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Park HS, Cho Y, Seo DH, Ahn SH, Hong S, Suh YJ, Chon S, Woo JT, Baik SH, Lee KW, Kim SH. Impact of diabetes distress on glycemic control and diabetic complications in type 2 diabetes mellitus. Sci Rep 2024; 14:5568. [PMID: 38448443 PMCID: PMC10917807 DOI: 10.1038/s41598-024-55901-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/28/2024] [Indexed: 03/08/2024] Open
Abstract
The effect of diabetes distress on glycemic control and its association with diabetes complications is still poorly understood. We aimed to study the clinical features of patients with high diabetes distress, focusing on changes in glycemic control and risk of diabetic complications. From the Korean National Diabetes Program data, we investigated 1862 individuals with type 2 diabetes mellitus (T2DM) who completed diabetic complication studies and the Korean version of the Problem Areas in Diabetes Survey (PAID-K). A total score of PAID-K ≥ 40 was considered indicative of high distress. Individuals with high distress (n = 589) had significantly higher levels of glycated hemoglobin than those without distress (7.4% vs. 7.1%, p < 0.001). This trend persisted throughout the 3-year follow-up period. Higher PAID-K scores were associated with younger age, female gender, longer duration of diabetes, and higher carbohydrate intake (all p < 0.05). There was a significant association between high distress and diabetic neuropathy (adjusted odds ratio, 1.63; p = 0.002), but no significant association was found with other complications, including retinopathy, albuminuria, and carotid artery plaque. In conclusion, high diabetes distress was associated with uncontrolled hyperglycemia and higher odds of having diabetic neuropathy.
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Affiliation(s)
- Hye-Sun Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yongin Cho
- Department of Endocrinology and Metabolism, Inha University College of Medicine, Incheon, Korea
| | - Da Hea Seo
- Department of Endocrinology and Metabolism, Inha University College of Medicine, Incheon, Korea
| | - Seong Hee Ahn
- Department of Endocrinology and Metabolism, Inha University College of Medicine, Incheon, Korea
| | - Seongbin Hong
- Department of Endocrinology and Metabolism, Inha University College of Medicine, Incheon, Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University College of Medicine, Incheon, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jeong-Taek Woo
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sei Hyun Baik
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kwan Woo Lee
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
| | - So Hun Kim
- Department of Endocrinology and Metabolism, Inha University College of Medicine, Incheon, Korea.
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, 27, Inhang-ro, Joong-gu, Incheon, 22332, Korea.
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Kershaw KA, Storer B, Braund T, Chakouch C, Coleshill M, Haffar S, Harvey S, Newby J, Sicouri G, Murphy M. The prevalence of anxiety in adult endocrinology outpatients: A systematic review and meta-analysis. Psychoneuroendocrinology 2023; 158:106357. [PMID: 37776733 DOI: 10.1016/j.psyneuen.2023.106357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Anxiety disorders and anxiety symptoms are common mental disorders in the medically unwell and have significant impacts on patients' quality of life and engagement with psychiatric and medical services. Several systematic reviews have examined the prevalence of anxiety in specific endocrinology settings with estimates varying significantly from study to study. No meta-analysis has examined anxiety rates across the endocrinology outpatient setting. The aim of this meta-analysis is to provide endocrinologists with a precise estimate of the prevalence of anxiety - and impacting factors - in their outpatient clinics. METHOD PubMed, Embase, Cochrane and PsycINFO databases and Google Scholar were searched to identify studies that assessed anxiety prevalence in endocrinology outpatients published up to 23 January 2023. This was part of a larger systematic review search of anxiety prevalence in common medical outpatient clinics. Data characteristics were extracted independently by two investigators. Studies of patients 16 years and older and representative of the clinic were included. The point prevalence of anxiety or anxiety symptoms was measured using validated self-report questionnaires or structured interviews. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Pooled estimates were analysed under the random-effects model and subgroup analyses on relevant variables were conducted under a mixed-effects model. Heterogeneity was assessed using the I2 statistic. RESULTS Fifty-nine studies with a total of 25,176 participants across 37 countries were included in this study. The overall pooled prevalence of anxiety or anxiety symptoms was 25·1% (95%CI 21·4-29·2; 6372/25,176; n = 59). Subgroup analyses revealed no difference in prevalence between outpatients with diabetes mellitus compared to other grouped endocrine disorders. Generalized Anxiety Disorder (GAD) was the most frequent clinical diagnosis 11·7% (95%CI 8·1-16·7; I2=87·93%; 443/4604; n = 17), while panic disorder was significantly higher in the non-diabetes group 9·5% (95%CI 5·9-14·9; I2=57·28%; 56/588; n = 8), compared to the diabetes group 5·2% (95%CI 3·7-7·3; I2=32·18%; 184/3669; n = 6). Estimates of prevalence were higher when assessed with a self-report scale 32·4% (95%CI 25·6-40·0; I2=96·06%; 1565/4675; n = 21) compared to diagnostic interview 17·6% (95%CI 12·2-24·7; I2=94·39%; 636/5168; n = 21). Outpatients in developing countries had higher rates of anxiety than those in developed countries. Female diabetes patients reported higher rates of anxiety compared to males. CONCLUSION Our study provides evidence that anxiety occurs frequently amongst endocrinology outpatients and at a higher rate than is estimated in the general population. Given the impact anxiety has on patient outcomes, it is important that effective management strategies be developed to support endocrinologists in identifying and treating these conditions in their outpatient clinics.
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Affiliation(s)
| | - Ben Storer
- The Black Dog Institute, Sydney, Australia
| | - Taylor Braund
- The Black Dog Institute, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia
| | | | | | - Sam Haffar
- The Black Dog Institute, Sydney, Australia
| | - Samuel Harvey
- The Black Dog Institute, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Jill Newby
- The Black Dog Institute, Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia
| | - Gemma Sicouri
- The Black Dog Institute, Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia
| | - Michael Murphy
- The Black Dog Institute, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia
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Shearrer GE. The Interaction of Glycemia with Anxiety and Depression Is Related to Altered Cerebellar and Cerebral Functional Correlations. Brain Sci 2023; 13:1086. [PMID: 37509016 PMCID: PMC10377615 DOI: 10.3390/brainsci13071086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/06/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Depression, type 2 diabetes (T2D), and obesity are comorbid, and prevention and treatment of all three diseases are needed. We hypothesized an inverse relationship between the connectivity of the cingulo-opercular task control network with the somatosensory mouth network and the interaction between HbA1c and depression. Three-hundred and twenty-five participants (BMI: 26.11 ± 0.29; Achenbach adult self-report (ASR) DSM depressive problems T-score (depression): 54.60 ± 6.77; Age: 28.26 ± 3.90 y; adult self-report anxiety and depression scale (anxiety and depression): 54.69 ± 7.27; HbA1c: 5.26 ± 0.29; 68% white) were sampled from the Human Connectome Project 1200 subjects PTN release. Inclusion criteria were: four (15 min) resting state fMRI scans; BMI; hemoglobin A1c (HbA1c); and complete adult self-report data. The following models were run to assess the connectivity between 15 independent fMRI components: the interaction of depression with HbA1c; anxiety and depression with HbA1c; depression with BMI; and anxiety and depression with BMI. All models were corrected for a reported number of depressive symptoms, head motion in the scanner, age, and race. Functional connectivity was modeled in FSLNets. Corrected significance was set at pFWE < 0.05. The interaction HbA1c and anxiety and depression was positively related to the connectivity of the cerebellum with the visual network (t = 3.76, pFWE = 0.008), frontoparietal network (t = 3.45, pFWE = 0.02), and somatosensory mouth network (t = 4.29, pFWE = 0.0004). Although our hypotheses were not supported, similar increases in cerebellar connectivity are seen in patients with T2D and overall suggest that the increased cerebellar connectivity may be compensatory for an increasingly poor glycemic control.
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Affiliation(s)
- Grace E Shearrer
- Department of Family and Consumer Sciences, Neuroscience Program, School of Computing, College of Agriculture, Life Sciences and Natural Resources, University of Wyoming, Laramie, WY 82070, USA
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Gelhorn H, Balantac Z, Shinde S, Thieu VT, Boye KS. The Burden of Type 2 Diabetes and the Value of Achieving Near Normoglycemia from the Patient Perspective. Diabetes Ther 2021; 12:1821-1837. [PMID: 34043162 PMCID: PMC8155797 DOI: 10.1007/s13300-021-01054-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) is extremely burdensome to people with T2D and associated with impaired health-related quality of life. This study explores the impact of T2D and potentially relevant outcomes for new therapies using a unique approach to in-depth qualitative interviews where people with T2D are asked to think about their future with T2D. METHODS A cross-sectional qualitative interview study among people with T2D from the USA and UK. Interviews explored their treatment journey, perceptions of their future with T2D, and the value of achieving normoglycemia (explored through presentation of two vignettes with hypothetical medications that reduced hemoglobin A1c [HbA1c] levels < 7% and < 5.7%). RESULTS Patients with T2D (N = 50; US n = 25; UK n = 25) were 66.0% male, had a mean body mass index (BMI) of 30.8 ± 6.3 kg/m2, and had a mean of 13.0 ± 10.0 years since diagnosis. Current diabetes treatments included diet and exercise only (8.0%), oral medications only (62.0%), oral plus injections (24.0%), and insulin only (6.0%). Despite being treated, participants reported over 25 different unmet needs related to their T2D across a broad range of domains. The most common concerns were diet, diabetes-related complications, weight changes, and psychological and emotional issues. A large majority of participants indicated that achieving lower HbA1c values would change their life. When reflecting on the value of improved glycemic control, patients primarily anticipated physical improvements and improved psychological well-being. When presented with two hypothetical treatments, about 70% of participants preferred the < 5.7% treatment option over the < 7% HbA1c treatment option. CONCLUSIONS People with T2D have a high disease burden, a broad range of unmet needs, and extremely varied experiences and expectations on the impacts of T2D on their lives and future. Many patients indicated that achieving near normoglycemia would substantially change their lives primarily in terms of their physical and emotional health.
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Affiliation(s)
- Heather Gelhorn
- Evidera Inc., 7101 Wisconsin Ave, Suite 1400, Bethesda, MD USA
| | - Zaneta Balantac
- Evidera Inc., 7101 Wisconsin Ave, Suite 1400, Bethesda, MD USA
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Huang Y, Xu Y, Liu A. Increased Levels of Serum Glycosylated Hemoglobin are Associated with Depressive Symptoms in a Population with Cancer (≥49 Years): An Antidepressant-Stratified Analysis. Clin Interv Aging 2021; 16:205-212. [PMID: 33564231 PMCID: PMC7866938 DOI: 10.2147/cia.s294704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/14/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose Patients with cancer tend to have a high prevalence of depressive symptoms. The direct relationship between serum glycosylated hemoglobin (GHb) levels and depressive symptoms in cancer patients is still uncertain. We aimed to evaluate the association with serum GHb levels with depressive symptoms in the population (aged ≥49 years) with cancer. Patients and Methods Longitudinal data in 204 participants with cancer obtained from The Irish LongituDinal Study on Ageing (TILDA) were used to investigate the association of serum GHb levels with depressive symptoms. Results Our results suggested a positive and significant association between serum GHb levels and depression score, independent of age, gender, body mass index (BMI), currently married, education, smoking status, drink alcohol, systolic and diastolic blood pressure (BP), physical activity, self-reported cardiovascular diseases and laboratory measurement in participants with cancer (coefficient =0.141, P<0.001; Model 2) at baseline (wave 1). Higher GHb levels did associate with higher prevalence of depressive symptoms in participants with cancer (OR=2.100, 95% CI 1.105–5.036, P=0.004; Model 2) after adjustment for these same confounding factors in wave 1 was made. Stratified analysis further showed that these significant associations were interfered by antidepressants. Sensitivity analysis showed that higher serum GHb levels in subjects with cancer were linked to higher prevalence of depression events during a follow-up of 4 years. Conclusion Our results found a significant association between elevated serum GHb levels and increased risk of depressive symptoms in the population aged ≥49 years with cancer after confounding factors were adjusted.
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Affiliation(s)
- Ying Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Yilin Xu
- Oncology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China.,Jiangxi Key Laboratory of Clinical Translational Cancer Research, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Anwen Liu
- Oncology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China.,Jiangxi Key Laboratory of Clinical Translational Cancer Research, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People's Republic of China
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