cross-sectional study and thus, no causal conclusions are possible.

Conclusions

Anxiety and poor social support in both genders and lower educational levels in women were associated with increased severity of depression. Early identification of risk factors and appropriate treatment at a primary care setting may help in reducing the morbidity and mortality associated with depression.

50 Years of Behavioral Science in Diabetes: A 2020 Vision of the Future

This article is adapted from a speech Dr. de Groot delivered in June 2020 as President, Health Care & Education, of the American Diabetes Association at the Association's 80th Scientific Sessions, which was held online as a result of coronavirus disease 2019. Dr. de Groot is an Associate Professor of Medicine in the Division of Endocrinology, Diabetes and Metabolism at Indiana University (IU) School of Medicine. She serves as the Acting Director of the IU Diabetes Translational Research Center. Dr. de Groot is the 2020 recipient of the Rachmiel Levine Medal for Leadership from the American Diabetes Association.In the year 2020, we marked the 50th anniversary of the field of behavioral science in diabetes in the modern era. Over this relatively short period of time, this field has charted the psychosocial landscape of prediabetes and diabetes by establishing the prevalence and impact of emotional and behavioral aspects of diabetes. Interventions to address these conditions have been developed that span the T2 to T4 translational research spectrum ranging from the intrapsychic to population-based interventions. Policies ranging from standards of care to Medicare benefits have been implemented. A review of research in the area of diabetes and depression is provided as an example of innovations in this field. Behavior is the foundation of all interventions we make in diabetes and prediabetes. As a mature science, it is critical to stemming the tide of diabetes and its outcomes. To make additional strides, we must rebalance our focus and augment funding for behavioral interventions for individuals, communities, and health care systems in conjunction with other forms of treatment.

Nutrition quality of life associated with affective functioning among Omani patients with type 2 diabetes from primary health care

Diabetes requires challenging lifelong dietary management, affects quality of life and heightens the impact of affective functioning. The aim of this study was to investigate the relationship between Nutrition Quality of Life (NQOL) and affective functioning in a sample of Omani patients with type 2 diabetes. A sample of 149 adults with type 2 diabetes was conveniently recruited from seven Primary Health Centers (PHCs) during follow-up visits. Data were gathered via face-to-face interviews. Pearson correlation and χ2 test of independence were applied to examine associations at P < 0⋅05. Most patients had poor glycemic control (71⋅1 %), BMI ≥ 25 kg/m2 (85⋅2 %) and central obesity (75⋅8 %), and moderate (54⋅4 %) and poor (32⋅9 %) level of NQOL. Based on the Hospital Anxiety and Depression Scale (HADS), 16⋅1 and 23⋅5 % of the sample endorsed the presence of anxiety and depression, respectively. A significant negative correlation was found between NQOL and HADS (r -0⋅590, P = 0⋅000), anxiety (r -0⋅597, P = 0⋅000) and depression (r -0⋅435, P = 0⋅000). There was a significant association between NQOL and HADS, χ2 (2) = 38⋅21, P < 0⋅01 that was large, Cramer's V = 0⋅51. Also, there were significant associations (P < 0⋅01) between NQOL and HADS when controlling for HbA1c, BMI, waist circumference and HMNT that were moderately to largely strong, Cramer's V = 0⋅43-0⋅55. There is an evident association between NQOL and affective functioning in adults with type 2 diabetes. Further research is recommended to confirm these relationships and to guide intervention programmes at PHCs to help improve the general quality of life of such patients.

Prevalence and associated factors of depression among diabetic outpatients attending diabetic clinic at public hospitals in Eastern Ethiopia: A cross-sectional study

Introduction:

Depression is one of the most common comorbid psychiatric disorders among diabetic patients. Depression among diabetic people has led to poor treatment adherence, defective treatment outcomes, and consequently worsened quality of life. However, there is a limited study conducted to assess the magnitude and factors associated with depression among diabetic patients in Ethiopia including this study area.

Objective:

This study aimed to assess the prevalence and factors associated with depression among adult diabetic outpatients attending diabetic clinic in Eastern Ethiopia.

Methods:

An institution-based cross-sectional study was conducted among 407 adult diabetic outpatients on treatment in Ethiopia in 2020. Patient Health Questionnaire-9 was used to assess depression among randomly selected samples. Bivariate and multivariate logistic regression was fitted to identify factors associated with depression among diabetic outpatients. A p value less than 0.05 with a 95% confidence interval was considered statistically significant.

Results:

The overall prevalence of depression among diabetic outpatients was found to be 48.9% (95% confidence interval: 44.2%, 53.4%). Being female (adjusted odds ratio = 1.50, 95% confidence interval: 1.39, 2.73), Khat chewing (adjusted odds ratio = 1.88, 95% confidence interval: 1.22, 2.93), having poor and moderate social support (adjusted odds ratio = 1.79, 95% confidence interval: 1.07, 2.98 and adjusted odds ratio = 1.90, 95% confidence interval: 1.14, 3.17, respectively), taking both oral hypoglycemic agents and insulin medication (adjusted odds ratio = 1.33, 95% confidence interval: 1.13, 2.80) and duration of diabetes mellitus for more than 6 years (adjusted odds ratio = 5.40, 95% confidence interval: 3.42, 8.14) were significantly associated with depression.

Conclusion:

This study revealed a relatively high prevalence of depression in diabetic outpatients. A lesser level of social support, taking oral and insulin treatment regimes, longer duration of illness, using Khat, and being female were associated with depression among diabetic outpatients. Therefore, early screening and identification of such factors could help ameliorate some of the deleterious effects of depression in diabetic outpatients.

Anxiety, depression and their associated risk factors among patients with diabetic foot ulcer: A two center cross-sectional study in Jordan and Saudi Arabia

BACKGROUND AND AIMS

To determine and analyze the factors related to anxiety and depression in patients having diabetic foot ulcer (DFU).

METHODS

This two-center, cross-sectional study was conducted among 250 patients with DFU, who were receiving treatment in the outpatient diabetes foot care clinic at Prince Sultan Military Medical City, Saudi Arabia and National Center for Diabetes, Endocrinology and Genetics, Jordan. Employing the Hospital Anxiety and Depression Scale (HADS), the anxiety and depression levels of the study population were measured. The demographic variables were also recorded.

RESULTS

Females displayed significantly higher anxiety (p = 0.032) and depression levels (p = 0.043); and those who were unmarried showed higher anxiety (p = 0.042). School educated patients showed reduced degrees of anxiety (p = 0.023) and depression (p = 0.003) and college educated showed reduced anxiety (p = 0.047) compared to uneducated. Compared to patients on treatment with diet, a significant decline was found in depression (p = 0.034) levels among orally treated patients. Compared to patients on oral medication, patients with oral and insulin treatments revealed higher depression (p = 0.026). Higher-income patients showed a significant decline for anxiety (p = 0.004). Patients who were past smokers had higher anxiety (p = 0.046) than current and never had been smokers. Higher anxiety (p = 0.017) was observed in patients having higher HbA1c levels, similarly, patients with three diabetes-related complications showed higher levels of anxiety (p = 0.001) and depression (p = 0.001).

CONCLUSION

Female gender, lower education levels, patients on oral and insulin treatments, low income, high HbA1c levels and patients experiencing a higher number of diabetes-related complications showed either higher anxiety or depression levels.

50 Years of Behavioral Science in Diabetes: A 2020 Vision of the Future

Editor's Note: This article is adapted from a speech Dr. de Groot delivered in June 2020 as President, Health Care & Education, of the American Diabetes Association. She delivered her address at the Association's 80th Scientific Sessions, which was held online as a result of the coronavirus disease 2019.

Investigating spatial convergence of diagnosed dementia, depression and type 2 diabetes prevalence in West Adelaide, Australia

BACKGROUND

Comorbid depression and type 2 diabetes (T2D) is an important risk factor for dementia. This study investigates the factors associated with, the spatial variation and spatial convergence of diagnosed cases of these conditions. This approach may identify areas with unmet needs.

METHODS

We used cross-sectional data (2010 to 2014) from 16 general practices in west Adelaide, Australia. Multi-level modelling accounting for individual-level characteristics nested within statistical area level 1 (SA1) determined covariate associations with these three diseases. Getis-Ord Gi method was used to investigate spatial variation, hot spots and cold spots of these conditions.

RESULTS

1.4% of active patients in west Adelaide aged 45 and above were diagnosed with dementia, 9.6% with depression and 13.3% with T2D. Comorbidity was significant across all three diseases. Elderly age (65+ years) was significantly associated with diagnosed dementia and T2D. Hyperlipidemia or hypertension diagnosis and belonging to lower socioeconomic status were significantly associated with diagnosed T2D and depression. The spatial distribution of each disease varied across west Adelaide. Spatial convergence of the three diseases was observed in two large hot spot clusters and one main cluster of cold spots.

LIMITATIONS

Due to underreporting, potentially significant covariates like alcohol intake were unable to be assessed. There may be a bias towards health-conscious individuals or patients managing diagnosed diseases that actively visit their general practice.

CONCLUSIONS

Patterns of spatial convergence and the shared associations in dementia, depression and diabetes enable policymakers to tailor interventions to the areas where risk of these conditions are greater.

Are normoglycaemic individuals at risk of depression? The depression-dysglycaemic phenotype from a European population-based cross-sectional study

BACKGROUND

Depression is a chronic non communicable disease. It is a growing public health concern with established links with a number of co-morbidities, including diabetes mellitus. The study aimed to estimate the prevalence of depression at a population level, establish the depression sub-population phenotypic characteristics while exploring for links between depression and a spectrum of glycemic abnormalities.

METHODS

A nationally representative cross-sectional study was conducted in Malta between 2014 and 2016. Participants were categorized into different sub-populations according to their glycaemic status. Depression prevalence rates and phenotypic characteristics for each sub-population were established. Multiple regression analysis was performed to identify links with depression.

RESULTS

Depression was prevalent in 17.15% (CI 95%: 16.01-18.36) with a female predominance. Those with known (as opposed to newly diagnosed) diabetes had the highest depression prevalence when compared to other glycemic sub-groups. These also exhibited a significant link with self-reported depression. However, at a population level, depression was mostly prevalent within the normoglycaemic sub-population.

CONCLUSIONS

The study confirms the strong link between diabetes and depression, especially, in a high risk dysglycaemic population. Of public health concern is the high depression occurrence within the normoglycaemic sub-population, which attributed for the majority of the Maltese population. In order to reduce the impact of mental health on the population, physicians may consider implementing depression screening clinical tools as part of their routine health check-ups at primary care level, irrespective of the glycaemic status of their patients.

Detection and prevalence of depression among adult type 2 diabetes mellitus patients attending non-communicable diseases clinics in Lilongwe, Malawi

Background

Depression is associated with chronic physical illnesses and negatively affects health outcomes. However, it often goes undiagnosed and untreated. We investigated the prevalence of depression among adult type 2 diabetes mellitus (T2DM) patients attending non-communicable diseases (NCD) clinics in Lilongwe, Malawi, and estimated the level of routine detection by NCD clinicians. This study set out to determine the prevalence of major depression and its detection among adult type 2 diabetes mellitus (T2DM) patients attending NCD clinics in Lilongwe, Malawi.

Methods

In a cross-sectional study design, 323 T2DM patients aged ≥ 18 years were screened for depression with the Patient Health Questionnare-9 (PHQ-9) followed by diagnostic assessment with the Structured Clinical Interview for DSM-IV (SCID). We analysed the association between presence of major depression and sociodemographic factors using logistic regression.

Results

Three quarters of the participants (76%) were females. The participants’ ages ranged from 21–79 years. Of the 323 participants, 58 (18%) met criteria for DSM-IV major depression. None of the cases of major depression had been identified by the NCD clinicians. Major depression was found not to be significantly associated with any of the sociodemographic factors.

Conclusions

We found that depression is common among NCD clinic attendees with T2DM in Malawi, and poorly detected by NCD clinicians. Given the high prevalence and challenges in clinical identification, integration of depression screening with a standardized validated tool should be a high priority so as to link patients to appropriate services.

Investigation on the association between diabetes distress and productivity among patients with uncontrolled type 2 diabetes mellitus in the primary healthcare institutions

AIMS

To investigate associations between diabetes distress and productivity, and to identify the potential risk factors that could affect these particular associations.

METHODS

This cross-sectional study was conducted in three outpatient healthcare institutions. Patients aged ≥21 years with uncontrolled T2DM and polypharmacy were included. The Problem Areas in Diabetes (PAID) measuring diabetes distress and Work Productivity and Activity Impairment General Health (WPAI-GH) measuring productivity were administered by trained interviewers.

RESULTS

A total of 259 patients were analysed. Point prevalence of clinically severe diabetes distress, work productivity loss and life productivity loss were 7.7%, 45.0% and 35.1% respectively. Diabetes distress was positively associated with work productivity loss (p = 0.001) and life productivity loss (p < 0.001). Multiple linear regression analysis demonstrated that diabetes distress (p = 0.003), the total number of chronic medications (p = 0.012), insulin therapy (p = 0.027) and the presence of chronic kidney disease (p = 0.038) were significantly associated with work impairment. Diabetes distress (p = 0.001) and the presences of osteoarthritis (p = 0.039) were significantly associated with activity impairment.

CONCLUSION

Healthcare professionals should screen patients for diabetes distress to prevent productivity losses, especially in patients with polypharmacy and/or on insulin and with coexisting osteoarthritis or chronic kidney disease.

Insulin resistance and obesity, and their association with depression in relatively young people: findings from a large UK birth cohort

BACKGROUND

Depression frequently co-occurs with disorders of glucose and insulin homeostasis (DGIH) and obesity. Low-grade systemic inflammation and lifestyle factors in childhood may predispose to DGIH, obesity and depression. We aim to investigate the cross-sectional and longitudinal associations among DGIH, obesity and depression, and to examine the effect of demographics, lifestyle factors and antecedent low-grade inflammation on such associations in young people.

METHODS

Using the Avon Longitudinal Study of Parents and Children birth cohort, we used regression analyses to examine: (1) cross-sectional and (2) longitudinal associations between measures of DGIH [insulin resistance (IR); impaired glucose tolerance] and body mass index (BMI) at ages 9 and 18 years, and depression (depressive symptoms and depressive episode) at age 18 years and (3) whether sociodemographics, lifestyle factors or inflammation [interleukin-6 (IL-6) at age 9 years] confounded any such associations.

RESULTS

We included 3208 participants. At age 18 years, IR and BMI were positively associated with depression. These associations may be explained by sociodemographic and lifestyle factors. There were no longitudinal associations between DGIH/BMI and depression, and adjustment for IL-6 and C-reactive protein did not attenuate associations between IR/BMI and depression; however, the longitudinal analyses may have been underpowered.

CONCLUSIONS

Young people with depression show evidence of DGIH and raised BMI, which may be related to sociodemographic and lifestyle effects such as deprivation, smoking, ethnicity and gender. In future, studies with larger samples are required to confirm this. Preventative strategies for the poorer physical health outcomes associated with depression should focus on malleable lifestyle factors.

The association between an increase in glucose levels and armed conflict-related stress: A population-based study

Studies have shown stress may lead to diabetes-related morbidities. In recent years during enhanced hostility periods, the population of Southern Israel experienced alert sirens and rocket fire on a daily basis. We investigated whether the exposure to these stressful circumstances, which peaked during three large military operations (MO), was associated with increased glucose levels among the civilian population. We included all fasting serum glucose tests taken between 2007-2014, of Clalit Health Services members in Southern Israel who had at least one fasting glucose test during an MO period and at least one test drawn at other times. We analyzed the association between MO periods and glucose using linear mixed-effects models. We included 408,706 glucose tests (10% during MO periods). Among subjects who reside in proximity to Gaza, glucose levels were 2.10% (95% CI 1.24%; 2.97%) higher in MO days compared to other times. A weaker effect was observed among subjects in more remote locations. In conclusion, we found stress to be associated with increased fasting glucose levels, especially among those who reside in locations in which the intensity of the threat is higher. Since glucose may be a marker of the population at cardiovascular risk, further studies are required.

Depression in context: Important considerations for youth with type 1 vs type 2 diabetes

BACKGROUND

Youth with diabetes are at increased risk for depression. However, severity and correlates of depressive symptoms may differ by diabetes type.

OBJECTIVE

Associations of depressive symptoms with global health, diabetes duration, and gender were compared between youth with type 1 and type 2 diabetes.

METHODS

A sample of 149 youth ages 12 to 21 diagnosed with either type 1 (n = 122) or type 2 (n = 27) diabetes were screened during routine clinic appointments. Regression models were constructed to examine differences by diabetes type.

RESULTS

Adolescents with type 2 diabetes had significantly higher depressive symptom scores (4.89 vs 2.99, P = .025) than those with type 1 diabetes. A significant interaction between global health and diabetes type on depressive symptoms revealed inverse associations between global health and depressive symptoms that was stronger among youth with type 2 diabetes (β = -.98, P < .001) than type 1 (β = -.48, P < .001). Further probing revealed that among youth with better global health, adolescents with type 1 had more depressive symptoms than those with type 2 diabetes (β = .33, P = .035). Diabetes duration and depressive symptoms were positively associated among individuals with type 2 (β = .86, P = .043), but not type 1 diabetes. No gender differences were detected.

CONCLUSION

These findings suggest that correlates of depressive symptoms in youth with diabetes differ by diabetes type. Global health appears to be an important correlate among youth with both types, whereas diabetes duration was only a significant factor among those with type 2 diabetes. The current findings can inform future psychosocial intervention efforts within both these populations.

Antidepressants Reduced Risk of Mortality in Patients With Diabetes Mellitus: A Population-Based Cohort Study in Taiwan

CONTEXT

The effect of antidepressant (ATD) use on mortality in patients with diabetes mellitus (DM) has not yet been sufficiently studied, although comorbid depression is common in this population.

OBJECTIVE

To explore the impact of ATDs on mortality among DM patients.

DESIGN

A retrospective cohort study in a national database.

SETTING

This population-based study used the National Health Insurance Research Database in Taiwan. Since 2000, we identified 53,412 cases of newly diagnosed patients with DM and depression. Patient cases were followed for assessing mortality until 2013.

MAIN OUTCOME MEASURE

The association between mortality and ATD use was explored adjusting for cumulative dosing.

RESULTS

Using the time-dependent Cox regression model, ATD use was associated with significantly reduced mortality among patients with DM [in the highest dose group: hazard ratio (HR), 0.65; 95% CI, 0.59 to 0.71]. Further analysis showed that differences in mortality existed across ATD categories: selective serotonin reuptake inhibitors (HR, 0.63; 95% CI, 0.56 to 0.71), serotonin-norepinephrine reuptake inhibitors (HR, 0.58; 95% CI, 0.44 to 0.78), norepinephrine-dopamine reuptake inhibitors (HR, 0.20; 95% CI, 0.07 to 0.63), mirtazapine (HR, 0.60; 95% CI, 0.45 to 0.82), tricyclic/tetracyclic antidepressants (HR, 0.73; 95% CI, 0.54 to 0.97), and trazodone (HR, 0.52; 95% CI, 0.29 to 0.91). However, reversible inhibitor of monoamine oxidase A (RIMA) was found to be associated with an increase, rather than a decrease, in total mortality (HR, 1.48; 95% CI, 1.09 to 1.99).

CONCLUSION

Most ATDs, but not RIMA, were associated with significantly reduced mortality among a population with comorbid DM and depression.

Higher risk of depression in individuals with type 2 diabetes and obesity: Results of a meta-analysis

The aim of this study was to determine the risk of having significant depressive symptoms in subjects with obesity and type 2 diabetes mellitus through a meta-analysis. Our results showed that individuals with obesity and diabetes have an increased risk of having significant symptoms of depression. In subgroup analyses, we observed that Caucasian populations have an increased risk of having these symptoms. Our meta-analysis suggests that obesity is associated with an increased risk of having significant depressive symptoms in patients with type 2 diabetes, and they could be even higher in Caucasian populations.

Risk factors for depression in elderly diabetic patients and the effect of metformin on the condition

Background

At present, only a few studies have focused on the risk factors for depression in elderly diabetic patients, and there is little evidence for the effect of metformin in depressed elderly patients with diabetes than on its effect on blood glucose. The aim of the current work was to study the risk factors for depression in elderly diabetic patients and to ascertain the effects of metformin on the depressive state.

Methods

We initiated a 1:4 matched case–control study. The case group comprised 110 elderly diabetic patients with depression from nine communities in Shenyang in 2017. The control group comprised 440 non-depressed elderly diabetic patients from the same communities, which were matched by gender and age (± 2 years of age) with the case group. Depression was measured using the Geriatric Depression Scale-15, and we performed matched univariate and multivariate logistic regression analyses.

Results

In the multivariate analysis, overweight status, poor physical capabilities and low activity level, and the presence of more than two additional illnesses were risk factors for depression in elderly patients with diabetes. For these risk factors, the adjusted ORs (all P < 0.05) were as follows: an adjusted OR of 2.031 and 95% CI of 1.180–3.495; an adjusted OR of 2.342 and 95% CI of 1.465–3.743; and an adjusted OR of 5.350 and 95% CI of 2.222–12.883, respectively. Patients taking metformin had a lower risk of depression than those taking no medication, with an adjusted OR of 0.567 and 95% CI of 0.323–0.997 (P < 0.05).

Conclusions

Overweight status, poor physical capabilities and low activity level, and the presence of more than two additional illnesses were risk factors for depression in elderly diabetic patients, and metformin was a protective factor against depression in elderly diabetic patients.

Program ACTIVE II: Outcomes From a Randomized, Multistate Community-Based Depression Treatment for Rural and Urban Adults With Type 2 Diabetes

OBJECTIVE

Depression (major depressive disorder [MDD]) in adults with type 2 diabetes mellitus (T2DM) is associated with worsened diabetes complications, increased health care costs, and early mortality. Program ACTIVE II was a randomized, controlled, multicenter treatment trial designed to test the comparative effectiveness of cognitive behavioral therapy (CBT) and/or community-based exercise (EXER) on diabetes and depression outcomes compared with usual care (UC).

RESEARCH DESIGN AND METHODS

Using a 2 × 2 factorial randomized controlled trial design, adults with T2DM for ≥1 year who met DSM-IV-TR criteria for MDD were randomized to CBT (10 sessions occurring over 12 weeks; N = 36), EXER (12 weeks of community-based exercise including six sessions with a personal trainer; N = 34), CBT+EXER (concurrent over a 12-week period; N = 34), and UC (N = 36). Primary outcomes were depression remission rate (assessed by psychiatric interviewers blind to assignment) and change in glycemic control (HbA_1c).

RESULTS

The mean age was 56.0 years (SD 10.7). Participants were female (77%), white (71%), and married (52%). After controlling for education and antidepressant use, odds of achieving full MDD remission in the intervention groups were 5.0-6.8 times greater than UC (P < 0.0167). The CBT+EXER group demonstrated improved HbA_1c compared with UC. For participants with a baseline HbA_1c ≥7.0%, exploratory post hoc subgroup analysis showed that the CBT+EXER group had a 1.1% improvement in HbA_1c (P < 0.0001) after controlling for covariates.

CONCLUSIONS

The Program ACTIVE behavioral treatment interventions demonstrated clinically meaningful improvements in depression outcomes in adults with T2DM and MDD. These community-based interventions are complementary to medical care and extend access to those in rural and urban areas.

The association between diabetes and depressive symptoms varies by quality of diabetes care across Europe

Background

Depressive symptoms are more common in adults with diabetes and may arise from the physical and psychosocial burden of disease. Better quality of diabetes care may be associated with a reduced disease burden and fewer depressive symptoms.

Methods

This cross-sectional study included 34 420 participants from 19 countries in the European Social Survey Round 7 (2014-2015). Countries were grouped into quartiles based on their quality of diabetes care as measured in the Euro Diabetes Index 2014. Individual-level depressive symptoms were measured using the 8-item Center for Epidemiologic Studies-Depression Scale. Negative binomial regression was used to compare the number of depressive symptoms between adults with and without diabetes in each quartile of diabetes care quality. Analyses included adjustment for covariates and survey weights.

Results

In countries with the highest quality of diabetes care, having diabetes was associated with only a 3% relative increase in depressive symptoms (95% CI 1.00-1.05). In countries in the second, third and fourth (lowest) quartiles of diabetes care quality, having diabetes was associated with a 13% (95% CI 1.08-1.17), 13% (1.08-1.19) and 22% (1.14-1.31) relative increase in depressive symptoms, respectively.

Conclusion

The association between diabetes and depressive symptoms appears stronger in European countries with lower quality of diabetes care. Potential pathways for this association include the financial aspects of diabetes care, access to services and differential exposure to the social determinants of heath. Further research is needed to unpack these mechanisms and improve the quality of life of people with diabetes across Europe.

Assessment of comorbid mild cognitive impairment and depression in patients with type 2 diabetes mellitus

CONTEXT

Depression, mild cognitive impairment, and dementia are highly prevalent chronic conditions associated with social, medical, and economic burdens. Although there are several epidemiological studies that have reported the prevalence of mild cognitive impairment or depressive syndrome in elderly diabetic population little is known about the comorbidity of these conditions. We aimed to study the prevalence of comorbid mild cognitive impairment (MCI) and depression in patients with Type 2 diabetes mellitus and its relation to glycemic control.

MATERIALS AND METHODS

the present work was carried on 400 patients with T2DM. History taking, physical examination, laboratory investigations (with special emphasis on glycemic profile and lipid profile parameters) were done for every patient. Assessment of anxiety and depression using the HADS score and assessment of mild cognitive impairment using MoCA score were done.

RESULTS

76% of studied patients had depression of varying degrees while 56.8% of studied patients had MCI. Decreased level of HDL-cholesterol and increased HADS anxiety score were significant predictors of depression. On the other hand, increased level of total cholesterol, decreased level of HDL-cholesterol, increased HADS depression score and decreased MoCA score were significant predictors of anxiety. HDL-cholesterol HADS anxiety score, FBG, and duration of DM were the significant predictors of MCI.

CONCLUSION

Increased level of total cholesterol, decreased level of HDL-cholesterol, increased HADS depression score and decreased MoCA score were significant predictors of anxiety. HDL-cholesterol, HADS anxiety score, FBG, and duration of DM were the significant predictors of MCI.

Is It Distress, Depression, or Both? Exploring Differences in the Diabetes Distress Scale and the Patient Health Questionnaire in a Diabetes Specialty Clinic

IN BRIEF Patients (n = 314) completed the Patient Health Questionnaire and the Diabetes Distress Scale as part of standard care. Although most patients (70.4%) had no symptoms of depression or diabetes-related distress, 23.9% scored high on the distress questionnaire in at least one of its four domains. Regular screening for distress related to the demands of living with diabetes is crucial in identifying and preventing poor health outcomes associated with diabetes-related distress.