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Farhat H, Alinier G, El Aifa K, Athemneh K, Gangaram P, Romero R, Khenissi MC, Al Shaikh L, Laughton J. Quality improvement tools to manage emergency callbacks from patients with diabetes in a prehospital setting. BMJ Open Qual 2023; 12:bmjoq-2022-002007. [PMID: 36599502 DOI: 10.1136/bmjoq-2022-002007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
Diabetes is rising at an alarming rate, as 1 in 10 adults worldwide now lives with the disease. In Qatar, a middle eastern Arab country, diabetes prevalence is equally concerning and is predicted to increase from 17% to 24% among individuals aged 45 and 54 years by 2050. While most healthcare strategies focus on preventative and improvement of in-hospital care of patients with diabetes, a notable paucity exists concerning diabetes in the prehospital setting should ideally be provided. This quality improvement study was conducted in a middle eastern ambulance service and aimed to reduce ambulance callbacks of patients with diabetes-related emergencies after refusing transport to the hospital at the first time. We used iterative four-stage problem-solving models. It focused on the education and training of both paramedics and patients. The study showed that while it was possible to reduce the rate of ambulance callbacks of patients with diabetes, this was short-lived and numbers increased again. The study demonstrated that improvements could be effective. Hence, changes that impacted policy, systems of care and ambulance protocols directed at managing and caring for patients with diabetes-related prehospital emergencies may be required to reify them.
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Affiliation(s)
- Hassan Farhat
- Ambulance Service, Hamad Medical Corporation, Doha, Qatar .,Faculty of Medicine, University of Sousse, Sousse, Tunisia.,Faculty of Sciences, University of Sfax, Sfax, Tunisia
| | - Guillaume Alinier
- Ambulance Service, Hamad Medical Corporation, Doha, Qatar.,University of Hertfordshire Faculty of Health and Human Sciences, Hatfield, UK.,Weill Cornell Medicine-Qatar, Doha, Qatar.,Northumbria University, Newcastle upon Tyne, UK
| | | | - Khawla Athemneh
- Hamad Healthcare Quality Institute, Hamad Medical Corporation, Doha, Qatar
| | - Padarath Gangaram
- Ambulance Service, Hamad Medical Corporation, Doha, Qatar.,Durban University of Technology, Durban, KwaZulu-Natal, South Africa
| | - Ricardo Romero
- Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | | | - Loua Al Shaikh
- Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - James Laughton
- Ambulance Service, Hamad Medical Corporation, Doha, Qatar
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52
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Battini V, Van Manen RP, Gringeri M, Mosini G, Guarnieri G, Bombelli A, Pozzi M, Nobile M, Radice S, Clementi E, Carnovale C. The potential antidepressant effect of antidiabetic agents: New insights from a pharmacovigilance study based on data from the reporting system databases FAERS and VigiBase. Front Pharmacol 2023; 14:1128387. [PMID: 36873988 PMCID: PMC9981969 DOI: 10.3389/fphar.2023.1128387] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/01/2023] [Indexed: 02/19/2023] Open
Abstract
Background: Growing evidence supports a bidirectional association between diabetes and depression; promising but limited and conflicting data from human studies support the intriguing possibility that antidiabetic agents may be used to relieve effectively depressive symptoms in diabetic patients. We investigated the potential antidepressant effects of antidiabetic drugs in a high-scale population data from the two most important pharmacovigilance databases, i.e., the FDA Adverse Event Reporting System (FAERS) and the VigiBase. Material and methods: From the two primary cohorts of patients treated with antidepressants retrieved from FDA Adverse Event Reporting System and VigiBase we identified cases (depressed patients experiencing therapy failure) and non-cases (depressed patients experiencing any other adverse event). We then calculated the Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Empirical Bayes Geometric Mean (EBGM), and Empirical Bayes Regression-Adjusted Mean (ERAM) for cases versus non-cases in relation with the concurrent exposure to at least one of the following antidiabetic agent: A10BA Biguanides; A10BB Sulfonylureas; A10BG Thiazolidinediones; A10BH DPP4-inhibitors; A10BJ GLP-1 analogues; A10BK SGLT2 inhibitors (i.e., those agents for which preliminary evidence from literature supports our pharmacological hypothesis). Results: For GLP-1 analogues, all the disproportionality scores showed values <1, i.e., statistically significant, in both analyses [from the FAERS: ROR confidence interval of 0.546 (0.450-0.662); PRR (p-value) of 0.596 (0.000); EBGM (CI) of 0.488 (0.407-0.582); ERAM (CI) of 0.480 (0.398-0.569) and VigiBase: ROR (CI) of 0.717 (0.559-0.921); PRR (p-value) of 0.745 (0.033); EBGM (CI) of 0.586 (0.464-0.733); ERAM of (CI): 0.515 (0.403-0.639)]. Alongside GLP-1 analogues, DPP-4 Inhibitors and Sulfonylureas showed the greatest potential protective effect. With regard to specific antidiabetic agents, liraglutide and gliclazide were associated with a statistically significant decrease in all disproportionality scores, in both analyses. Conclusion: The findings of this study provide encouraging results, albeit preliminary, supporting the need for further clinical research for investigating repurposing of antidiabetic drugs for neuropsychiatric disorders.
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Affiliation(s)
- Vera Battini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital, Università degli Studi di Milano, Milan, Italy
| | | | - Michele Gringeri
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Giulia Mosini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Greta Guarnieri
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Anna Bombelli
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Marco Pozzi
- Scientific Institute, IRCCS E Medea, Bosisio Parini, Italy
| | - Maria Nobile
- Scientific Institute, IRCCS E Medea, Bosisio Parini, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital, Università degli Studi di Milano, Milan, Italy.,Scientific Institute, IRCCS E Medea, Bosisio Parini, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital, Università degli Studi di Milano, Milan, Italy
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53
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Sher L. Prevention of suicidal behavior in diabetes: the role of primary care. QJM 2022; 115:789-792. [PMID: 35861432 DOI: 10.1093/qjmed/hcac173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Indexed: 12/15/2022] Open
Abstract
Studies in different countries suggest that the rates of suicide ideation, attempts and death are increased in patients with diabetes in comparison to the general population. Suicidal behavior in patients with diabetes is a significant but underappreciated problem. Elevated suicide risk in individuals with diabetes may be related to comorbid psychiatric disorders, particularly depression. Considerable evidence suggests a bidirectional relationship between diabetes and depression: individuals with diabetes are at elevated risk of developing depression and patients with depression are more likely to develop diabetes. Frequent comorbidity of diabetes and depression may be related to psychosocial and neurobiological factors. Other comorbid psychiatric conditions including anxiety and alcohol use disorders may also increase suicide risk in diabetes. Primary care physicians are likely the key to suicide prevention efforts in individuals with diabetes since they see almost half of individuals who die by suicide within 1 month of their suicide. The management of potentially suicidal patients with diabetes in primary care comprises six major components: management of diabetes and its complications, especially conditions associated with pain; diagnosis and treatment of comorbid psychiatric disorders; frequent assessment of suicide risk; restricting access to the means of suicide; specific treatments to reduce the predisposition to attempt suicide; and referral to psychiatric care. Suicide prevention in individuals with diabetes and other medical disorders is a difficult but critically important task.
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Affiliation(s)
- L Sher
- From the James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA
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Nunes JC, Yu J, Arnott C, Jardine MJ, Perkovic V, Mahaffey KW. Canagliflozin, mental health adverse events and diabetes: Exploratory analysis of the CREDENCE trial and CANVAS Program. Diabetes Obes Metab 2022; 24:2459-2464. [PMID: 35938182 DOI: 10.1111/dom.14832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/24/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Julio C Nunes
- Stanford Center for Clinical Research, Stanford University, Palo Alto, California
| | - Jie Yu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Clare Arnott
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Meg J Jardine
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Concord Repatriation General Hospital, Sydney, Australia
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Medicine, University of New South Wales, Sydney, Australia
- The Royal North Shore Hospital, Sydney, Australia
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Stanford University, Palo Alto, California
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Agudelo-Botero M, Giraldo-Rodríguez L, Dávila-Cervantes CA. Type 2 diabetes and depressive symptoms in the adult population in Mexico: a syndemic approach based on National Health and Nutrition Survey. BMC Public Health 2022; 22:2049. [PMID: 36352364 PMCID: PMC9643915 DOI: 10.1186/s12889-022-14405-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
Background The syndemic approach allows the analysis of clusters of diseases that affect a population in contexts of geographic, social and economic inequalities at the same moment and time. This study aims to analyze, from a syndemic perspective, the relationship between type 2 diabetes (T2D) and depressive symptoms in Mexican adults and its association with individual, contextual and structural factors. Methods Observational, cross-sectional study based on secondary data from Mexico’s National Health and Nutrition Survey 2018–19. The sample of this study consisted of 16 835 adults, which represented a total of 78 463 734 persons aged ≥ 20 years. Bivariate descriptive analyses were performed and logistic regression models were estimated to analyze the association between T2D and depressive symptoms with various co-variables. In addition, interactions between T2D and depressive symptoms with obesity, educational level, and socioeconomic status were tested. Results In the study population, 12.2% of adults aged 20 years and older self-reported having T2D, 14.7% had depressive symptoms and 2.8% had both diseases. There was a statistically significant relationship between T2D and depressive symptoms. The prevalence of T2D and depressive symptoms was higher compared to people who did not have these two conditions. Obesity increased the probability of having T2D, while violence was statistically associated with people having depressive symptoms. A low level of education increased the odds ratio of having T2D and depressive symptoms. Conclusion The availability of analytical frameworks such as the syndemic perspective could help to identify areas of opportunity for decision making and actions for population groups that–because of their individual, contextual and structural disadvantages–are at greater risk of experiencing poorer health outcomes due to the presence of T2D and depressive symptoms.
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56
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Zhu L, Ferries E, Suthoff E, Namjoshi M, Bera R. Economic burden and antidepressant treatment patterns among patients with major depressive disorder in the United States. J Manag Care Spec Pharm 2022; 28:S2-S13. [DOI: 10.18553/jmcp.2022.28.11-a.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Stefan S, Alzedaneen Y, Whitlatch HB, Malek R, Munir K. Effects of Electroconvulsive Therapy on Glycemic Control in Type 1 Diabetes. Cureus 2022; 14:e30222. [PMID: 36381878 PMCID: PMC9651074 DOI: 10.7759/cureus.30222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
Electroconvulsive therapy (ECT) is a treatment modality for refractory depression and other severe psychiatric diseases. Depression is a common comorbid condition of diabetes. Yet, evidence regarding the effect of ECT on glycemic control in patients with diabetes is limited and conflicting, with reports of both exacerbation and amelioration of hyperglycemia. A 52-year-old Caucasian man with a history of type 1 diabetes mellitus (T1DM) was admitted for ECT therapy in the setting of worsening depression refractory to medical treatment. Pre-admission glycemic control was poor. He had significant glycemic variability during his hospitalization with hyper- and hypoglycemia. He required near-daily adjustment of insulin doses and distinct “ECT day” and “non-ECT day” insulin regimens. By the conclusion of his ECT course, in addition to achieving favorable psychiatric recovery, he had a marked improvement in glycemic control. This suggests that the treatment of depression may have beneficial effects on improving glycemic control in patients with T1DM.
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58
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Amin M, Syed S, Wu R, Postolache TT, Gragnoli C. Familial Linkage and Association of the NR3C1 Gene with Type 2 Diabetes and Depression Comorbidity. Int J Mol Sci 2022; 23:ijms231911951. [PMID: 36233250 PMCID: PMC9569497 DOI: 10.3390/ijms231911951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
Impairment in the hypothalamic-pituitary-adrenal (HPA) axis and cortisol pathway may be major contributing factors to the common pathogenesis of major depressive disorders (MDD) and type 2 diabetes (T2D). A significant player in the neuroendocrine HPA axis and cortisol response is the glucocorticoid receptor (GR), which is encoded by the nuclear receptor subfamily 3 group C member (NR3C1) gene. Variants in the NR3C1 gene have been reported in patients with MDD and obesity and found to confer reduced risk for quantitative metabolic traits and T2D in Cushing syndrome; variants have not been reported in T2D and MDD-T2D comorbid patients. We studied 212 original Italian families with a rich family history for T2D and tested 24 single nucleotide polymorphisms (SNPs) in the NR3C1 gene for linkage to and linkage disequilibrium (LD) with T2D and MDD across different inheritance models. We identified a total of 6 novel SNPs significantly linked/in LD to/with T2D (rs6196, rs10482633, rs13186836, rs13184611, rs10482681 and rs258751) and 1 SNP (rs10482668) significantly linked to/in LD with both T2D and MDD. These findings expand understanding of the role that NR3C1 variants play in modulating the risk of T2D-MDD comorbidity. Replication and functional studies are needed to confirm these findings.
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Affiliation(s)
- Mutaz Amin
- Institut National de la Santé et de la Recherche Médicale (INSERM), US14-Orphanet, 75014 Paris, France
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Al-Neelain University, Khartoum 11121, Sudan
| | - Shumail Syed
- Division of Endocrinology, Department of Medicine, Creighton University School of Medicine, Omaha, NE 68124, USA
| | - Rongling Wu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA
- Department of Statistics, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Teodor Tudorel Postolache
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Denver, CO 80246, USA
- Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD 21090, USA
| | - Claudia Gragnoli
- Division of Endocrinology, Department of Medicine, Creighton University School of Medicine, Omaha, NE 68124, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA
- Molecular Biology Laboratory, Bios Biotech Multi-Diagnostic Health Center, 00197 Rome, Italy
- Correspondence: ; Tel.: +1-(508)-246-9330
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59
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Waseem M, Talha M, Khatri M. Response to "Symptoms of depression are associated with reduced leisure-time physical activity in adult individuals with type 1 diabetes". Acta Diabetol 2022; 59:1395-1396. [PMID: 35790605 DOI: 10.1007/s00592-022-01924-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/14/2022] [Indexed: 11/01/2022]
Affiliation(s)
| | | | - Mahima Khatri
- Dow University of Health Sciences, Bridgeview, Karachi, Pakistan
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60
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Yang W, Liu M, Tian Y, Zhang Q, Zhang J, Chen Q, Suo L, Chen Y. The increased prevalence of depression and anxiety in T2DM patients associated with blood glucose fluctuation and sleep quality. BMC Endocr Disord 2022; 22:232. [PMID: 36114534 PMCID: PMC9482159 DOI: 10.1186/s12902-022-01147-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Current evidence demonstrates that blood glucose fluctuation can be associated with depression and anxiety. The association among blood glucose fluctuation, traditional risk factors and emotional disorders in T2DM should be studied and clarified. METHODS A total of 182 diabetic patients including 81 patients with depression or anxiety and 101 patients without emotional disorder were enrolled into this study. Data were obtained through medical history and questionnaire survey. Data were analyzed using appropriate statistical methods. RESULTS The comparison results of basic information between the two groups showed that the differences of the proportion of female were statistically significant (p = 0.002). There was no statistical difference in laboratory examination indexes between the two groups, however, standard deviation of blood glucose (SDBG) and postprandial glucose excursion (PPGE) of the comorbidity group were significantly higher than that of control group (p = 0.032 and p = 0.037). The results of questionnaire survey showed that there were statistically significant differences in sleep quality, PSQI and dietary habit between the two groups (p < 0.001, p < 0.001 and p < 0.001). Stratified analysis results according to gender showed that the percentage of cognitive disorder, anxiety and depression in female group was significantly higher than that in male group (p = 0.001, p < 0.001 and p < 0.001). Mini-mental state examination (MMSE), self-rating anxiety scale (SAS) and patient health questionnaire (PHQ-9) score in female group were also higher than male group (p = 0.001, p < 0.001 and p < 0.001). Logistic regression analysis results showed that SDBG and sleep quality were associated with emotional disorders in T2DM (p = 0.040 and p < 0.001) and the OR values of these factors were 7.588 (1.097-52.069) and 4.428 (2.649-7.401). CONCLUSIONS Blood glucose fluctuation and sleep quality are associated with the increased prevalence of depression and anxiety disorders in T2DM.
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Affiliation(s)
- Wei Yang
- Department of Endocrinology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Min Liu
- Department of Hospital Infection Control, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, Guangdong, China.
| | - Yuan Tian
- Department of Endocrinology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Qianwei Zhang
- Department of Endocrinology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jiahua Zhang
- Department of Endocrinology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Qiaoyun Chen
- Department of Endocrinology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Lixia Suo
- Department of Endocrinology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Yang Chen
- Department of Neurology, The 904Th Hospital of PLA, Medical School of Anhui Medical University, Wuxi, Jiangsu, China.
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Tang KR, Mo XW, Zhou XY, Chen YY, Liu DD, He LL, Ma QY, Li XJ, Chen JX. Xiaoyao San, a Chinese herbal formula, ameliorates depression-like behavior in mice through the AdipoR1/AMPK/ACC pathway in hypothalamus. JOURNAL OF INTEGRATIVE MEDICINE 2022; 20:442-452. [PMID: 35906133 DOI: 10.1016/j.joim.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 06/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Depression and metabolic disorders have overlapping psychosocial and pathophysiological causes. Current research is focused on the possible role of adiponectin in regulating common biological mechanisms. Xiaoyao San (XYS), a classic Chinese medicine compound, has been widely used in the treatment of depression and can alleviate metabolic disorders such as lipid or glucose metabolism disorders. However, the ability of XYS to ameliorate depression-like behavior as well as metabolic dysfunction in mice and the underlying mechanisms are unclear. METHODS An in vivo animal model of depression was established by chronic social defeat stress (CSDS). XYS and fluoxetine were administered by gavage to the drug intervention group. Depression-like behaviors were analyzed by the social interaction test, open field test, forced swim test, and elevated plus maze test. Glucose levels were measured using the oral glucose tolerance test. The involvement of certain molecules was validated by immunofluorescence, histopathology, and Western blotting. In vitro, hypothalamic primary neurons were exposed to high glucose to induce neuronal damage, and the neuroprotective effect of XYS was evaluated by cell counting kit-8 assay. Immunofluorescence and Western blotting were used to evaluate the influences of XYS on adiponectin receptor 1 (AdipoR1), adenosine 5'-monophosphate-activated protein kinase (AMPK), acetyl-coenzyme A carboxylase (ACC) and other related proteins. RESULTS XYS ameliorated CSDS-induced depression-like behaviors and glucose tolerance impairment in mice and increased the level of serum adiponectin. XYS also restored Nissl bodies in hypothalamic neurons in mice that exhibited depression-like behaviors and decreased the degree of neuronal morphological damage. In vivo and in vitro studies indicated that XYS increased the expression of AdipoR1 in hypothalamic neurons. CONCLUSION Adiponectin may be a key regulator linking depression and metabolic disorders; regulation of the hypothalamic AdipoR1/AMPK/ACC pathway plays an important role in treatment of depression by XYS.
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Affiliation(s)
- Kai-Rui Tang
- Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Xiao-Wei Mo
- Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Xing-Yi Zhou
- Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Yue-Yue Chen
- Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Dong-Dong Liu
- Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Liang-Liang He
- College of Pharmacy, Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Qing-Yu Ma
- Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Xiao-Juan Li
- Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou 510632, Guangdong Province, China.
| | - Jia-Xu Chen
- Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Jinan University, Guangzhou 510632, Guangdong Province, China.
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Waheed U, Heald AH, Stedman M, Solomon E, Rea R, Eltom S, Gibson JM, Grady K, Nouwen A, Rayman G, Paisley A. Distress and Living with Diabetes: Defining Characteristics Through an Online Survey. Diabetes Ther 2022; 13:1585-1597. [PMID: 35831740 PMCID: PMC9281294 DOI: 10.1007/s13300-022-01291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION There is considerable evidence for diabetes reducing quality of life. The impact of such a diagnosis on mental health is less well understood and was subsequently explored here. METHODS Online PHQ-9 scores (which calculate the severity of depression), Diabetes Distress Screening Scale (DDSS) and EQ-5D-5L (quality-of-life) questionnaires were completed by patients with diabetes, followed by the extraction of data where possible from responders' clinical records. RESULTS A total of 133 people submitted questionnaires. However, not all data items could be completed by each patient; 35% (45/130) had type I diabetes mellitus (T1DM); 55% (64/117) were women. The overall median age of 117 responders was 60 (IQR 50-68 years). The median aggregated response scores were: EQ-5D-5L 0.74 (IQR 0.64-0.85) (lower quality of life than UK population median of 0.83), DDSS 1.9 (IQR1.3-2.7) (≥ 2 indicates moderate distress) and PHQ-9 5 (IQR2-11) (≥ 5 indicates depression). Higher diabetes distress (DDSS)/lower quality of life EQ-5D-5L/higher depressive symptoms (PHQ-9) linked to female sex (DDSS 0.5/25% above median), younger age (< 50 years DDSS 0.7/35% above median), fewer years after diagnosis (< 10 years DDSS 0.8/40% above median), and obesity (BMI > 35 DDSS 0.6/30% above median). Additionally, a HbA1c reading of ≤ 48 mmol/mol was associated with higher DDSS scores, as did a reduction of more than 5 mmol/mol in HbA1c over the last three HbA1c measurements. The 30 individuals with a history of prescribed antidepressant medication also showed higher diabetes distress scores (DDSS 0.9, equating to 45% above the median). The DDSS score elevation came from an increase in emotional burden and regimen-related distress. DDSS scores were not significantly linked to diabetes type, insulin use, absolute level/change in blood glucose HbA1c. Physician-related distress showed a similar pattern. CONCLUSIONS A low level of stress in relation to diabetes management may be associated with lower HbA1c. The larger impact of diabetes on mental health in younger women/people with shorter diabetes duration should be noted when considering psychosocial intervention/behavior change messaging. Physician-related distress is a potentially remediable factor. However, this sample was self-selecting, limiting generalization to other samples.
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Affiliation(s)
- Unaiza Waheed
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK
| | - Adrian H Heald
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK.
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
| | | | - Emma Solomon
- Department of Clinical Psychology, Salford Royal Hospital, Salford, UK
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK
| | - Saydah Eltom
- Pharmacy Department, Salford Royal Hospital, Salford, UK
| | - J Martin Gibson
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Katherine Grady
- Research for the Future, Northern Care Alliance NHS Group, Salford, UK
| | - Arie Nouwen
- Department of Psychology, Middlesex University, London, UK
| | - Gerry Rayman
- The Ipswich Diabetes Centre and Research Unit, Ipswich Hospital NHS Trust, Colchester, Essex, UK
| | - Angela Paisley
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Wium-Andersen IK, Jørgensen TSH, Jørgensen MB, Osler M, Wium-Andersen MK. Diabetes, sleep disorders and risk of depression - A Danish register-based cohort study. J Diabetes Complications 2022; 36:108266. [PMID: 35932548 DOI: 10.1016/j.jdiacomp.2022.108266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
AIMS We examined the influence of comorbid sleep disorder on the association between type 2 diabetes (T2D) and risk of incident depression. METHODS The study population (N = 232,489) was based on all individuals registered aged ≥40 years with a T2D diagnosis between January 1, 2000 to December 31, 2012 in the Danish National Diabetes Register and a matched reference population. The risk of incident depression (diagnosis or anti-depressant medication) following T2D and possible effect modification of comorbid sleep disorder was estimated using adjusted Cox proportional hazards regression. Sleep disorder was defined as a diagnosis of insomnia, hypersomnia or sleep-wake schedule disorders or use of sleep medication (z-drugs or melatonin) in the Danish National Patient Registry or the Danish National Prescription Registry. RESULTS At study entry, 15.3 % of the participants had a sleep disorder. During follow-up, 2.6 % were diagnosed with depression and 32.1 % received antidepressant medication. The unadjusted hazard ratio (HR) for depression was 1.54 (95%CI 1.52-1.56) for patients with diabetes, which attenuated to 1.50 (1.48-1.52) after adjustment for sleep disorders, which further attenuated to 1.27 (1.26-1.29) in the model further adjusted for psychiatric and somatic comorbidities. The analyses of T2D and sleep disorder as independent and combined variables compared with none of the conditions on risk of depression, showed a HR of 1.27 (95 % CI 1.19-1.35) for T2D without sleep disorder, 1.46 (95 % CI 1.33-1.59) for sleep disorders without T2D, and 1.49 (95%CI 1.37-1.63) for both conditions. CONCLUSIONS T2D and sleep disorders were independently associated with subsequent risk of depression and individuals with both conditions experienced the greatest relative risk. Sleep disorders neither explained nor amplified the relation between diabetes and depression.
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Affiliation(s)
| | - Terese Sara Høj Jørgensen
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farigmagsgade 5, 1014 Copenhagen K, Denmark
| | | | - Merete Osler
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farigmagsgade 5, 1014 Copenhagen K, Denmark
| | - Marie Kim Wium-Andersen
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
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Kusnanto K, Arifin H, Pradipta RO, Gusmaniarti G, Kuswanto H, Setiawan A, Lee BO. Resilience-based Islamic program as a promising intervention on diabetes fatigue and health-related quality of life. PLoS One 2022; 17:e0273675. [PMID: 36048792 PMCID: PMC9436096 DOI: 10.1371/journal.pone.0273675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/11/2022] [Indexed: 12/08/2022] Open
Abstract
Psychological problems commonly experienced by patients with type 2 diabetes mellitus (T2DM) cause diabetes fatigue conditions that can further worsen the treatment prognosis. We conducted this investigation to determine the effectiveness of a resilience-based Islamic program on diabetes fatigue and health-related quality of life (HRQoL) by measuring the biochemical indicators of T2DM. This was a quasi-experimental study performed from May to August 2021, in which 80 respondents aged 18–64 years diagnosed with T2DM were included through purposive sampling at a male:female sex ratio of 1:1 in the control group and 17:23 in the treatment group. A resilience-based Islamic program (a combination of stress management, mindfulness, prayer, and dhikr (the ritual formula of Sufi brotherhood recited devotionally in praise of Allah and as a means of attaining ecstatic experience)) was implemented in the treatment group for six sessions by blended online and offline interventions. Multidimensional Fatigue Inventory-20 and World Health Organization Quality of Life, Brief Form were used to evaluate diabetes fatigue and HRQoL. Blood tests were performed to measure HbA1c, total antioxidant serum, insulin, cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) levels from baseline to 3 months. Statistical analyses were conducted using paired t test, Wilcoxon signed-rank test, independent t test, and Mann–Whitney U test. The resilience-based Islamic program had a beneficial impact on the levels of HbA1c (p < 0.001), lipid profile (triglyceride) (p = 0.011), HDL-c (p = 0.01), LDL-c (p < 0.001), total antioxidant serum (p = 0.001), insulin (p < 0.001), diabetes fatigue (p < 0.05), and HRQoL (p < 0.05) in patients of the treatment group. The results of biochemical tests related to T2DM also indicated a reduction in diabetes fatigue and an increase in HRQoL due to the resilience-based Islamic program. Considering that a patient’s resilience to diabetes is an important factor in the management of diabetes fatigue, the resilience-based Islamic program can be applied at public health centers and community levels to increase T2DM resilience.
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Affiliation(s)
- Kusnanto Kusnanto
- Department of Fundamental Nursing Care, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Hidayat Arifin
- Department of Medical and Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
- Doctoral Program in School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Rifky Octavia Pradipta
- Department of Fundamental Nursing Care, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- * E-mail:
| | - Gusmaniarti Gusmaniarti
- Early Childhood Teacher Education Study Program, Faculty of Teacher Training and Education, Universitas Muhammadiyah Surabaya, Surabaya, Indonesia
| | - Heri Kuswanto
- Department of Statistics, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
| | - Agus Setiawan
- Department of Community Health Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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Thangiah G, Johar H, Ismail R, Reininghaus U, Bärnighausen T, Thurairajasingam S, Reidpath D, Su TT. Diabetes Treatment and Mental Illness: A Call for an Integrated Health Care System in Underserved Semi-Rural Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10015. [PMID: 36011650 PMCID: PMC9408510 DOI: 10.3390/ijerph191610015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
Diabetes mellitus (DM) management imposes a tremendous psychological burden on patients. The study investigates the association between DM treatment with blood glucose (BG) control and common mental health conditions. A cross-sectional study was conducted among 1821 individuals with DM in a community-based survey conducted in 2013. Information on respondents’ sociodemographic, mental health, DM treatment, and BG levels was collected. Multinomial logistic regression was employed to examine the association of diabetes treatment with controlled BG levels (<11.1 mmol/L) (42.5%, n = 774) or uncontrolled BG levels (34.3%, n = 625) compared with those not undergoing treatment (23.2%, n = 422) on depression anxiety, and stress. Having DM treatment and controlled BG was associated with high depressive symptoms (Relative Risk Ratio, RRR: 2.42; 95% CI 1.33−4.41) and high anxiety symptoms (1.66; 1.08−2.56) but not with perceived stress. However, treated DM with uncontrolled BG was associated with anxiety (high: 1.64; 1.05−2.56; low: 2.59; 1.10−6.09) but not depression or perceived stress. Our results suggest that being treated for DM, regardless of glucose control status, was associated with anxiety symptoms, whereas being treated with controlled BG was associated with high depressive symptoms. This situation highlights the need for integrative, multidisciplinary care for DM patients with mental health comorbidities.
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Affiliation(s)
- Govindamal Thangiah
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Malaysia
| | - Hamimatunnisa Johar
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Malaysia
- Department of Psychosomatic Medicine and Psychotherapy, University of Giessen and Marburg, 35392 Giessen, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, 85764 Munich, Germany
| | - Roshidi Ismail
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Malaysia
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159 Mannheim, Germany
- ESRC Centre for Society and Mental Health, King’s College London, London WC2R 2LS, UK
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, 69117 Heidelberg, Germany
| | - Sivakumar Thurairajasingam
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru 80100, Malaysia
| | - Daniel Reidpath
- Institute for Global Health and Development, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Tin Tin Su
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Malaysia
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, 69117 Heidelberg, Germany
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Hu J, Zheng X, Shi G, Guo L. Associations of multiple chronic disease and depressive symptoms with incident stroke among Chinese middle-aged and elderly adults: a nationwide population-based cohort study. BMC Geriatr 2022; 22:660. [PMID: 35953770 PMCID: PMC9373457 DOI: 10.1186/s12877-022-03329-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the population aging, multiple chronic diseases, depressive symptoms, and stroke are increasingly common among middle-aged and elderly adults worldwide. This study aimed to explore the independent associations of multiple chronic diseases and depressive symptoms as well as their combination with incident stroke in a prospective cohort of Chinese middle-aged and elderly adults, and to sensitively estimate the association between each type of chronic disease and incident stroke. METHODS This study used data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 8389 participants meeting the inclusion criteria at baseline (between 2011 and 2012) survey were included, and 7108 eligible participants completed the follow-up survey over 8 years (Wave 4, in 2018). Questionnaire information, physical examination, and clinical and biochemical measurements were collected. RESULTS The mean (SD) age at baseline was 58.5 (± 9.1) years. Multiple chronic disease and depressive symptoms were independently associated with incident stroke. After adjusting for control variables, patients having 1 type of chronic disease and depressive symptoms were at 1.943 (95% CI = 1.166-3.238) times higher risk of incident stroke than those without chronic disease and depressive symptoms, and patients having at least 2 types of chronic diseases and depressive symptoms were at 3.000 (95% CI = 1.846-4.877) times higher risk of incident stroke; the magnitudes of the associations increased by the numbers of having chronic diseases and depressive symptoms. Sensitivity analyses incorporating all five types of chronic disease (i.e., hypertension, dyslipidemia, heart disease, diabetes, and chronic kidney disease) showed that the magnitude of the associations between hypertension and incident stroke was most significant. CONCLUSIONS We identified significant independent and combined longitudinal associations of multiple chronic diseases and depressive symptoms with incident stroke, and the combined associations reflected a dose-response relationship. The association between hypertension and incident stroke was strongest among the five chronic diseases.
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Affiliation(s)
- Jingyang Hu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China
| | - Xinyu Zheng
- Cerebrovascular Disease Department, Zhuhai People's Hospital Medical Group, 519000, Zhuhai, People's Republic of China
| | - Guangduoji Shi
- Cerebrovascular Disease Department, Zhuhai People's Hospital Medical Group, 519000, Zhuhai, People's Republic of China
| | - Lan Guo
- Cerebrovascular Disease Department, Zhuhai People's Hospital Medical Group, 519000, Zhuhai, People's Republic of China.
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Steenblock C, Hassanein M, Khan EG, Yaman M, Kamel M, Barbir M, Lorke DE, Rock JA, Everett D, Bejtullah S, Heimerer A, Tahirukaj E, Beqiri P, Bornstein SR. Diabetes and COVID-19: Short- and Long-Term Consequences. Horm Metab Res 2022; 54:503-509. [PMID: 35724689 PMCID: PMC9363150 DOI: 10.1055/a-1878-9566] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
When the corona pandemic commenced more than two years ago, it was quickly recognized that people with metabolic diseases show an augmented risk of severe COVID-19 and an increased mortality compared to people without these comorbidities. Furthermore, an infection with SARS-CoV-2 has been shown to lead to an aggravation of metabolic diseases and in single cases to new-onset metabolic disorders. In addition to the increased risk for people with diabetes in the acute phase of COVID-19, this patient group also seems to be more often affected by long-COVID and to experience more long-term consequences than people without diabetes. The mechanisms behind these discrepancies between people with and without diabetes in relation to COVID-19 are not completely understood yet and will require further research and follow-up studies during the following years. In the current review, we discuss why patients with diabetes have this higher risk of developing severe COVID-19 symptoms not only in the acute phase of the disease but also in relation to long-COVID, vaccine breakthrough infections and re-infections. Furthermore, we discuss the effects of lockdown on glycemic control.
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Affiliation(s)
- Charlotte Steenblock
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mohamed Hassanein
- Department of Diabetes and Endocrinology, Dubai Hospital, Dubai, United Arab Emirates
| | - Emran G Khan
- Endocrinology and Diabetology, King's College Hospital London, Dubai, United Arab Emirates
| | - Mohamad Yaman
- Building 6, Nesmah Technology, Dubai, United Arab Emirates
| | - Margrit Kamel
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mahmoud Barbir
- Department of Cardiology, Harefield Hospital, Harefield, United Kingdom of Great Britain and Northern Ireland
| | - Dietrich E Lorke
- Department of Anatomy and Cellular Biology, Khalifa University, Abu Dhabi, United Arab Emirates
| | - John A Rock
- College of Medicine & Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Dean Everett
- Department of Pathology and Infectious Diseases, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Adrian Heimerer
- Research Unit, College Heimerer, Prishtina, Republic of Kosovo
| | - Ermal Tahirukaj
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Petrit Beqiri
- Research Unit, College Heimerer, Prishtina, Republic of Kosovo
| | - Stefan R Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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Sun Y, Yu Y, Zhang H, Wang B, Chen C, Wang Y, Tan X, Zhang J, Chen Y, Xia F, Lu Y, Wang N. Joint Exposure to Positive Affect, Life Satisfaction, Depressive Symptoms, and Neuroticism and Incident Type 2 Diabetes. J Clin Endocrinol Metab 2022; 107:e3186-e3193. [PMID: 35552706 DOI: 10.1210/clinem/dgac304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Indexed: 01/05/2023]
Abstract
CONTEXT Whether the psychological wellbeing status could be a risk factor for type 2 diabetes is unclear. OBJECTIVE We aimed to measure the association between combined psychological wellbeing factors and type 2 diabetes and investigate whether this association was modified by genetic predisposition. METHODS Prospective cohort study from the UK Biobank. In total, 127 496 participants who completed a psychological wellbeing questionnaire and did not have type 2 diabetes at baseline (2006-2010) were included; among them, 88 584 (69.5%) were analyzed to determine their genetic predisposition. The main outcome measure was incident type 2 diabetes. RESULTS During the median follow-up of 10.0 years, 2547 incident type 2 diabetes cases were documented. Moderate to extreme unhappiness, satisfaction score ≤3, presence of broad depression, and a neuroticism score ≥3 were all significantly and independently associated with an increased risk of diabetes. When considered as a combination indicator, compared with individuals in the highest quartile of the psychological wellbeing score, the fully adjusted hazard ratios (95% CI) of type 2 diabetes were 1.41 (1.21-1.65) in the third quartile, 1.45 (1.24-1.69) in the second quartile, and 1.73 (1.48-2.01) in the lowest quartile. In the stratified analysis, we observed significant interactions between age and physical activity, and type 2 diabetes (Pinteraction < .001 and 0.049, respectively). However, there was no significant interaction between the psychological wellbeing score and genetic susceptibility to diabetes (Pinteraction = .980). CONCLUSION Worse overall psychological wellbeing was associated with a significantly increased risk of type 2 diabetes in a dose-response fashion regardless of genetic predisposition.
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Affiliation(s)
- Ying Sun
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuefeng Yu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Haojie Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Bin Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiao Tan
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Jihui Zhang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Fangzhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Korsbæk JJ, Beier D, Hagen SM, Molander LD, Jensen RH. Psychiatric Comorbidities in Patients With Idiopathic Intracranial Hypertension: A Prospective Cohort Study. Neurology 2022; 99:e199-e208. [PMID: 35473759 DOI: 10.1212/wnl.0000000000200548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/02/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Psychiatric disease is a frequent comorbidity in idiopathic intracranial hypertension (IIH) and has been associated with a poor subjective outcome. No prospective studies have investigated psychiatric comorbidities in new-onset IIH. Our primary aim was to investigate disease severity in IIH depending on comorbid psychiatric disease. Important secondary outcomes were disease severity after 6 months and prevalence of psychiatric diseases in IIH. METHODS This prospective, observational cohort study consecutively included patients with clinically suspected, new-onset IIH from 2 headache centers. A standardized diagnostic workup was completed to confirm or exclude IIH according to the revised Friedman criteria: semi-structured interview, neurologic and neuro-ophthalmologic examination, lumbar puncture with opening pressure (OP), and neuroimaging. Exclusion criteria were known IIH, secondary intracranial hypertension, missing data, and pregnancy. Disease severity was evaluated based on papilledema, visual fields, OP, and headache in patients with IIH without psychiatric disease (IIH-P) compared with patients with IIH with psychiatric disease (IIH+P). A blinded neuro-ophthalmologist assessed visual outcomes. Age- and sex-matched prevalence rates of psychiatric diseases in the general population were found in national reports. RESULTS A total of 258 patients were screened; 69 were excluded. A total of 189 patients with clinically suspected IIH were then evaluated with the diagnostic workup and IIH was confirmed in 111 patients (58.7%). A total of 45% of patients with IIH had a psychiatric comorbidity. Visual fields were worse in patients with IIH+P at baseline (-8.0 vs -6.0 dB; p = 0.04) and after 6 months (-5.5 vs -4.0 dB; p < 0.01) compared with IIH-P. Highly prevalent psychiatric disorders were major depressive disorder (24.3%; n = 27), anxiety or stress-related disorders (24.3%; n = 27), and emotionally unstable personality disorder (6.3%; n = 7). Substance abuse (1.8%), schizophrenia (0.9%), and bipolar disorder (0.9%) were rare. In the general population, prevalence estimates of major depressive disorder and emotionally unstable personality disorder were 1.8%-3.3% and 2%, respectively. DISCUSSION Visual fields were significantly worse at baseline and 6 months in IIH+P compared with IIH-P. Psychiatric comorbidities, particularly depression and emotionally unstable personality disorder, were highly prevalent in IIH. Increased awareness of psychiatric disease as a marker for worse visual status may improve patient care.
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Affiliation(s)
- Johanne Juhl Korsbæk
- From the Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup (J.J.K., R.H.J.), and Department of Ophthalmology, Rigshospitalet (S.M.H.), University of Copenhagen; Departments of Neurology (D.B.) and Ophthalmology (L.D.M.) and OPEN, Odense Patient Data Explorative Network (D.B.), Odense University Hospital; and Department of Clinical Research (D.B.), University of Southern Denmark
| | - Dagmar Beier
- From the Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup (J.J.K., R.H.J.), and Department of Ophthalmology, Rigshospitalet (S.M.H.), University of Copenhagen; Departments of Neurology (D.B.) and Ophthalmology (L.D.M.) and OPEN, Odense Patient Data Explorative Network (D.B.), Odense University Hospital; and Department of Clinical Research (D.B.), University of Southern Denmark
| | - Snorre Malm Hagen
- From the Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup (J.J.K., R.H.J.), and Department of Ophthalmology, Rigshospitalet (S.M.H.), University of Copenhagen; Departments of Neurology (D.B.) and Ophthalmology (L.D.M.) and OPEN, Odense Patient Data Explorative Network (D.B.), Odense University Hospital; and Department of Clinical Research (D.B.), University of Southern Denmark
| | - Laleh Dehghani Molander
- From the Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup (J.J.K., R.H.J.), and Department of Ophthalmology, Rigshospitalet (S.M.H.), University of Copenhagen; Departments of Neurology (D.B.) and Ophthalmology (L.D.M.) and OPEN, Odense Patient Data Explorative Network (D.B.), Odense University Hospital; and Department of Clinical Research (D.B.), University of Southern Denmark
| | - Rigmor Højland Jensen
- From the Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup (J.J.K., R.H.J.), and Department of Ophthalmology, Rigshospitalet (S.M.H.), University of Copenhagen; Departments of Neurology (D.B.) and Ophthalmology (L.D.M.) and OPEN, Odense Patient Data Explorative Network (D.B.), Odense University Hospital; and Department of Clinical Research (D.B.), University of Southern Denmark.
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Hedge V, Carter K, Downey W, Sharp H. Prevalence of Diabetes Distress Among Adolescents With Type 1 Diabetes Mellitus. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Habib S, Sangaraju SL, Yepez D, Grandes XA, Talanki Manjunatha R. The Nexus Between Diabetes and Depression: A Narrative Review. Cureus 2022; 14:e25611. [PMID: 35784974 PMCID: PMC9249007 DOI: 10.7759/cureus.25611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 12/30/2022] Open
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Thirumoorthy C, Deepa M, Srikumar BN, Hannah W, Venkatesan U, Nikhil PJ, Hemavathy S, Binukumar B, Anjana RM, Ram U, Balasubramanyam M, Saravanan P, Mohan V, Gokulakrishnan K. Altered levels of neurobiological biomarkers at the interface of depression and gestational diabetes mellitus in Asian Indian women. Neuropeptides 2022; 93:102245. [PMID: 35461022 DOI: 10.1016/j.npep.2022.102245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/17/2022] [Accepted: 04/03/2022] [Indexed: 11/21/2022]
Abstract
AIM Gestational diabetes mellitus (GDM) might predispose the mothers to depression. Studies have reported the role of biomarkers either in GDM or depression, but very few have examined them in GDM with depression. The present study profiled the circulating levels of brain-derived neurotrophic factor (BDNF), Beta Endorphin (BE) and nesfatin-1 in women with GDM (with and without depression). METHODS 160 pregnant women at 24-28 weeks of pregnancy (NGT/GDM with & without depression, n = 40 each) were randomly selected from the ongoing STRiDE (STratification of Risk of Diabetes in Early pregnancy) study. Depression score was derived using PHQ-9 questionnaire and ELISA was used to quantify the biomarkers. RESULTS Circulatory levels of BDNF, BE and nesfatin-1 were lower in GDM women with or without depression compared to NGT without depression, however, nesfatin-1 levels were higher in NGT with depression. Notably, GDM with depression had the lowest levels of BDNF and BE. Both BDNF and BE levels were negatively correlated with depression, 1 h and 2 h plasma glucose. Regression analysis confirmed that each standard deviation decreases in BDNF and BE were independently associated with higher odds of GDM with or without depression even after adjusting for potential confounders. CONCLUSION Our study has identified altered levels of a panel of neurobiological biomarkers (BDNF/BE/nesfatin-1) in those with combined GDM and depression. BDNF/BE could be potential biomarkers to assess the higher risk of coexisting depression and GDM.
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Affiliation(s)
- C Thirumoorthy
- Department of Neurochemistry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - M Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - B N Srikumar
- Department of Neurophysiology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - W Hannah
- Department of Epidemiology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - U Venkatesan
- Department of Epidemiology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - P J Nikhil
- Department of Neurochemistry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - S Hemavathy
- Department of Epidemiology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - B Binukumar
- Department of Biostatistics, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - R M Anjana
- Department of Diabetology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - Uma Ram
- Seethapathy Clinic & Hospital, Chennai, India
| | - M Balasubramanyam
- Department of Cell & Molecular Biology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - P Saravanan
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, UK; Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton, UK
| | - V Mohan
- Department of Diabetology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - K Gokulakrishnan
- Department of Neurochemistry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India.
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Martins LB, Braga Tibães JR, Berk M, Teixeira AL. Diabetes and mood disorders: shared mechanisms and therapeutic opportunities. Int J Psychiatry Clin Pract 2022; 26:183-195. [PMID: 34348557 DOI: 10.1080/13651501.2021.1957117] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this manuscript is to provide a comprehensive and critical overview of the current evidence on the association between Diabetes mellitus (DM) and mood disorders [i.e., Major depressive disorder (MDD) and bipolar disorder (BD)], and therapeutic opportunities. METHODS We searched in MEDLINE (via Ovid) for placebo-controlled clinical trials published in the last 20 years that assessed drug repurposing approaches for the treatment of DM or mood disorders. RESULTS We found seven studies that aimed to verify the effects of antidepressants in patients diagnosed with DM, and eight studies that tested the effect of antidiabetic drugs in patients diagnosed with MDD or BD. Most studies published in the last two decades did not report a positive effect of antidepressants on glycemic control in patients with DM. On the other hand, antidiabetic drugs seem to have a positive effect on the treatment of MDD and BD. CONCLUSIONS While effect of antidepressants on glycemic control in patients with DM is still controversial, the use of antidiabetic drugs may be a promising strategy for patients with MDD or BD. Prospective studies are still needed.Key pointsMood disorders in patients with DM affect glycemic control, potentially increasing mortality risk.The effect of antidepressants on glycemic control in patients with DM is still controversial. The coexistence of complicated DM and a mood disorders would require a careful, individualised, and comprehensive evaluation.Insulin resistance may increase the risk of depressive symptoms and is associated with worse outcomes in BD.The use antidiabetic drugs may be a promising strategy for patients with MDD or BD. However, prospective trials are needed to prove a potential antidepressant activity of antidiabetic drugs.
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Affiliation(s)
- Laís Bhering Martins
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.,Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jenneffer Rayane Braga Tibães
- Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Agricultural, Food and Nutritional Science, Division of Human Nutrition, University of Alberta, Edmonton, Canada
| | - Michael Berk
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Geelong, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, Parkville, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Antonio Lucio Teixeira
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.,Instituto de Ensino e Pesquisa, Belo Horizonte, Brazil
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Bakker JJ, Lameijer A, Flores Guerrero JL, Bilo HJG, van Dijk PR. Commencement of flash glucose monitoring is associated with a decreased rate of depressive disorders among persons with diabetes (FLARE-NL7). BMJ Open Diabetes Res Care 2022; 10:10/3/e002769. [PMID: 35725018 PMCID: PMC9214349 DOI: 10.1136/bmjdrc-2022-002769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Depressive disorders are more common among persons with diabetes, as compared with persons without diabetes. The burden of glucose management is known to associate with depressive symptoms. This study aims to assess the effects of commencement of FreeStyle Libre flash glucose monitoring (FSL-FGM) on the mental health status of persons with diabetes. RESEARCH DESIGN AND METHODS Post-hoc analysis of data from a 1-year prospective nationwide FSL-FGM registry. Participants who used FSL-FGM for 12 months and completed the 12-Item Short Form Health Survey version 2 (SF-12v2) questionnaires at baseline, 6 and 12 months were included. An SF-12v2 Mental Component Score (MCS) of ≤45 was used as a cut-off to discriminate between persons with and without a depressive disorder. RESULTS A total of 674 patients were included with a mean age of 48.2 (±15.8) years, 51.2% men, 78.2% type 1 diabetes and baseline HbA1c 62.8 (±13.4) mmol/mol (7.9±1.2%). At baseline, 235 (34.9%) persons had an SF-12 MCS ≤45 while after 6 and 12 months these numbers decreased: 202 (30.0%, p<0.01) and 173 (25.7%, p<0.01). Overall, MCS improved from 48.5 at baseline to 50.7 after 6 months and 51.3 after 12 months. In multivariable regression analysis, age and MCS at baseline were associated with improvement of MCS after 12 months of FSL-FGM use. CONCLUSIONS This analysis suggests that use of FSL-FGM is associated with a decreased rate of depressive disorders among persons with diabetes. Future studies are needed to corroborate these findings.
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Affiliation(s)
- Julia J Bakker
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Annel Lameijer
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Jose L Flores Guerrero
- University of Groningen, University Medical Center Groningen, Department of Nephrology, Groningen, The Netherlands
| | - Henk J G Bilo
- Isala, Diabetes Research Center, Zwolle, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - Peter R van Dijk
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
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Pal K, Sharma M, Mukadam NM, Petersen I. Initiation of antidepressant medication in people with type 2 diabetes living in the UK - a retrospective cohort study. Pharmacoepidemiol Drug Saf 2022; 31:892-900. [PMID: 35638365 PMCID: PMC9542279 DOI: 10.1002/pds.5484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 05/03/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
Introduction Depression is a common comorbidity in people with type 2 diabetes and it is associated with poorer outcomes. There is limited data on the treatments used for depression in this population. The aim of this study was to explore the rates of initiation of antidepressant prescriptions in people with type 2 diabetes in the UK and identify those most at risk of needing such treatment. Research Design and Methods This was a retrospective cohort study using data from IQVIA Medical Research Data (IMRD)‐UK data. Data from general practices in IMRD‐UK between January 2008 and December 2017 were used for this study. Results The overall rates of antidepressant prescribing were stable over the study period. The rate of initiation of antidepressant medication in people with type 2 diabetes was 22.93 per 1000 person years at risk (PYAR) with a 95%CI 22.48 to 23.39 compared to 16.89 per 1000 PYAR (95%CI 16.77 to 17.01) in an age and gender matched cohort. The risk of being prescribed antidepressant medication with age had a U‐shaped distribution with the lowest risk in the 65–69 age group. The peak age for antidepressant initiation in men and women was 40–44, with a rate in men of 32.78 per 1000 PYAR (95% CI 29.57 to 36.34) and a rate in women of 46.80 per 1000 PYAR (95% CI 41.90 to 52.26). People with type 2 diabetes with in the least deprived quintile had an initiation rate of 19.66 per 1000 PYAR (95%CI 18.67 to 20.70) compared to 27.19 per 1000 PYAR (95%CI 25.50 to 28.93) in the most deprived quintile, with a 32% increase in the risk of starting antidepressant medication (95%CI 1.22 to 1.43). Conclusions People with type 2 diabetes were 30% more likely to be started on antidepressant medication than people without type 2 diabetes. Women with type 2 diabetes were 35% more likely than men to be prescribed antidepressants and the risks increased with deprivation and in younger or older adults, with the lowest rates in the 65–69 year age band. The rates of antidepressant prescribing were broadly stable over the 10‐year period in this study. The antidepressant medications prescribed changed slightly over time with sertraline becoming more widely used and fewer prescriptions of citalopram.
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Affiliation(s)
- Kingshuk Pal
- Department of Primary Care and Population Health, U3 Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Manuj Sharma
- Department of Primary Care and Population Health, U3 Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | | | - Irene Petersen
- Department of Primary Care and Population Health, U3 Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
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76
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Cornely RM, Subramanya V, Owen A, McGee RE, Kulshreshtha A. A mixed-methods approach to understanding the perspectives, experiences, and attitudes of a culturally tailored cognitive behavioral therapy/motivational interviewing intervention for African American patients with type 2 diabetes: a randomized parallel design pilot study. Pilot Feasibility Stud 2022; 8:107. [PMID: 35597972 PMCID: PMC9123732 DOI: 10.1186/s40814-022-01066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/06/2022] [Indexed: 11/12/2022] Open
Abstract
Background African American (AA) adults are 60% more likely to be diagnosed with diabetes mellitus (DM) and experience more complications than non-Hispanic White adults. Cognitive behavioral therapy (CBT) has shown to be an effective modality for helping patients improve health behaviors and regulate emotional states. Motivational interviewing (MI) addresses participant engagement and motivation. Therefore, MI was combined with CBT as an approach to the process of learning using CBT skills to promote healthy lifestyle choices. We aimed to assess the effects of a culturally tailored CBT/MI intervention on glycemic control in AA participants and understand their perspectives, attitudes, and experiences while participating in this intervention. Methods Using a randomized, parallel design pilot study (web-based group vs in-person group), 20 participants aged ≥ 18 years, identifying as AA and having a glycosylated hemoglobin (HbA1c) > 8%, were recruited. A CBT/MI intervention was administered in six sessions over 3 months. Participants completed baseline and follow-up assessments on measures for diabetes control (HbA1c), self-efficacy, generalized anxiety, depression, perceived stress, health-related quality of life, and cognitive ability. Post-CBT/MI intervention focus groups were conducted to determine patient perspectives regarding the intervention. Results Fourteen participants completed the study, their mean HbA1c improved from 10.0 to 8.9% (t(26) = 0.5, p-value = 0.06). The Diabetes Distress Scale demonstrated decreased distress overall (t(26) = 2.6; p-value = 0.02). The Generalized Anxiety Disorder Scale demonstrated decreased generalized anxiety for all participants (t(26) = 2.2; p = 0.04). Themes identified in focus groups included (1) intervention group social support through information sharing, (2) mental health and personal identities in diabetes understanding and management, and (3) receptivity to CBT/MI intervention positively impacts self-efficacy through improved health literacy. Conclusion This group-based, culturally tailored CBT/MI intervention for type 2 DM care was positively received by AA participants and helped improve diabetes control, as demonstrated by the change in HbA1c. There were additional benefits of social support through group interactions and a stronger sense of self-efficacy due to health education. A comprehensive treatment plan using a CBT/MI intervention may be useful in promoting healthy diabetes self-management. Trial registration ClinicalTrials.gov, NCT03562767. Registered on 19 June 2018
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Affiliation(s)
- Ronald M Cornely
- Behavioral, Social, & Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Vinita Subramanya
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ashley Owen
- Department of Family and Preventive Medicine, Emory University School of Medicine, 4500 North Shallowford Rd
- Suite 134, Atlanta, GA, 30338, USA
| | - Robin E McGee
- Behavioral, Social, & Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ambar Kulshreshtha
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. .,Department of Family and Preventive Medicine, Emory University School of Medicine, 4500 North Shallowford Rd
- Suite 134, Atlanta, GA, 30338, USA.
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Fluoxetine Treatment Decreases Cardiac Vagal Input and Alters the Serotonergic Modulation of the Parasympathetic Outflow in Diabetic Rats. Int J Mol Sci 2022; 23:ijms23105736. [PMID: 35628547 PMCID: PMC9148001 DOI: 10.3390/ijms23105736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022] Open
Abstract
Comorbid diabetes and depression constitutes a major health problem, worsening associated cardiovascular diseases. Fluoxetine's (antidepressant) role on cardiac diabetic complications remains unknown. We determined whether fluoxetine modifies cardiac vagal input and its serotonergic modulation in male Wistar diabetic rats. Diabetes was induced by alloxan and maintained for 28 days. Fluoxetine was administered the last 14 days (10 mg/kg/day; p.o). Bradycardia was obtained by vagal stimulation (3, 6 and 9 Hz) or i.v. acetylcholine administrations (1, 5 and 10 μg/kg). Fluoxetine treatment diminished vagally-induced bradycardia. Administration of 5-HT originated a dual action on the bradycardia, augmenting it at low doses and diminishing it at high doses, reproduced by 5-CT (5-HT1/7 agonist). 5-CT did not alter the bradycardia induced by exogenous acetylcholine. Decrease of the vagally-induced bradycardia evoked by high doses of 5-HT and 5-CT was reproduced by L-694,247 (5-HT1D agonist) and blocked by prior administration of LY310762 (5-HT1D antagonist). Enhancement of the electrical-induced bradycardia by 5-CT (10 μg/kg) was abolished by pretreatment with SB269970 (5-HT7 receptor antagonist). Thus, oral fluoxetine treatment originates a decrease in cardiac cholinergic activity and changes 5-HT modulation of bradycardic responses in diabetes: prejunctional 5-HT7 receptors augment cholinergic-evoked bradycardic responses, whereas prejunctional 5-HT1D receptors inhibit vagally-induced bradycardia.
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Fioretti C, Mugnaini C. Living with type 1 diabetes mellitus in emerging adulthood: A qualitative study. Br J Health Psychol 2022; 27:1226-1240. [PMID: 35587032 DOI: 10.1111/bjhp.12596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Few studies have investigated the impact of diabetes considering its effects on developmental tasks that are typical of emerging adulthood. The present study aimed to investigate how emerging adults with a chronic condition such as type 1 diabetes mellitus manage with this developmental phase. METHODS 30 emerging adults diagnosed with diabetes (18-34 years, females = 19) took part in an autobiographical interview investigating their experience of dealing with type 1 diabetes. Narratives were analysed by means of a qualitative thematic analysis of an inductive type. RESULTS Thematic analysis pointed out five thematic areas strictly related to the tasks of emerging adulthood: the development of intimate relationships, university life, work and plans for the future, the achievement of individual autonomy, the construction of an adult identity and family planning. Every thematic area reported a number of subthemes related to specific difficulties experienced by participants in reaching their developmental tasks due to chronic disease. Emerged themes considered both negative and positive outcomes of living with type 1 diabetes mellitus in emerging adulthood, such as a personal growth related to identity development. CONCLUSION The authors discussed results considering complexities and resources associated with diabetes in the light of developmental tasks of emerging adulthood.
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Affiliation(s)
- Chiara Fioretti
- Department of Human, Philosophical and Educational Sciences (DISUFF), University of Salerno, Fisciano, Italy
| | - Chiara Mugnaini
- Developmental Psychologist, Private Practice, Florence, Italy.,Tuscan Association for Children and Young People with Diabetes, Scandicci, Florence, Italy
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Hou F, Han X, Wang Q, Zhou S, Zhang J, Shen G, Zhang Y. Cross-Sectional Associations between Living and Built Environments and Depression Symptoms among Chinese Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105819. [PMID: 35627355 PMCID: PMC9140945 DOI: 10.3390/ijerph19105819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 02/04/2023]
Abstract
In this study, we explored the cross-sectional associations between living and built environments and depression among older Chinese adults. Data from 5822 participants were obtained. Depression symptoms were evaluated through the use of the Patient Health Questionnaire (PHQ-9), with a score higher than 4 categorized as having depression symptoms. The living environment was assessed by asking about dust in the environment and barrier-free facilities. We considered the presence of amenities within a 10 min walking distance and the proportion of green space within an 800 m distance from participants’ dwellings to reflect the built environment. Data were analyzed by multilevel logistic regression. Participants living in a non-dusty environment with proximity to green space had a lower risk of depression (non-dusty environment: OR = 0.784, 95% CI = 0.642, 0.956; green space: OR = 0.834, 95% CI = 0.697, 0.998). However, having no access to barrier-free facilities and hospital proximity increased the depression risk (barrier-free facilities: OR = 1.253, 95% CI = 1.078, 1.457; hospital: OR = 1.318, 95% CI = 1.104, 1.574). Dusty environments, access to barrier-free facilities and proximity to hospitals and green spaces were associated with depression symptoms among older Chinese adults.
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Affiliation(s)
- Fangfang Hou
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Xiao Han
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Qiong Wang
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Shuai Zhou
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Jingya Zhang
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Guodong Shen
- Department of Geriatrics, The First Affiliated Hospital of University of Science and Technology of China, Gerontology Institute of Anhui Province, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
- Anhui Provincial Key Laboratory of Tumor Immunotherapy and Nutrition Therapy, Hefei 230001, China
- Correspondence: (G.S.); (Y.Z.); Tel.: +86-551-62282371 (G.S.); +86-551-65161220 (Y.Z.)
| | - Yan Zhang
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
- Correspondence: (G.S.); (Y.Z.); Tel.: +86-551-62282371 (G.S.); +86-551-65161220 (Y.Z.)
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Loseby P, Schache K, Cavadino A, Young S, Hofman PL, Serlachius A. The role of protective psychological factors, self-care behaviors, and HbA1c in young adults with type 1 diabetes. Pediatr Diabetes 2022; 23:380-389. [PMID: 34967089 DOI: 10.1111/pedi.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate whether protective psychological factors in young adults with type 1 diabetes are associated with more optimal self-care behaviors and HbA1c, and to explore possible mediators between protective psychological factors and HbA1c. RESEARCH DESIGN AND METHODS This cross-sectional study examined the associations between protective psychological factors (optimism, positive efficacy expectancies, and self-compassion), maladaptive psychological factors (depression, anxiety, and stress), self-care behaviors, and HbA1c in 113 young adults (17-25 years) with type 1 diabetes in Auckland, New Zealand. Pearson's correlations, multiple linear regressions, and multiple mediation analyses were used to examine associations and mediators. RESULTS Higher positive efficacy expectancies (beliefs about coping with difficulties) were associated with more optimal HbA1c (β = -0.26, 95% CI: -1.99 to -0.45) and more optimal self-care behaviors (β = 0.33, 95% CI: 0.28 to 0.92) in the adjusted models. Higher levels of self-compassion were associated with more optimal self-care behaviors (β = 0.27, 95% CI: 0.09 to 0.43). Depression was associated with less optimal self-care behaviors (β = -0.35, 95% CI: -1.33 to -0.43) and stress was associated with less optimal HbA1c (β = 0.26, 95% CI: 0.27 to 1.21). Mediation results suggested that self-care behaviors mediated the relationship between all three of the protective psychological factors and more optimal HbA1c, and that lower stress also mediated the relationship between higher self-compassion and more optimal HbA1c. CONCLUSIONS This study adds to the emerging literature that protective psychological factors may play an adaptive role in improving health outcomes in young adults with type 1 diabetes. Interventions targeting protective psychological factors present a promising approach to optimizing wellbeing and self-care in youth with type 1 diabetes.
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Affiliation(s)
- Philippa Loseby
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Kiralee Schache
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.,Psychological Medicine, Counties Manukau Health, Auckland, New Zealand
| | - Alana Cavadino
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Simon Young
- North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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Ronaldson A, Freestone M, Zhang H, Marsh W, Bhui K. Using Structural Equation Modelling in Routine Clinical Data on Diabetes and Depression: Observational Cohort Study. JMIRX MED 2022; 3:e22912. [PMID: 37725546 PMCID: PMC10414237 DOI: 10.2196/22912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 09/21/2023]
Abstract
BACKGROUND Large data sets comprising routine clinical data are becoming increasingly available for use in health research. These data sets contain many clinical variables that might not lend themselves to use in research. Structural equation modelling (SEM) is a statistical technique that might allow for the creation of "research-friendly" clinical constructs from these routine clinical variables and therefore could be an appropriate analytic method to apply more widely to routine clinical data. OBJECTIVE SEM was applied to a large data set of routine clinical data developed in East London to model well-established clinical associations. Depression is common among patients with type 2 diabetes, and is associated with poor diabetic control, increased diabetic complications, increased health service utilization, and increased health care costs. Evidence from trial data suggests that integrating psychological treatment into diabetes care can improve health status and reduce costs. Attempting to model these known associations using SEM will test the utility of this technique in routine clinical data sets. METHODS Data were cleaned extensively prior to analysis. SEM was used to investigate associations between depression, diabetic control, diabetic care, mental health treatment, and Accident & Emergency (A&E) use in patients with type 2 diabetes. The creation of the latent variables and the direction of association between latent variables in the model was based upon established clinical knowledge. RESULTS The results provided partial support for the application of SEM to routine clinical data. Overall, 19% (3106/16,353) of patients with type 2 diabetes had received a diagnosis of depression. In line with known clinical associations, depression was associated with worse diabetic control (β=.034, P<.001) and increased A&E use (β=.071, P<.001). However, contrary to expectation, worse diabetic control was associated with lower A&E use (β=-.055, P<.001) and receipt of mental health treatment did not impact upon diabetic control (P=.39). Receipt of diabetes care was associated with better diabetic control (β=-.072, P<.001), having depression (β=.018, P=.007), and receiving mental health treatment (β=.046, P<.001), which might suggest that comprehensive integrated care packages are being delivered in East London. CONCLUSIONS Some established clinical associations were successfully modelled in a sample of patients with type 2 diabetes in a way that made clinical sense, providing partial evidence for the utility of SEM in routine clinical data. Several issues relating to data quality emerged. Data improvement would have likely enhanced the utility of SEM in this data set.
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Affiliation(s)
- Amy Ronaldson
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Mark Freestone
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Haoyuan Zhang
- School for Electronic Engineering and Computer Science, Queen Mary University of London, London, United Kingdom
| | - William Marsh
- School for Electronic Engineering and Computer Science, Queen Mary University of London, London, United Kingdom
| | - Kamaldeep Bhui
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- Department of Psychiatry, Nuffield Department of Primary Care Sciences, University of Oxford, Oxford, United Kingdom
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Deom Tardif A, Gogovor A, Guay-Bélanger S, Audet D, Parent N, Gaudreau A, Remy-Lamarche D, Vigneault L, Ngueta G, Bilodeau A, Légaré F. Integration of sex and gender in a continuing professional development course on diabetes and depression: a mixed methods feasibility study. BMJ Open 2022; 12:e050890. [PMID: 35459660 PMCID: PMC9036429 DOI: 10.1136/bmjopen-2021-050890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Assess the feasibility and impact of a continuous professional development (CPD) course on type 2 diabetes and depression on health professionals' intention to include sex and gender considerations in patient care. DESIGN AND SETTING In collaboration with CPD organisations and patient-partners, we conducted a mixed-methods feasibility controlled trial with postintervention measures in three Canadian provinces. PARTICIPANTS Of 178 eligible health professionals, 127 completed questionnaires and 67 participated in semistructured group discussions. INTERVENTION AND COMPARATOR An interactive 1 hour CPD course, codesigned with patient-partners, on diabetes and depression that included sex and gender considerations (innovation) was compared with a similar course that did not include them (comparator). OUTCOMES Feasibility of recruitment and retention of CPD organisations and patient-partners throughout the study; adherence to planned activities; health professionals' intention to include sex and gender considerations in patient care as measured by the CPD-Reaction questionnaire; and barriers and facilitators using the Theoretical Domains Framework. RESULTS All recruited CPD organisations and patient-partners remained engaged throughout the study. All planned CPD courses occurred. Overall, 71% of eligible health professionals participated (63% under 44 years old; 79.5% women; 67.7% practising in French; 66.9% practising in Quebec; 78.8% in urban practice). After training, mean intention scores for the innovation (n=49) and control groups (n=78) were 5.65±0.19 and 5.19±0.15, respectively. Mean difference was -0.47 (CI -0.95 to 0.01; p=0.06). Adjusted for age, gender and practice settings, mean difference was -0.57 (CI -1.09 to -0.05; p=0.03). We identified eight theoretical domains related to barriers and six related to facilitators for providing sex-adapted and gender-adapted diabetes and depression care. CONCLUSIONS CPD training on diabetes and depression that includes sex and gender considerations is feasible and, compared with CPD training that does not, may prompt health professionals to modify their care. Addressing identified barriers and facilitators could increase intention. TRIAL REGISTRATION NUMBER NCT03928132 with ClinicalTrials.gov; Post-results.
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Affiliation(s)
- Alèxe Deom Tardif
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Amédé Gogovor
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Sabrina Guay-Bélanger
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Denis Audet
- University Family Medicine Group Saint-François-d'Assise, Quebec, Quebec, Canada
| | - Nicole Parent
- Direction de la formation professionnelle, Médecins francophones du Canada, Montreal, Quebec, Canada
| | - André Gaudreau
- Patient Partner, Université Laval, Quebec, Quebec, Canada
| | | | - Luc Vigneault
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Patient Partner, CAP Rétablissement, Quebec, Quebec, Canada
| | - Gérard Ngueta
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - André Bilodeau
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - France Légaré
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
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83
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Impact of lipid ratio as an objective indicator of mental health status in Indian Individuals with Diabetes mellitus: an observational pilot study. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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84
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Steenblock C, Schwarz PEH, Perakakis N, Brajshori N, Beqiri P, Bornstein SR. The interface of COVID-19, diabetes, and depression. DISCOVER MENTAL HEALTH 2022; 2:5. [PMID: 35253006 PMCID: PMC8886346 DOI: 10.1007/s44192-022-00007-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/27/2022] [Indexed: 02/07/2023]
Abstract
Comorbid diabetes with depression is a challenging and often under-recognized clinical problem. During the current COVID-19 pandemic, a communicable disease is thriving on the increasing incidences of these non-communicable diseases. These three different health problems are bidirectionally connected forming a vicious cycle. Firstly, depressed individuals show a higher risk of developing diabetes and patients with diabetes have a higher risk of developing symptoms of depression. Secondly, patients with diabetes have a higher risk of developing severe COVID-19 as well as of experiencing breakthrough infections. Thirdly, in both patients with type 2 diabetes and in COVID-19 survivors the prevalence of depression seems to be increased. Fourthly, lockdown and quarantine measurements during the COVID-19 pandemic has led to an increase in depression. Therefore, it is of importance to increase the awareness of this interface between depression, diabetes and COVID-19. Finally, as symptoms of post-COVID, diabetes and depression may be overlapping, there is a need for educating skilled personnel in the management of these comorbidities.
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Affiliation(s)
- Charlotte Steenblock
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Peter E. H. Schwarz
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
- Paul Langerhans Institute Dresden (PLID), Helmholtz Center Munich, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
| | - Nikolaos Perakakis
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
- Paul Langerhans Institute Dresden (PLID), Helmholtz Center Munich, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
| | - Naime Brajshori
- Research Unit, Heimerer College, Prishtina, Republic of Kosovo
| | - Petrit Beqiri
- Research Unit, Heimerer College, Prishtina, Republic of Kosovo
| | - Stefan R. Bornstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
- Paul Langerhans Institute Dresden (PLID), Helmholtz Center Munich, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
- Department of Diabetes, School of Life Course Science and Medicine, Kings College London, London, UK
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85
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Hess EM, Riggs LM, Michaelides M, Gould TD. Mechanisms of ketamine and its metabolites as antidepressants. Biochem Pharmacol 2022; 197:114892. [PMID: 34968492 PMCID: PMC8883502 DOI: 10.1016/j.bcp.2021.114892] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 02/06/2023]
Abstract
Treating major depression is a medical need that remains unmet by monoaminergic therapeutic strategies that commonly fail to achieve symptom remission. A breakthrough in the treatment of depression was the discovery that the anesthetic (R,S)-ketamine (ketamine), when administered at sub-anesthetic doses, elicits rapid (sometimes within hours) antidepressant effects in humans that are otherwise resistant to monoaminergic-acting therapies. While this finding was revolutionary and led to the FDA approval of (S)-ketamine (esketamine) for use in adults with treatment-resistant depression and suicidal ideation, the mechanisms underlying how ketamine or esketamine elicit their effects are still under active investigation. An emerging view is that metabolism of ketamine may be a crucial step in its mechanism of action, as several metabolites of ketamine have neuroactive effects of their own and may be leveraged as therapeutics. For example, (2R,6R)-hydroxynorketamine (HNK), is readily observed in humans following ketamine treatment and has shown therapeutic potential in preclinical tests of antidepressant efficacy and synaptic potentiation while being devoid of the negative adverse effects of ketamine, including its dissociative properties and abuse potential. We discuss preclinical and clinical studies pertaining to how ketamine and its metabolites produce antidepressant effects. Specifically, we explore effects on glutamate neurotransmission through N-methyl D-aspartate receptors (NMDARs) and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs), synaptic structural changes via brain derived neurotrophic factor (BDNF) signaling, interactions with opioid receptors, and the enhancement of serotonin, norepinephrine, and dopamine signaling. Strategic targeting of these mechanisms may result in novel rapid-acting antidepressants with fewer undesirable side effects compared to ketamine.
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Affiliation(s)
- Evan M Hess
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - Lace M Riggs
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.,Program in Neuroscience and Training Program in Integrative Membrane Biology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - Michael Michaelides
- Biobehavioral Imaging & Molecular Neuropsychopharmacology Unit, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD 21224, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Todd D Gould
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Departments of Pharmacology and Anatomy & Neurobiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Baltimore Veterans Affairs Medical Center, Veterans Affairs Maryland Health Care System, Baltimore, MD 21201, USA.
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86
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Yu Y, He X, Wang Y, Zhang J, Tang C, Rong P. Transcutaneous auricular vagal nerve stimulation inhibits limbic-regional P2X7R expression and reverses depressive-like behaviors in Zucker diabetic fatty rats. Neurosci Lett 2022; 775:136562. [PMID: 35245625 DOI: 10.1016/j.neulet.2022.136562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 11/29/2022]
Abstract
Zucker diabetic fatty (ZDF) rats develop type 2 diabetes (T2D) along with depressive-like behaviors. Transcutaneous auricular vagal nerve stimulation (taVNS) has antidiabetic and antidepressant-like effects in ZDF rats; however, the underlying antidepressant-like mechanisms are unclear. The purinergic receptor P2X7R, which is related to inflammation and depression, is upregulated in the limbic brain regions of depressed patients and rodents and is considered as a potential therapeutic target. Thus, this study aimed to provide preliminary evidence at the molecular level of taVNS antidepressant-like effect in ZDF rats through testing their limbic-regional P2X7R expression. ZDF rats were subjected to taVNS and transcutaneous non-vagal nerve stimulation (tnVNS). Body weight and blood glucose levels were monitored weekly. Depressive-like behaviors were evaluated with the open-field test (OFT) and forced swimming test (FST). Limbic-regional P2X7R expression was examined by western blotting (WB). P2X7R expressing cells were detected by immunohistochemistry (IHC). Compared to their lean littermates (ZL rats), ZDF rats developed obesity, hyperglycemia, and depressive-like behaviors with elevated limbic-regional P2X7R expression. taVNS but not tnVNS lowered body weight, reduced and stabilized blood glucose levels, suppressed limbic-regional P2X7R expression, and reversed the depressive-like behaviors. P2X7R was found primarily expressed in ZDF rats' limbic-regional astrocytes. In conclusion, taVNS inhibits ZDF rats' limbic-regional P2X7R expression, which may be one of the taVNS antidepressant-like mechanisms.
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Affiliation(s)
- Yutian Yu
- Acupuncture Department, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Ninth School of Clinical Medicine, Peking University, Beijing, China; Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Xun He
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinling Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chunzhi Tang
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China.
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87
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Aubert CE, Henderson JB, Kerr EA, Holleman R, Klamerus ML, Hofer TP. Type 2 Diabetes Management, Control and Outcomes During the COVID-19 Pandemic in Older US Veterans: an Observational Study. J Gen Intern Med 2022; 37:870-877. [PMID: 34993873 PMCID: PMC8735737 DOI: 10.1007/s11606-021-07301-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/23/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND The COVID-19 pandemic required a change in outpatient care delivery models, including shifting from in-person to virtual visits, which may have impacted care of vulnerable patients. OBJECTIVE To describe the changes in management, control, and outcomes in older people with type 2 diabetes (T2D) associated with the shift from in-person to virtual visits. DESIGN AND PARTICIPANTS In veterans aged ≥ 65 years with T2D, we assessed the rates of visits (in person, virtual), A1c measurements, antidiabetic deintensification/intensification, ER visits and hospitalizations (for hypoglycemia, hyperglycemia, other causes), and A1c level, in March 2020 and April-November 2020 (pandemic period). We used negative binomial regression to assess change over time (reference: pre-pandemic period, July 2018 to February 2020), by baseline Charlson Comorbidity Index (CCI; > 2 vs. <= 2) and A1c level. KEY RESULTS Among 740,602 veterans (mean age 74.2 [SD 6.6] years), there were 55% (95% CI 52-58%) fewer in-person visits, 821% (95% CI 793-856%) more virtual visits, 6% (95% CI 1-11%) fewer A1c measurements, and 14% (95% CI 10-17%) more treatment intensification during the pandemic, relative to baseline. Patients with CCI > 2 had a 14% (95% CI 12-16%) smaller relative increase in virtual visits than those with CCI <= 2. We observed a seasonality of A1c level and treatment modification, but no association of either with the pandemic. After a decrease at the beginning of the pandemic, there was a rebound in other-cause (but not hypo- and hyperglycemia-related) ER visits and hospitalizations from June to November 2020. CONCLUSION Despite a shift to virtual visits and a decrease in A1c measurement during the pandemic, we observed no association with A1c level or short-term T2D-related outcomes, providing some reassurance about the adequacy of virtual visits. Further studies should assess the longer-term effects of shifting to virtual visits in different populations to help individualize care, improve efficiency, and maintain appropriate care while reducing overuse.
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Affiliation(s)
- Carole E Aubert
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland. .,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland. .,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - James B Henderson
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Consulting for Statistics, Computing & Analytics Research (CSCAR), University of Michigan, Ann Arbor, MI, USA
| | - Eve A Kerr
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rob Holleman
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Mandi L Klamerus
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Timothy P Hofer
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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88
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Bilu C, Einat H, Zimmet P, Vishnevskia-Dai V, Schwartz WJ, Kronfeld-Schor N. Beneficial effects of voluntary wheel running on activity rhythms, metabolic state, and affect in a diurnal model of circadian disruption. Sci Rep 2022; 12:2434. [PMID: 35165331 PMCID: PMC8844006 DOI: 10.1038/s41598-022-06408-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/19/2022] [Indexed: 12/14/2022] Open
Abstract
Emerging evidence suggests that disruption of circadian rhythmicity contributes to development of comorbid depression, cardiovascular diseases (CVD), and type 2 diabetes mellitus (T2DM). Physical exercise synchronizes the circadian system and has ameliorating effects on the depression- and anxiety-like phenotype induced by circadian disruption in mice and sand rats. We explored the beneficial effects of voluntary wheel running on daily rhythms, and the development of depression, T2DM, and CVD in a diurnal animal model, the fat sand rat (Psammomys obesus). Voluntary exercise strengthened general activity rhythms, improved memory and lowered anxiety- and depressive-like behaviors, enhanced oral glucose tolerance, and decreased plasma insulin levels and liver weight. Animals with access to a running wheel had larger heart weight and heart/body weight ratio, and thicker left ventricular wall. Our results demonstrate that exercising ameliorates pathological-like daily rhythms in activity and blood glucose levels, glucose tolerance and depressive- and anxiety-like behaviors in the sand rat model, supporting the important role of physical activity in modulating the “circadian syndrome” and circadian rhythm-related diseases. We suggest that the utilization of a diurnal rodent animal model may offer an effective way to further explore metabolic, cardiovascular, and affective-like behavioral changes related to chronodisruption and their underlying mechanisms.
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89
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Kamrul-Hasan ABM, Hannan MA, Asaduzzaman M, Rahman MM, Alam MS, Amin MN, Kabir MR, Chanda PK, Jannat N, Haque MZ, Banik SR, Hasan MJ, Selim S. Prevalence and predictors of diabetes distress among adults with type 2 diabetes mellitus: a facility-based cross-sectional study of Bangladesh. BMC Endocr Disord 2022; 22:28. [PMID: 35065623 PMCID: PMC8783990 DOI: 10.1186/s12902-022-00938-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/10/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Diabetes distress (DD) is common and has considerable impacts on diabetes management. Unfortunately, DD is less discussed and frequently underestimated. This study evaluated the prevalence and predictors of DD in adults with type 2 diabetes mellitus (T2DM). METHODS A cross-sectional study was conducted at several specialized endocrinology outpatient clinics in Bangladesh from July 2019 to June 2020; 259 adults with T2DM participated. Participants' DD and depression were measured using the 17-item Diabetes Distress Scale (DDS-17) and 9-item Patient Health Questionnaire (PHQ-9), respectively. DDS-17 scores ≥2 and PHQ-9 scores ≥10 were the cutoffs for DD and significant depression, respectively. RESULTS The mean (±SD) age of the participants was 50.36 (±12.7) years, with the majority (54.8%) being male; their median (IQR) duration of diabetes was 6 (3-11) years. Among the study participants, 52.5% had DD (29.7% moderate and 22.8% high DD). The prevalence of emotional burden, physician-related distress, regimen-related distress, and interpersonal distress was 68.7, 28.6, 66, and 37.7%, respectively. Depression was present in 40.5%; 28.6% of the participants had DD and depression. The total DDS-17 score was positively correlated with the PHQ-9 score (r = 0.325, p < 0.001). Rural residence (OR 1.94), presence of any diabetic complication (OR 3.125), insulin use (OR 2.687), and presence of major depression (OR 4.753) were positive predictors of DD. In contrast, age ≥ 40 years at diabetes diagnosis (OR 0.047) and diabetes duration of > 10 years (OR 0.240) were negative predictors of DD (p < 0.05 in all instances). CONCLUSIONS The prevalence of DD in our setting is notably high; DD and depression frequently overlap. Screening for diabetes distress may be considered, especially in high-risk patients.
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Affiliation(s)
- A B M Kamrul-Hasan
- Department of Endocrinology, Mymensingh Medical College, Mymensingh, 2207, Bangladesh.
| | | | - Md Asaduzzaman
- Department of Endocrinology, Shaheed Sheikh Abu Naser Specialized Hospital, Khulna, Bangladesh
| | | | | | | | | | - Palash Kumar Chanda
- Department of Endocrinology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh
| | - Nadia Jannat
- Department of Endocrinology, Aalok Healthcare & Hospital Ltd., Dhaka, Bangladesh
| | - Md Zahurul Haque
- Department of Chronic Diseases, Government Homeopathic Medical College, Dhaka, Bangladesh
| | - Sanjoy Ranjon Banik
- Department of Endocrinology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh
| | | | - Shahjada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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90
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Andrade DMB, Rocha RM, Ribeiro ÍJS. Depressive symptoms among older adults with diabetes mellitus: a cross-sectional study. SAO PAULO MED J 2022; 141:e2021771. [PMID: 36197348 PMCID: PMC10065091 DOI: 10.1590/1516-3180.2021.0771.r5.09082022] [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: 09/17/2021] [Accepted: 08/09/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a chronic disease with long-term consequences that is often associated with depressive symptoms. This relationship predicts increased morbidity and mortality rates, leading to serious health consequences. OBJECTIVE To identify the prevalence and health factors associated with depressive symptoms among older adults with diabetes mellitus. DESIGN AND SETTING An observational cross-sectional study was conducted among 236 older adults in the Basic Healthcare Units of Jequié, Brazil. METHODS A survey containing sociodemographic, behavioral, and health conditions was used as a data collection instrument, in addition to the Geriatric Depression Scale. The main inclusion criterion was older adults diagnosed with diabetes mellitus. To identify the risk factors associated with depressive symptoms among older adults with diabetes mellitus, logistic regression analysis was conducted for calculating the odds ratio (OR), and a 95% confidence interval (CI) was considered statistically significant. RESULTS The prevalence of depressive symptoms was 24.2% among older adults with diabetes, corroborating the Brazilian average of 30%. The final multivariate analysis model for the risk of depressive symptoms showed a significant association with diabetes complications [OR = 2.50, 95% CI 1.318-4.74)] and osteoporosis [OR = 2.75, 95% CI 1.285-5.891)]. CONCLUSION A high prevalence of depressive symptoms was observed among older adults with diabetes. Critically examining older adults with diabetes mellitus is necessary, and screening for depressive symptoms is highly recommended, especially for those with complications resulting from diabetes mellitus and musculoskeletal comorbidities, such as osteoporosis, as it seems to be associated with depressive symptoms.
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Affiliation(s)
| | - Roseanne Montargil Rocha
- PhD. Nurse and Full Professor, Department of Health II,
Universidade Estadual de Santa Cruz (UESC), Ilhéus (BA), Brazil
| | - Ícaro José Santos Ribeiro
- PhD. Nurse Researcher and Professor, Department of Health II,
Universidade Estadual do Sudoeste da Bahia (UESB), Jequié (BA), Brazil
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91
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Kurniawidjaja M, Susilowati IH, Erwandi D, Kadir A, Hasiholan BP, Al Ghiffari R. Identification of Depression Among Elderly During COVID-19. J Prim Care Community Health 2022; 13:21501319221085380. [PMID: 35333667 PMCID: PMC8958696 DOI: 10.1177/21501319221085380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Elderly population is increasing, while the world has been facing the novel coronavirus (COVID-19), which causes a greater adverse impact among older population in various aspects of their lives, such as depression, daily routine disruption, illness, and social and emotional issues. The purpose of this study was to assess the elderly’s depression during the COVID-19 pandemic, and the risk factors including socio-demographic, physical and psychosocial conditions, as well as family support. The method used was cross-sectional design, with a total sampling of 457 participants. The measuring instruments used were ADL (Activities of Daily Living Scale) and IADL (Lowton and Brody Instrumental Activities of Daily Living Scale) for physical activities assessment, APGAR (Adaptability, Participation, Growth, Affection, Resolution) for family support function assessment, and Geriatric Depression Scale (GDS) for depression level measurement, with additional questions for psychosocial assessment. 212 elderlies (46.4%) were found with no depression tendency, 183 elderlies (40%) had a tendency of depression, and 62 elderlies (13.6%) had depression. These depression issues were significantly linked to retirement and income among elderly, dependency, fitness and health status, family and social support, and sources of funds. In the presence of depression, control measures for social, health, and psychosocial support must be implemented in order to minimize its impact among the elderly.
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Affiliation(s)
- Meily Kurniawidjaja
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | - Indri Hapsari Susilowati
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | - Dadan Erwandi
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | - Abdul Kadir
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | - Bonardo Prayogo Hasiholan
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | - Rijal Al Ghiffari
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
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92
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Brown MJ, Hill NL, Haider MR. Age and gender disparities in depression and subjective cognitive decline-related outcomes. Aging Ment Health 2022; 26:48-55. [PMID: 33325263 PMCID: PMC8206234 DOI: 10.1080/13607863.2020.1861214] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Determine the association between depression and SCD-related outcomes by age and gender. METHODS Using 2018 Behavioral Risk Factor Surveillance System survey data, crude and multivariable logistic regression models were used to determine the associations between depression and SCD-related outcomes by age and gender. RESULTS Among respondents 45 to 69, depression was associated with SCD [adjusted OR (aOR): 4.36; 95% CI: 3.24-5.86]; needing assistance with activities due to confusion/memory loss (aOR: 2.38; 95% CI: 1.26 - 4.51); needing help with activities and the help is not available (aOR: 4.46; 95% CI: 1.31 - 15.2); and having discussed confusion/memory loss with a health care professional (aOR: 1.87; 95% CI: 1.09 - 3.23). However, among respondents 70 and older, depression was associated with SCD (aOR): 3.52; 95% CI: 2.06-6.02); needing help with activities and the help is not available (aOR: 0.09; 95% CI: 0.01-0.56); confusion/memory loss interfering with work/social activities (aOR: 2.44; 95% CI: 1.03-5.79); and having discussed confusion/memory loss with a health care professional (aOR): 2.99; 95% CI: 1.20-7.40). Depression was positively associated with SCD among men (aOR): 3.68; 95% CI: 2.52-5.38) and women (aOR): 4.76; 95% CI: 3.29-6.87; and was positively associated with all SCD-related outcomes among men except for confusion/memory loss interfering with work/social activities and given up chores. Depression was positively associated with the latter among women (aOR): 2.10; 95% CI: 1.09-4.06). DISCUSSION SCD interventions should include assessment of and intervention for depression, and consider age and gender differences.
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Affiliation(s)
- Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Office of the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Nikki L Hill
- College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Mohammad Rifat Haider
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
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93
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Kaur H, Scholl JC, Owens-Gary M. Depression and Diabetes in Workers Across the Life Span: Addressing the Health of America's Workforce-Behavioral Risk Factor Surveillance System, 2014-2018. Diabetes Spectr 2022; 35:198-206. [PMID: 35668882 PMCID: PMC9160556 DOI: 10.2337/ds21-0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Harpriya Kaur
- Division of Science Integration, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH
- Corresponding author: Harpriya Kaur,
| | - Juliann C. Scholl
- Division of Science Integration, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH
| | - Michelle Owens-Gary
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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94
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Dinh Le T, Huy Duong H, Thi Nguyen L, Phi Thi Nguyen N, Tien Nguyen S, Van Ngo M. The Relationship Between Depression and Multifactorial Control and Microvascular Complications in Vietnamese with Type 2 Diabetes Mellitus Aged 30-60 Years. Diabetes Metab Syndr Obes 2022; 15:1185-1195. [PMID: 35464259 PMCID: PMC9031987 DOI: 10.2147/dmso.s354443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/01/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Depression is a common mental disorder in people with type 2 diabetes mellitus (T2DM). Depression and T2DM have a reciprocal interaction through many factors, of which the most important is the multifactorial control and microvascular complications of T2DM. AIM This research aims to determine the rate of depression and the association between depression and multifactorial control and microvascular complications in patients with T2DM aged 30-60 years in Vietnam. METHODS A cross-sectional and descriptive study was conducted on 231 outpatients with T2DM at Bach Mai hospital, Hanoi, Vietnam. Depression severity was measured with the Patient Health Questionnaire-9 (PHQ-9). RESULTS The rate of depression in patients with T2DM aged 30-60 years was 16.9% (in which, the rate of mild depression was 15.2% and moderate depression was 1.7%; no serious depression). The prevalence of depression was higher in female patients than in male patients (p = 0.049). There is a statistically significant difference in the rate of depression by age, duration of diabetes, and treatment method for type 2 diabetes. Poor HbA1c control and microvascular complications increase the risk of depression (OR = 2.37; 95% CI 1.11-5.02, p = 0.033 and OR = 2.62; 95% CI 1.15-5.93, p = 0.027, respectively). When the multivariate analysis was performed, it was shown that sex, treatment for glycemic control, and microvascular complications had a statistically significant influence on PHQ-9 score. CONCLUSION In Vietnam, there are 16.9% of patients with T2DM aged 30-60 years suffer from depression. Poor HbA1c control, the presence of microvascular complications, and without antihyperglycemic treatment increase the risk of developing depression.
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Affiliation(s)
- Tuan Dinh Le
- Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
- Department of Rheumatology and Endocrinology,Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
- Correspondence: Tuan Dinh Le, Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, 160 Phung Hung Street, Phuc La Ward, Ha Dong District, Hanoi City, Vietnam, Tel +840388166078, Email
| | - Hoang Huy Duong
- Department of Neurology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
- Hoang Huy Duong, Department of Neurology, Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Ky Ba Ward, Thai Binh, Vietnam, Tel +84 912675919, Email
| | - Ly Thi Nguyen
- Department of Internal Medicine, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
- Postgraduate Student, Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Nga Phi Thi Nguyen
- Department of Rheumatology and Endocrinology,Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Son Tien Nguyen
- Department of Rheumatology and Endocrinology,Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Manh Van Ngo
- Postgraduate Training Management Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
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95
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Adams RN, Athinarayanan SJ, McKenzie AL, Hallberg SJ, McCarter JP, Phinney SD, Gonzalez JS. Depressive symptoms improve over 2 years of type 2 diabetes treatment via a digital continuous remote care intervention focused on carbohydrate restriction. J Behav Med 2022; 45:416-427. [PMID: 35084637 PMCID: PMC9160138 DOI: 10.1007/s10865-021-00272-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 12/13/2021] [Indexed: 01/02/2023]
Abstract
Depressive symptoms are prevalent among people with type 2 diabetes (T2D) and, even at low severity levels, are associated with worse diabetes outcomes. Carbohydrate restriction is an effective treatment for T2D but its long-term impacts on depressive symptoms are unclear. In the current study we explored changes in depressive symptoms over 2 years among 262 primarily non-depressed T2D patients participating in a continuous remote care intervention emphasizing carbohydrate restriction. Subclinical depressive symptoms decreased over the first 10 weeks and reductions were maintained out to 2 years. Increased frequency of blood ketone levels indicative of adherence to low carbohydrate eating predicted decreases in depressive symptoms. Concerns have been raised with recommending restrictive diets due to potential negative impacts on quality-of-life factors such as mood; however, results of the current study support positive rather than negative long-term impacts of closely monitored carbohydrate restriction on depressive symptoms.
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Affiliation(s)
- Rebecca N Adams
- Virta Health Corp, 501 Folsom Street, San Francisco, CA, 94105, USA.
| | | | - Amy L McKenzie
- Virta Health Corp, 501 Folsom Street, San Francisco, CA, 94105, USA
| | - Sarah J Hallberg
- Virta Health Corp, 501 Folsom Street, San Francisco, CA, 94105, USA
- Indiana University Health Arnett, Lafayette, IN, USA
| | - James P McCarter
- Abbott Diabetes Care, Alameda, CA, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Departments of Medicine (Endocrinology) and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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96
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Development and Validation of the Depression Inventory for Type 1 Diabetes (DID-1). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312529. [PMID: 34886259 PMCID: PMC8657055 DOI: 10.3390/ijerph182312529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
People with type 1 diabetes (T1D) are more likely to have depression than the general population and their prognosis is worse. Unfortunately, the characteristics of persons with T1D lead to inadequate screening for depression in this population. To aid in the detection of depression in this population, this study was undertaken to develop a depressive symptoms assessment instrument specific to patients with T1D and to examine its psychometric properties. A total of 207 people with T1D participated in this study. The reliability of the new scale was assessed using Cronbach’s alpha and the Spearman-Brown split-half coefficient. The Depression Inventory for type 1 Diabetes (DID-1), composed of 45 items on a Likert scale (1–7), shows high internal and temporal consistency, as well as adequate concurrent, convergent and discriminant validity. Factor analysis identified 7 factors (Symptoms of depression, Diminished interest, Hopelessness and dissatisfaction, Guilt, Fear, frustration and irritability, Defenselessness, and Interference in daily life) that explained 61.612% of the total variability. The cut-off score for diagnosis was set at 155 points. It was concluded that the DID-1 scale is a reliable, valid and useful tool for the assessment of depressive symptoms, eliminating the bias of other nonspecific diabetes scales.
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97
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Understanding the Relationship between Depression and Chronic Diseases Such as Diabetes and Hypertension: A Grounded Theory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212130. [PMID: 34831886 PMCID: PMC8618720 DOI: 10.3390/ijerph182212130] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 01/10/2023]
Abstract
There is a bi-directional relationship between depression and chronic illnesses such as diabetes and hypertension. This comorbidity is associated with higher mortality risk and diminishes the efficacy of interventions. The specific mechanisms of this mutual influence are still not fully understood, and most intervention protocols address these conditions separately. This study aims to improve our understanding of this relationship. We interviewed 18 patients and 24 health care professionals, focusing on understanding the different ways in which depression and chronic illness could influence each other. Our results show a common cyclical pattern and specific situations where the reported bi-directional relationship does not occur. We discuss the importance of opening a space for the patient’s grief process after the chronic illness diagnosis, managing the demands and stress of the patient’s treatment, and how to adjust the treatment to the different needs and possibilities of each person.
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98
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Burns RJ, Briner E, Schmitz N. Trajectories of Depressive Symptoms and Incident Diabetes: A Prospective Study. Ann Behav Med 2021; 56:311-316. [PMID: 34791017 DOI: 10.1093/abm/kaab094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Elevated depressive symptoms are associated with an increased risk for diabetes. Depression is a heterogeneous and chronic condition in which symptoms may remit, emerge, lessen, or intensify over time. PURPOSE The purpose of this study was to determine if trajectories of depressive symptoms measured at five time points over 8 years predicted incident diabetes over an 8-year follow-up in middle-aged and older adults. A secondary aim was to determine if trajectories of depressive symptoms predict incident diabetes, above and beyond depressive symptoms measured at a single time point. METHODS Data came from the Health and Retirement Study (n = 9,233). Depressive symptoms were measured biennially from 1998 to 2006. Self-reported incident diabetes was measured during an 8-year follow-up. RESULTS Five trajectories of depressive symptoms were identified (no depressive symptoms, low depressive symptoms, low-moderate depressive symptoms, moderate depressive symptoms, elevated and increasing depressive symptoms). Compared to the no depressive symptoms trajectory group (referent), all other trajectory groups were at higher risk of developing diabetes after adjusting for covariates. In most cases, trajectory group membership was associated with incident diabetes after controlling for depressive symptoms at a single time point. CONCLUSIONS Patterns of depressive symptoms over time were associated with incident diabetes. Patterns of depressive symptoms may be more predictive of diabetes incidence than depressive symptoms measured at a single time point.
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Affiliation(s)
- Rachel J Burns
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Esther Briner
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Norbert Schmitz
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Population-Based Medicine, Institute of Health Sciences, University Hospital Tuebingen, Tübingen, Germany
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99
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Aljohani W, Algohani L, Alzahrani A, Bazuhair M, Bawakid A, Aljuid L, Al-Ahdal A. Prevalence of Depression Among Patients With Type 2 Diabetes at King Abdullah Medical City. Cureus 2021; 13:e18447. [PMID: 34745773 PMCID: PMC8560658 DOI: 10.7759/cureus.18447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | | | - Latifa Aljuid
- Biochemistry, King Abdul-Aziz University, Jeddah, SAU
| | - Amin Al-Ahdal
- Family Medicine, King Abdullah Medical City, Makkah, SAU
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100
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Lopes A, Roque F, Morgado S, Dinis C, Herdeiro MT, Morgado M. Behavioral Sciences in the Optimization of Pharmacological and Non-Pharmacological Therapy for Type 2 Diabetes. Behav Sci (Basel) 2021; 11:bs11110153. [PMID: 34821614 PMCID: PMC8614941 DOI: 10.3390/bs11110153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022] Open
Abstract
Type 2 diabetes mellitus is one of the main chronic diseases worldwide, with a significant impact on public health. Behavioral changes are an important step in disease prevention and management, so the way in which individuals adapt their lifestyle to new circumstances will undoubtedly be a predictor of the success of the treatments instituted, contributing to a reduction in the morbidity and mortality that may be associated with them. It is essential to prepare and educate all diabetic patients on the importance of changing behavioral patterns in relation to the disease, with health professionals assuming an extremely important role in this area, both from a pharmacological and non-pharmacological point of view, and also ensuring the monitoring of the progress of these measures. Diabetes is a chronic disease that requires a high self-management capacity on the part of patients in order to achieve success in treating the disease, and non-adherence to therapy or non-compliance with the previously defined plan, together with an erratic lifestyle, will contribute to failure in controlling the disease. The lower adherence to pharmacological and non-pharmacological treatment in diabetes is mainly correlated to socio-economic aspects, lower health literacy, the side effects associated with the use of antidiabetic therapy or even the concomitant use of several drugs. This article consists of a narrative review that aims to synthesize the findings published in the literature, retrieved by searching databases, manuals, previously published scientific articles and official texts, following the methodology of the Scale for Assessment of Narrative Review Articles (SANRA). We aim to address the importance of behavioral sciences in the treatment of diabetes, in order to assess behavior factors and barriers for behavior changes that have an impact on the therapeutic and non-therapeutic optimization in patients with type 2 diabetes mellitus control.
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Affiliation(s)
- António Lopes
- Pharmaceutical Services of Unity Local of Health of Guarda (ULS da Guarda), 6300-035 Guarda, Portugal; (A.L.); (C.D.)
- Health Sciences Faculty, University of Beira Interior (FCS-UBI), 6200-506 Covilhã, Portugal;
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI-IPG), 6300-559 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
- Correspondence:
| | - Sandra Morgado
- Pharmaceutical Services of University Hospital Center of Cova da Beira, 6200-251 Covilhã, Portugal;
| | - Cristina Dinis
- Pharmaceutical Services of Unity Local of Health of Guarda (ULS da Guarda), 6300-035 Guarda, Portugal; (A.L.); (C.D.)
| | - Maria Teresa Herdeiro
- Institute of Biomedicine, Department of Medical Sciences (iBiMED-UA), University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Manuel Morgado
- Health Sciences Faculty, University of Beira Interior (FCS-UBI), 6200-506 Covilhã, Portugal;
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI-IPG), 6300-559 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
- Pharmaceutical Services of University Hospital Center of Cova da Beira, 6200-251 Covilhã, Portugal;
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