1
|
Prigge R, Wild SH, Jackson CA. Depression, diabetes, comorbid depression and diabetes and risk of all-cause and cause-specific mortality: a prospective cohort study. Diabetologia 2022; 65:1450-1460. [PMID: 35622126 PMCID: PMC9345808 DOI: 10.1007/s00125-022-05723-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/08/2022] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to investigate the risks of all-cause and cause-specific mortality among participants with neither, one or both of diabetes and depression in a large prospective cohort study in the UK. METHODS Our study population included 499,830 UK Biobank participants without schizophrenia and bipolar disorder at baseline. Type 1 and type 2 diabetes and depression were identified using self-reported diagnoses, prescribed medication and hospital records. Mortality was identified from death records using the primary cause of death to define cause-specific mortality. We performed Cox proportional hazards models to estimate the risk of all-cause mortality and mortality from cancer, circulatory disease and causes of death other than circulatory disease or cancer among participants with either depression (n=41,791) or diabetes (n=22,677) alone and with comorbid diabetes and depression (n=3597) compared with the group with neither condition (n=431,765), adjusting for sociodemographic and lifestyle factors, comorbidities and history of CVD or cancer. We also investigated the interaction between diabetes and depression. RESULTS During a median of 6.8 (IQR 6.1-7.5) years of follow-up, there were 13,724 deaths (cancer, n=7976; circulatory disease, n=2827; other causes, n=2921). Adjusted HRs of all-cause mortality and mortality from cancer, circulatory disease and other causes were highest among people with comorbid depression and diabetes (HRs 2.16 [95% CI 1.94, 2.42]; 1.62 [95% CI 1.35, 1.93]; 2.22 [95% CI 1.80, 2.73]; and 3.60 [95% CI 2.93, 4.42], respectively). The risks of all-cause, cancer and other mortality among those with comorbid depression and diabetes exceeded the sum of the risks due to diabetes and depression alone. CONCLUSIONS/INTERPRETATION We confirmed that depression and diabetes individually are associated with an increased mortality risk and also identified that comorbid depression and diabetes have synergistic effects on the risk of all-cause mortality that are largely driven by deaths from cancer and causes other than circulatory disease and cancer.
Collapse
Affiliation(s)
- Regina Prigge
- Usher Institute, Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
| | - Sarah H Wild
- Usher Institute, Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Caroline A Jackson
- Usher Institute, Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
2
|
Nazary Abrbekoh F, Salimi L, Saghati S, Amini H, Fathi Karkan S, Moharamzadeh K, Sokullu E, Rahbarghazi R. Application of microneedle patches for drug delivery; doorstep to novel therapies. J Tissue Eng 2022; 13:20417314221085390. [PMID: 35516591 PMCID: PMC9065468 DOI: 10.1177/20417314221085390] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/17/2022] [Indexed: 12/14/2022] Open
Abstract
In the past decade, microneedle-based drug delivery systems showed promising approaches to become suitable and alternative for hypodermic injections and can control agent delivery without side effects compared to conventional approaches. Despite these advantages, the procedure of microfabrication is facing some difficulties. For instance, drug loading method, stability of drugs, and retention time are subjects of debate. Besides, the application of novel refining fabrication methods, types of materials, and instruments are other issues that need further attention. Herein, we tried to summarize recent achievements in controllable drug delivery systems (microneedle patches) in vitro and in vivo settings. In addition, we discussed the influence of delivered drugs on the cellular mechanism and immunization molecular signaling pathways through the intradermal delivery route. Understanding the putative efficiency of microneedle patches in human medicine can help us develop and design sophisticated therapeutic modalities.
Collapse
Affiliation(s)
| | - Leila Salimi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sepideh Saghati
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Amini
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sonia Fathi Karkan
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Keyvan Moharamzadeh
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Emel Sokullu
- Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Reza Rahbarghazi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Applied Cell Sciences, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
3
|
Paula Farias Waltrick A, Henrique Bernardo de Lima Silva A, Cristina de Carvalho M, Aparecida Comotti de Oliveira B, Naliwaiko K, Maria da Cunha J, Menezes Zanoveli J. Preventive treatment with fish oil facilitates the antidepressant-like effect of antidepressant drugs in type-1 diabetes mellitus rats: implication of serotonergic system. Neurosci Lett 2022; 772:136477. [DOI: 10.1016/j.neulet.2022.136477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/04/2022] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
|
4
|
Wang WK, Zhou Y, Fan L, Sun Y, Ge F, Xue M. The antidepressant-like effects of Danggui Buxue Decoction in GK rats by activating CREB/BDNF/TrkB signaling pathway. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 89:153600. [PMID: 34130073 DOI: 10.1016/j.phymed.2021.153600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/24/2021] [Accepted: 05/14/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND High rates of co-morbidity have been reported in patients with diabetes mellitus with depression (DD). Danggui Buxue Decoction (DBD), a Traditional Chinese Medicine formula composed of Angelica and Astragalus, has been historically used for the treatment of diabetes. PURPOSE This study aimed to investigated whether DBD and its main active component, ferulic acid (FA) from Angelica, could ameliorate depression-like behavior in DD and the underlying mechanisms. METHODS Goto-Kakizaki (GK) rats were administered DBD (4 or 8 g/kg) by oral gavage during a 4-week period of chronic unpredictable mild stress. After 4 weeks, blood glucose, glycated serum protein, serum insulin, oral glucose tolerance and depression-like behavior were examined, along with brain-derived neurotrophic factor (BDNF)-related signaling pathway proteins and the ultrastructure of hippocampal tissues. UPLC-QTOF-MS was adopted to detect the absorption of FA in the serum and hippocampus. Rat primary hippocampal cells were cultured in a DD model. Protein and mRNA levels of genes involved in BDNF-related signaling and neuroplasticity were analyzed. RESULTS DBD effectively improved glucose tolerance in DD rats and relieved depression-like behavior. Upregulation of cAMP response element binding protein (CREB), BDNF, and tropomyosin receptor kinase B (TrkB) and improvement of the hippocampal neuron ultrastructure supported the antidepressant-Like effects of DBD on the hippocampal neurons. In addition, DBD enhanced the protein and mRNA levels of components of the CREB/BDNF/TrkB pathway in rat primary hippocampal cells induced by elevated glycemia and cortisol. Interestingly, FA, the main component of DBD absorbed in the blood and hippocampus, showed similar effects as DBD on primary hippocampal cells. CONCLUSION This study suggests that the TCM formula DBD effectively serves as a potential therapeutic agent for prevention of DD through regulatory effects on the CREB/BDNF/TrkB pathway to protect and remodel hippocampal neurons. Moreover, FA contributes significantly to the treatment effects of DBD.
Collapse
Affiliation(s)
- Wen-Kai Wang
- College of Traditional Chinese Medicine•College of Intergrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing, China
| | - Yuan Zhou
- School of Medicine•Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 138 Xianlin Rd, Nanjing, China
| | - Lu Fan
- School of Medicine•Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 138 Xianlin Rd, Nanjing, China
| | - Yue Sun
- College of Traditional Chinese Medicine•College of Intergrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing, China
| | - Fan Ge
- College of Traditional Chinese Medicine•College of Intergrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing, China
| | - Mei Xue
- College of Traditional Chinese Medicine•College of Intergrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing, China.
| |
Collapse
|
5
|
Chaves YC, Genaro K, Crippa JA, da Cunha JM, Zanoveli JM. Cannabidiol induces antidepressant and anxiolytic-like effects in experimental type-1 diabetic animals by multiple sites of action. Metab Brain Dis 2021; 36:639-652. [PMID: 33464458 DOI: 10.1007/s11011-020-00667-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022]
Abstract
Cannabidiol (CBD), a phytocannabinoid compound, presents antidepressant and anxiolytic-like effects in the type-1 diabetes mellitus(DM1) animal model. Although the underlying mechanism remains unknown, the type-1A serotonin receptor (5-HT1A) and cannabinoids type-1 (CB1) and type-2 (CB2) receptors seem to play a central role in mediating the beneficial effects on emotional responses. We aimed to study the involvement of these receptors on an antidepressant- and anxiolytic-like effects of CBD and on some parameters of the diabetic condition itself. After 2 weeks of the DM1 induction in male Wistar rats by streptozotocin (60 mg/kg; i.p.), animals were treated continuously for 2-weeks with the 5-HT1A receptor antagonist WAY100635 (0.1 mg/kg, i.p.), CB1 antagonist AM251 (1 mg/kg i.p.) or CB2 antagonist AM630 (1 mg/kg i.p.) before the injection of CBD (30 mg/kg, i.p.) or vehicle (VEH, i.p.) and then, they were submitted to the elevated plus-maze and forced swimming tests. Our findings show the continuous treatment with CBD improved all parameters evaluated in these diabetic animals. The previous treatment with the antagonists - 5-HT1A, CB1, or CB2 - blocked the CBD-induced antidepressant-like effect whereas only the blockade of 5-HT1A or CB1 receptors was able to inhibit the CBD-induced anxiolytic-like effect. Regarding glycemic control, only the blockade of CB2 was able to inhibit the beneficial effect of CBD in reducing the glycemia of diabetic animals. These findings indicated a therapeutic potential for CBD in the treatment of depression/anxiety associated with diabetes pointing out a complex intrinsic mechanism in which 5-HT1A, CB1, and/or CB2 receptors are differently recruited.
Collapse
MESH Headings
- Animals
- Anti-Anxiety Agents/pharmacology
- Anti-Anxiety Agents/therapeutic use
- Antidepressive Agents/pharmacology
- Antidepressive Agents/therapeutic use
- Cannabidiol/pharmacology
- Cannabidiol/therapeutic use
- Diabetes Mellitus, Experimental/chemically induced
- Diabetes Mellitus, Experimental/drug therapy
- Diabetes Mellitus, Experimental/psychology
- Diabetes Mellitus, Type 1/chemically induced
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/psychology
- Male
- Maze Learning/drug effects
- Maze Learning/physiology
- Rats
- Rats, Wistar
- Receptor, Cannabinoid, CB1/agonists
- Receptor, Cannabinoid, CB1/metabolism
- Receptor, Serotonin, 5-HT1A/metabolism
Collapse
Affiliation(s)
- Yane Costa Chaves
- Department of Pharmacology, Biological Science Sector, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Karina Genaro
- Institute of Neurosciences and Behavior (INeC), University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
- Department of Pharmaceutical Sciences, University of California, Irvine, CA, USA
| | - José Alexandre Crippa
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- National Institute of Science and Technology for Translational Medicine (INCT-TM- CNPq), Ribeirão Preto, São Paulo, Brazil
| | - Joice Maria da Cunha
- Department of Pharmacology, Biological Science Sector, Federal University of Paraná, Curitiba, Paraná, Brazil
- Institute of Neurosciences and Behavior (INeC), University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Janaína Menezes Zanoveli
- Department of Pharmacology, Biological Science Sector, Federal University of Paraná, Curitiba, Paraná, Brazil.
- Institute of Neurosciences and Behavior (INeC), University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil.
| |
Collapse
|
6
|
Grover A, Sharma K, Gautam S, Gautam S, Gulati M, Singh SK. Diabetes and Its Complications: Therapies Available, Anticipated and Aspired. Curr Diabetes Rev 2021; 17:397-420. [PMID: 33143627 DOI: 10.2174/1573399816666201103144231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/26/2020] [Accepted: 09/12/2020] [Indexed: 11/22/2022]
Abstract
Worldwide, diabetes ranks among the ten leading causes of mortality. Prevalence of diabetes is growing rapidly in low and middle income countries. It is a progressive disease leading to serious co-morbidities, which results in increased cost of treatment and over-all health system of the country. Pathophysiological alterations in Type 2 Diabetes (T2D) progressed from a simple disturbance in the functioning of the pancreas to triumvirate to ominous octet to egregious eleven to dirty dozen model. Due to complex interplay of multiple hormones in T2D, there may be multifaceted approach in its management. The 'long-term secondary complications' in uncontrolled diabetes may affect almost every organ of the body, and finally may lead to multi-organ dysfunction. Available therapies are inconsistent in maintaining long term glycemic control and their long term use may be associated with adverse effects. There is need for newer drugs, not only for glycemic control but also for prevention or mitigation of secondary microvascular and macrovascular complications. Increased knowledge of the pathophysiology of diabetes has contributed to the development of novel treatments. Several new agents like Glucagon Like Peptide - 1 (GLP-1) agonists, Dipeptidyl Peptidase IV (DPP-4) inhibitors, amylin analogues, Sodium-Glucose transport -2 (SGLT- 2) inhibitors and dual Peroxisome Proliferator-Activated Receptor (PPAR) agonists are available or will be available soon, thus extending the range of therapy for T2D, thereby preventing its long term complications. The article discusses the pathophysiology of diabetes along with its comorbidities, with a focus on existing and novel upcoming antidiabetic drugs which are under investigation. It also dives deep to deliberate upon the novel therapies that are in various stages of development. Adding new options with new mechanisms of action to the treatment armamentarium of diabetes may eventually help improve outcomes and reduce its economic burden.
Collapse
Affiliation(s)
- Anu Grover
- Ipca Laboratories, Mumbai - 400063, India
| | - Komal Sharma
- Bhupal Nobles' Institute of Pharmaceutical Sciences, Udaipur, India
| | - Suresh Gautam
- Department of Biochemistry, Pacific Institute of Medical Sciences, Udaipur, India
| | - Srishti Gautam
- Ravinder Nath Tagore Medical College and Maharana Bhupal Govt. Hospital, Udaipur, India
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab- 144411, India
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab- 144411, India
| |
Collapse
|
7
|
Almeida SS, Zizzi FB, Cattaneo A, Comandini A, Di Dato G, Lubrano E, Pellicano C, Spallone V, Tongiani S, Torta R. Management and Treatment of Patients With Major Depressive Disorder and Chronic Diseases: A Multidisciplinary Approach. Front Psychol 2020; 11:542444. [PMID: 33101117 PMCID: PMC7546762 DOI: 10.3389/fpsyg.2020.542444] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/01/2020] [Indexed: 12/26/2022] Open
Abstract
In patients with physical chronic diseases, the prevalence of major depressive disorder (MDD) is approximately 2- to 3-fold higher than in the general population, and it can reach up to 20-40%. The comorbidity of MDD with chronic medical diseases is associated with poorer quality of life, increased medical symptom burden, poor adherence to self-care regimens, increased risk of functional impairment, morbidity, and mortality, and also higher medical costs. Despite this evidence, in routine practice, psychological issues and concerns are frequently inadequately managed. This consensus document proposes that a proper diagnosis, a multidisciplinary approach, and a personalized treatment plan would allow patients with MDD and chronic comorbidities to be more compliant, to improve the outcomes, to reduce possible relapses in the long term, and to prevent or better manage complications and adverse events. This proposal might be useful for any health professionals who deal with patients with chronic diseases, as it can help to pay more attention to the emotional impact of these conditions, in particular in terms of depressive symptoms.
Collapse
Affiliation(s)
- Susana Sousa Almeida
- Portuguese Institute of Oncology Porto (IPO Porto), Hospital Cuf Porto (HCuf Porto), University of Porto (FMUP), Porto, Portugal
| | | | - Agnese Cattaneo
- Angelini RR&D (Research, Regulatory & Development) - Angelini S.p.A, Rome, Italy
| | - Alessandro Comandini
- Angelini RR&D (Research, Regulatory & Development) - Angelini S.p.A, Rome, Italy
| | - Giorgio Di Dato
- Angelini RR&D (Research, Regulatory & Development) - Angelini S.p.A, Rome, Italy
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Clelia Pellicano
- Laboratory of Neuropsychiatry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Vincenza Spallone
- Division of Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Serena Tongiani
- Angelini RR&D (Research, Regulatory & Development) - Angelini S.p.A, Rome, Italy
| | - Riccardo Torta
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, A.O.U. "Città della Salute e della Scienza" Hospital, Turin, Italy
| |
Collapse
|
8
|
Hussain A, Wani ZA, Shah H, Zargar AH, Margoob MA, Qureshi W. Depression and diabetes: An experience from Kashmir. Indian J Psychiatry 2020; 62:167-171. [PMID: 32382176 PMCID: PMC7197822 DOI: 10.4103/psychiatry.indianjpsychiatry_46_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/06/2019] [Accepted: 12/25/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a common chronic metabolic disorder characterized by hyperglycemia. Minimal attention has been paid toward the relationship between diabetes and depression in developing countries such as India, despite a number of studies in developed countries, exploring casual pathway between the two highly prevalent conditions. The aim of this study was to estimate the prevalence and severity of depression among patients of diabetes attending the endocrinology department of a tertiary care hospital of Kashmir. METHODOLOGY A total of 527 patients having diabetes of ≥6 months with age ranging from 18 years to 60 years were screened for major depressive disorder (MDD) using Diagnostic and Statistical Manual IV-based criteria. Severity of depression was assessed by the Montgomery-Asberg Depression Rating Scale. RESULTS Depression was present in 39.65% of patients. Depression was more prevalent in the age group of 29-38 years, in females as compared to males, among literates and government employees. Prevalence of depression among Type 1 diabetic patients was 60%, while as in case of Type 2, it was 37.75%. Depressed patients had higher fasting blood glucose levels as compared to nondepressed diabetic patients. CONCLUSION MDD is inordinately high among adult diabetic patients, and majority of the depressive patients have moderate intensity of MDD.
Collapse
Affiliation(s)
- Arshad Hussain
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Zaid Ahmad Wani
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Hamidullah Shah
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Abdul Hamid Zargar
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mushtaq Ahmad Margoob
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Waseem Qureshi
- Department of Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
| |
Collapse
|
9
|
Alves Peres H, Leira Pereira LR, Zangiacomine Martinez E, Viana CM, de Freitas MCF. Elucidating factors associated with non-adherence among Type 1 diabetes patients in primary care setting in Southeastern Brazil. Prim Care Diabetes 2020; 14:85-92. [PMID: 31262602 DOI: 10.1016/j.pcd.2019.06.002] [Citation(s) in RCA: 4] [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: 12/23/2018] [Revised: 06/04/2019] [Accepted: 06/07/2019] [Indexed: 11/15/2022]
Abstract
AIMS To explore the factors associated with adherence and non-adherence to the pharmacological treatment of patients with T1DM in primary care setting southeast Brazil. METHODS We conducted a cross-sectional study with 158 patients attending in the primary health care in the city of Franca southeast Brazil and measure adherence to antidiabetic medication. Adherence was measure using Morisky-Green Test modified. RESULTS The majority of patients was adherence to antidiabetic medication (63.2%). More than one third of patients were non-adherent treated pharmacologically and comorbidities most prevalent were hypertension (63.8%), dyslipidemia (43.1%) and depression (32.8%). Depression were strongest predictor OR=2.8 (1.2-6.5) of non-adherence. CONCLUSION Depression is a factor associated with non-adherence to pharmacological treatment in patients with T1DM, and in clinical practice, screening for depression and intervention as well as pharmaceutical care may improve adherence to pharmacotherapy.
Collapse
Affiliation(s)
- Heverton Alves Peres
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil.
| | - Leonardo Régis Leira Pereira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Edson Zangiacomine Martinez
- Department of Social Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | | | - Maria Cristina Foss de Freitas
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
| |
Collapse
|
10
|
Kious BM, Kondo DG, Renshaw PF. Creatine for the Treatment of Depression. Biomolecules 2019; 9:E406. [PMID: 31450809 PMCID: PMC6769464 DOI: 10.3390/biom9090406] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/28/2022] Open
Abstract
Depressed mood, which can occur in the context of major depressive disorder, bipolar disorder, and other conditions, represents a serious threat to public health and wellness. Conventional treatments are not effective for a significant proportion of patients and interventions that are often beneficial for treatment-refractory depression are not widely available. There is, therefore, an immense need to identify novel antidepressant strategies, particularly strategies that target physiological pathways that are distinct from those addressed by conventional treatments. There is growing evidence from human neuroimaging, genetics, epidemiology, and animal studies that disruptions in brain energy production, storage, and utilization are implicated in the development and maintenance of depression. Creatine, a widely available nutritional supplement, has the potential to improve these disruptions in some patients, and early clinical trials indicate that it may have efficacy as an antidepressant agent.
Collapse
Affiliation(s)
- Brent M Kious
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA.
| | - Douglas G Kondo
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA
- George E. Wahlen Veterans Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Perry F Renshaw
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA
- George E. Wahlen Veterans Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| |
Collapse
|
11
|
Herder C, Hermanns N. Subclinical inflammation and depressive symptoms in patients with type 1 and type 2 diabetes. Semin Immunopathol 2019; 41:477-489. [PMID: 30778653 DOI: 10.1007/s00281-019-00730-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/04/2019] [Indexed: 02/07/2023]
Abstract
Depression is a frequent comorbidity of type 1 diabetes (T1D) and type 2 diabetes (T2D). Depression and diabetes are linked by a bidirectional relationship, but the underlying mechanisms are still incompletely understood. Experimental, observational and intervention studies showed that inflammatory processes contribute to the development of depression in animal models and humans. Given the high risk of morbidity and mortality in patients with the double burden of diabetes and depression, this review provides an overview of epidemiological studies that addressed the relationship between biomarkers of inflammation and depressive symptoms or depression in diabetes patients. In patients with T1D, there is some evidence that higher levels of high-sensitivity C-reactive protein (hsCRP), IL-6, IL-1 receptor antagonist (IL-1RA) and sICAM-1 may be related to depressive symptoms or (for hsCRP) lower treatment response. For T2D, hsCRP, IL-1RA, CCL2 and adiponectin or its isoforms were associated with depressive symptoms in at least two studies, whereas positive associations of IL-1β, IL-6 and IL-18 with depressive symptoms or depression were reported from single cohorts. However, the number of studies is too low for any meaningful meta-analysis. Prospective life course studies including both patients with T1D and T2D, a comprehensive assessment of systemic inflammation and repeated assessment of depressive symptoms should represent a future research priority to clarify to what extent subclinical inflammation affects the risk of depression in patients with diabetes. A better understanding of the role of inflammatory processes may help to identify subtypes of depression with partly different pathogenesis, which could have consequences with respect to therapeutic options including immunomodulation.
Collapse
Affiliation(s)
- Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany. .,Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. .,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
| | - Norbert Hermanns
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.,Department for Psychology, Otto Friedrich University of Bamberg, Bamberg, Germany
| |
Collapse
|
12
|
Association of visceral fat area with the presence of depressive symptoms in Chinese postmenopausal women with normal glucose tolerance. Menopause 2018. [PMID: 28640157 DOI: 10.1097/gme.0000000000000917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Depression is one of the most common mental disorders, and women are more vulnerable to depression than men, particularly during stages of hormonal fluctuations. After menopause, fat accumulation shifts from the subcutaneous area to the visceral area, and the risk of metabolic disorder increases in parallel. The present study aimed to evaluate the association between abdominal fat distribution and the presence of depressive symptoms in postmenopausal women. METHODS Visceral fat area (VFA) was detected by magnetic resonance imaging. Depressive symptoms were evaluated with Zung's Self-Rating Depression Scale. RESULTS In all, 437 normoglycemic postmenopausal women with a mean age of 58.4 ± 5.0 years (mean age at final menstrual period: 50.1 ± 3.5 years) were enrolled in the present study, including 117 individuals with depressive symptoms and 320 individuals without depressive symptoms. The prevalence of abdominal obesity in women with depressive symptoms was much higher than that in those without depressive symptoms (37.6% vs 27.5%; P = 0.042). Participants with depressive symptoms showed elevated VFA values (74.6 ± 29.8 vs 65.9 ± 28.9 cm; P = 0.006). Multivariate stepwise regression analysis demonstrated that VFA was independently correlated with the presence of depressive symptoms (standardized β = 0.099, P = 0.012). CONCLUSIONS In Chinese postmenopausal women, visceral fat accumulation was an independent and positive factor significantly associated with the presence of depressive symptoms.
Collapse
|
13
|
Herder C, Schmitt A, Budden F, Reimer A, Kulzer B, Roden M, Haak T, Hermanns N. Longitudinal associations between biomarkers of inflammation and changes in depressive symptoms in patients with type 1 and type 2 diabetes. Psychoneuroendocrinology 2018. [PMID: 29525039 DOI: 10.1016/j.psyneuen.2018.02.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Depressive disorders represent a frequent comorbidity of type 1 diabetes (T1D) and type 2 diabetes (T2D). Subclinical inflammation increases the risk of depressive symptoms in the general population, but the relationship appears complex and bidirectional, and longitudinal data from patients with diabetes are lacking. Therefore, this study aimed to analyse associations between changes in depressive symptoms and changes in biomarkers of inflammation in patients with T1D and T2D and to investigate the hypothesis that higher baseline levels of biomarkers of inflammation are related to a less pronounced reduction of depressive symptoms over time. METHODS Depressive symptoms and systemic levels of six biomarkers of inflammation were assessed in 168 individuals with T1D and 103 individuals with T2D who participated in baseline and 1-year follow-up examinations. Data were obtained from two matching randomised controlled trials addressing diabetes distress and depressive symptoms. Longitudinal associations between biomarkers and depressive symptoms were estimated using linear regression models adjusting for multiple confounders. RESULTS In patients with T2D, reductions in depressive symptoms were associated with reductions in high-sensitivity C-reactive protein (hsCRP), interleukin (IL)-18 and IL-1 receptor antagonist (IL-1RA) (P ≤ 0.016), whereas no associations were seen for IL-6, CCL2 and adiponectin. Higher CCL2 levels at baseline were associated with lower subsequent reduction in depressive symptoms (P = 0.018). Neither baseline levels nor changes in biomarkers in subclinical inflammation were associated with changes in depressive symptoms in patients with T1D. CONCLUSIONS Reductions of depressive symptoms were longitudinally associated with reductions in biomarkers of inflammation in patients with T2D. Higher baseline CCL2 levels were related with lower reduction of depressive symptoms in this group. No such associations were observed in patients with T1D, suggesting that risk factors and pathomechanisms linking inflammation and depression may differ between diabetes types.
Collapse
Affiliation(s)
- Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
| | - Andreas Schmitt
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.
| | - Florian Budden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
| | - André Reimer
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.
| | - Bernhard Kulzer
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, Otto Friedrich University of Bamberg, Bamberg, Germany.
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Thomas Haak
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.
| | - Norbert Hermanns
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, Otto Friedrich University of Bamberg, Bamberg, Germany.
| |
Collapse
|
14
|
Santos DC, Pizarro MH, Barros BSV, de Melo LGN, Porto LC, Silva DA, Gomes MB. Does ancestry influence health-related quality of life in type 1 diabetes patients? A nationwide study in Brazil. Acta Diabetol 2018; 55:377-385. [PMID: 29397447 DOI: 10.1007/s00592-017-1096-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/28/2017] [Indexed: 02/07/2023]
Abstract
AIMS The aim of the present study was to evaluate the relationship between self-reported color/race and genomic ancestry with HRQoL of patients with type 1 diabetes in a highly admixed population. METHODS This was a nationwide, cross-sectional study conducted with 1760 patients with type 1 diabetes from 2011 to 2014 at public clinics in all five Brazilian geographical regions. Information on HRQoL was obtained from two self-completed questionnaires: Short Form-6 Dimensions (SF-6D) and EuroQol-5 Dimensions (EQ-5D) with a visual analogue scale (EQ-VAS). Genomic ancestry was assessed using a Multiplex PCR methodology. Utility scores generated from the questionnaires were analyzed with multivariate logistic regression models. RESULTS We included 1698 patients. Those patients who self-reported as black had lower EQ-VAS scores compared to the patients who self-reported as white (67.46 ± 18.45; 72.37 ± 16.44, respectively, p = 0.02). In a linear regression model, each 1% increase in African ancestry resulted in a 9.5 point decrease in EQ-VAS score (p < 0.001). In a multivariate logistic regression, after adjusting for demographic, socioeconomic status and diabetes-related variables, African ancestry remained associated with lower EQ-VAS scores. CONCLUSION A higher level of African ancestry implicates on lower quality of life even after adjustments for sociodemographic and diabetes-related data. Gender, physical activity and diabetes-related microvascular complications were strongly associated with low HRQoL in all three questionnaires used. This fact highlights the importance of social aspects when assessing quality of life, as well as the need for regular practice of physical activity and prevention of chronic complications to improve patients' quality of life.
Collapse
Affiliation(s)
- Deborah Conte Santos
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77- 3º andar - Vila Isabel, Rio de Janeiro, RJ, CEP 20551-030, Brazil.
| | - Marcela Haas Pizarro
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77- 3º andar - Vila Isabel, Rio de Janeiro, RJ, CEP 20551-030, Brazil
| | - Bianca S V Barros
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77- 3º andar - Vila Isabel, Rio de Janeiro, RJ, CEP 20551-030, Brazil
| | - Laura G Nunes de Melo
- Department of Ophthalmology, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luis Cristovão Porto
- Histocompatibility and Cryopreservation Laboratory (HLA), State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dayse A Silva
- DNA Diagnostic Laboratory (LDD), State University of Rio Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marilia Brito Gomes
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77- 3º andar - Vila Isabel, Rio de Janeiro, RJ, CEP 20551-030, Brazil
| |
Collapse
|
15
|
Association between pro- and anti-inflammatory cytokines and depressive symptoms in patients with diabetes-potential differences by diabetes type and depression scores. Transl Psychiatry 2018; 7:1. [PMID: 29520075 PMCID: PMC5843637 DOI: 10.1038/s41398-017-0009-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Subclinical inflammation has been implicated in the development of depression, a common comorbidity of type 1 diabetes (T1D) and type 2 diabetes (T2D). This study aimed to characterise the relationships between biomarkers of inflammation and depressive symptoms in T1D and T2D. Biomarkers of inflammation were measured in serum of participants with elevated depressive symptoms and T1D (n = 389, mean age 38 years, diabetes duration 15 ± 11 years) or T2D (n = 204, mean age 56 years, diabetes duration 13 ± 8 years). Subclinical depression was examined using three questionnaires (Center for Epidemiologic Studies Depression [CES-D], Patient Health Questionnaire-9 [PHQ-9], 5-item World Health Organization Well-Being Index [WHO-5]). In T1D, levels of interleukin-1 receptor antagonist (IL-1RA) were positively associated with two depression scores (CES-D, PHQ-9), and high-sensitivity C-reactive protein (hsCRP) was positively associated with depression for one score (WHO-5) after adjustment for age, sex, body mass index, diabetes duration, metabolic variables, medication and comorbidities (P = 0.008-0.042). In T2D, IL-18 and IL-1RA were positively associated with depression for two scores (IL-18: PHQ-9, WHO-5; IL-1RA: CES-D, WHO-5), hsCRP was associated with one depression score (PHQ-9), and adiponectin showed an inverse association with one depression score (PHQ-9) after adjustment (P = 0.006-0.048). No associations were found for IL-6 and CC-chemokine ligand 2 (CCL2). In conclusion, we observed associations between hsCRP, IL-1RA and depressive symptoms in patients with diabetes. In T2D, there was additional evidence for associations of IL-18 and (inversely) adiponectin with depressive symptoms. The strength of the associations appeared to depend on diabetes type and the method used to asssess depressive symptoms.
Collapse
|
16
|
Russell‐Jones D, Pouwer F, Khunti K. Identification of barriers to insulin therapy and approaches to overcoming them. Diabetes Obes Metab 2018; 20:488-496. [PMID: 29053215 PMCID: PMC5836933 DOI: 10.1111/dom.13132] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/28/2017] [Accepted: 10/14/2017] [Indexed: 12/15/2022]
Abstract
Poor glycaemic control in type 2 diabetes (T2D) is a global problem despite the availability of numerous glucose-lowering therapies and clear guidelines for T2D management. Tackling clinical or therapeutic inertia, where the person with diabetes and/or their healthcare providers do not intensify treatment regimens despite this being appropriate, is key to improving patients' long-term outcomes. This gap between best practice and current level of care is most pronounced when considering insulin regimens, with studies showing that insulin initiation/intensification is frequently and inappropriately delayed for several years. Patient- and physician-related factors both contribute to this resistance at the stages of insulin initiation, titration and intensification, impeding achievement of optimal glycaemic control. The present review evaluates the evidence and reasons for this delay, together with available methods for facilitation of insulin initiation or intensification.
Collapse
Affiliation(s)
- David Russell‐Jones
- Department of Diabetes and EndocrinologyRoyal Surrey County Hospital NHS Foundation TrustGuildfordUK
| | - Frans Pouwer
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
| | - Kamlesh Khunti
- College of Medicine, Biological Sciences and Psychology, Leicester Diabetes CentreUniversity of LeicesterUK
| |
Collapse
|