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Weiss F, Brancati GE, Elefante C, Petrucci A, Gemmellaro T, Lattanzi L, Perugi G. Type 2 diabetes mellitus is associated with manic morbidity in elderly patients with mood disorders. Int Clin Psychopharmacol 2024; 39:294-304. [PMID: 37824397 DOI: 10.1097/yic.0000000000000515] [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] [Indexed: 10/14/2023]
Abstract
The association between mood disorders, especially bipolar disorder (BD), and metabolic disorders, is long known. However, to which extent metabolic disorders affect the course of mood disorders in late life is still open to inquiring. To assess the impact of type 2 diabetes mellitus (T2DM) on late-life mood disorders a retrospective chart review was performed. Elderly depressive patients (≥ 65 years) diagnosed with Major Depressive Disorder (N = 57) or BD (N = 43) and followed up for at least 18 months were included and subdivided according to the presence of T2DM comorbidity. Vascular encephalopathy (39.1% vs. 15.6%, P = 0.021) and neurocognitive disorders (21.7% vs. 5.2%, P = 0.028), were more frequently reported in patients with T2DM than in those without. Patients with T2DM showed a greater percentage of follow-up time in manic episodes (r = -0.23, P = 0.020) and a higher rate of manic episode(s) during follow-up (21.7% vs. 5.2%, P = 0.028) than those without. When restricting longitudinal analyses to patients with bipolar spectrum disorders, results were confirmed. In line with the well-known connection between BD and metabolic disorders, our data support an association between T2DM and unfavorable course of illness in the elderly with BD.
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Affiliation(s)
- Francesco Weiss
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | | | - Camilla Elefante
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | | | - Teresa Gemmellaro
- Department of Psychiatry, North-Western Tuscany Region, NHS, Local Health Unit, Cecina-LI
| | | | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
- Institute of Behavioral Science 'G. De Lisio', Pisa, Italy
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Li S, Yang D, Zhou X, Chen L, Liu L, Lin R, Li X, Liu Y, Qiu H, Cao H, Liu J, Cheng Q. Neurological and metabolic related pathophysiologies and treatment of comorbid diabetes with depression. CNS Neurosci Ther 2024; 30:e14497. [PMID: 37927197 PMCID: PMC11017426 DOI: 10.1111/cns.14497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The comorbidity between diabetes mellitus and depression was revealed, and diabetes mellitus increased the prevalence of depressive disorder, which ranked 13th in the leading causes of disability-adjusted life-years. Insulin resistance, which is common in diabetes mellitus, has increased the risk of depressive symptoms in both humans and animals. However, the mechanisms behind the comorbidity are multi-factorial and complicated. There is still no causal chain to explain the comorbidity exactly. Moreover, Selective serotonin reuptake inhibitors, insulin and metformin, which are recommended for treating diabetes mellitus-induced depression, were found to be a risk factor in some complications of diabetes. AIMS Given these problems, many researchers made remarkable efforts to analyze diabetes complicating depression from different aspects, including insulin resistance, stress and Hypothalamic-Pituitary-Adrenal axis, neurological system, oxidative stress, and inflammation. Drug therapy, such as Hydrogen Sulfide, Cannabidiol, Ascorbic Acid and Hesperidin, are conducive to alleviating diabetes mellitus and depression. Here, we reviewed the exact pathophysiology underlying the comorbidity between depressive disorder and diabetes mellitus and drug therapy. METHODS The review refers to the available literature in PubMed and Web of Science, searching critical terms related to diabetes mellitus, depression and drug therapy. RESULTS In this review, we found that brain structure and function, neurogenesis, brain-derived neurotrophic factor and glucose and lipid metabolism were involved in the pathophysiology of the comorbidity. Obesity might lead to diabetes mellitus and depression through reduced adiponectin and increased leptin and resistin. In addition, drug therapy displayed in this review could expand the region of potential therapy. CONCLUSIONS The review summarizes the mechanisms underlying the comorbidity. It also overviews drug therapy with anti-diabetic and anti-depressant effects.
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Affiliation(s)
- Sixin Li
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Dong Yang
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Xuhui Zhou
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Lu Chen
- Department of Gastroenterology, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of GastroenterologyBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Lini Liu
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Ruoheng Lin
- Department of Psychiatry, National Clinical Research Center for Mental DisordersThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Xinyu Li
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Ying Liu
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Huiwen Qiu
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Hui Cao
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Jian Liu
- Center for Medical Research and Innovation, The First Hospital, Hunan University of Chinese MedicineChangshaHunanChina
| | - Quan Cheng
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaHunanChina
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Ohene‐Agyei P, Gamble GD, Harding JE, Crowther CA. Prevalence and determinants of perinatal mental disorders in women with gestational diabetes in New Zealand: Findings from a national longitudinal study. Acta Obstet Gynecol Scand 2024; 103:459-469. [PMID: 38063006 PMCID: PMC10867385 DOI: 10.1111/aogs.14738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Concurrent diagnosis of gestational diabetes mellitus and mental disorders is associated with adverse outcomes for mother and child, but there is limited information about prevalence or which women are at risk. MATERIAL AND METHODS This study was a prospective cohort study of women with gestational diabetes from 10 hospitals in New Zealand who reported anxiety (6-item Spielberger State-Trait Anxiety Inventory), depression (Edinburgh Postnatal Depression Scale) and health-related quality of life (36-Item Short-Form General Health Survey) at time of gestational diabetes diagnosis (baseline), 36 weeks' gestation, and 6 months postpartum. Potential predictors were assessed using multivariable logistic regression. RESULTS Among 414 respondents, 17% reported anxiety, 16% vulnerability to depression and 27% poor mental health-related quality of life at time of gestational diabetes diagnosis. At 36 weeks' gestation, prevalence decreased for vulnerability to depression (8%) and poor mental health-related quality of life (20%). Younger maternal age, Pacific ethnicity, previous history of gestational diabetes, and older gestational age at time of gestational diabetes diagnosis were associated with poorer mental health outcomes. At 6 months postpartum the prevalence of mental disorders did not differ from in late pregnancy and they were associated with later gestational age at time of gestational diabetes diagnosis and elevated 2-hour postprandial glucose concentrations. CONCLUSIONS Perinatal mental disorders are common at time of diagnosis among women with gestational diabetes in New Zealand and had decreased by late pregnancy and at 6 months after birth. These disorders are more common among women with specific risk factors who may therefore benefit from additional support.
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Affiliation(s)
| | - Greg D. Gamble
- Liggins InstituteUniversity of AucklandAucklandNew Zealand
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Schmitt A, Beran M, Geraets A, Iversen MM, Nefs G, Nouwen A, Pouwer F, Huber JW, Schram MT. Associations between HbA1c Reduction and Change in Depressive Symptoms following Glucose-lowering Treatment in Adults: A Systematic Review of Intervention Studies. Curr Diabetes Rev 2024; 20:e020623217607. [PMID: 37278034 DOI: 10.2174/1573399820666230602124223] [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: 11/07/2022] [Revised: 04/18/2023] [Accepted: 05/03/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Hyperglycemia constitutes a likely pathway linking diabetes and depressive symptoms; lowering glycemic levels may help reduce diabetes-comorbid depressive symptoms. Since randomized controlled trials can help understand temporal associations, we systematically reviewed the evidence regarding the potential association of hemoglobin HbA1c lowering interventions with depressive symptoms. METHODS PubMed, PsycINFO, CINAHL, and EMBASE databases were searched for randomized controlled trials evaluating HbA1c-lowering interventions and including assessment of depressive symptoms published between 01/2000-09/2020. Study quality was evaluated using the Cochrane Risk of Bias tool. PROSPERO registration: CRD42020215541. RESULTS We retrieved 1,642 studies of which twelve met our inclusion criteria. Nine studies had high and three unclear risks of bias. Baseline depressive symptom scores suggest elevated depressive symptoms in five studies. Baseline HbA1c was <8.0% (<64 mmol/mol) in two, 8.0-9.0% (64-75 mmol/mol) in eight, and ≥10.0% (≥86 mmol/mol) in two studies. Five studies found greater HbA1c reduction in the treatment group; three of these found greater depressive symptom reduction in the treatment group. Of four studies analyzing whether the change in HbA1c was associated with the change in depressive symptoms, none found a significant association. The main limitation of these studies was relatively low levels of depressive symptoms at baseline, limiting the ability to show a lowering in depressive symptoms after HbA1c reduction. CONCLUSIONS We found insufficient available data to estimate the association between HbA1c reduction and depressive symptom change following glucose-lowering treatment. Our findings point to an important gap in the diabetes treatment literature. Future clinical trials testing interventions to improve glycemic outcomes might consider measuring depressive symptoms as an outcome to enable analyses of this association.
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Affiliation(s)
- Andreas Schmitt
- Research Institute Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Johann-Hammer- Straße 24, 97980 Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
| | - Magdalena Beran
- Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Anouk Geraets
- Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, MHeNs School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Marjolein M Iversen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 27, 6525 EZ Nijmegen, The Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with Type 1 Diabetes, Blaak 6, 3011 TA Rotterdam, The Netherlands
| | - Arie Nouwen
- Department of Psychology, Middlesex University London, The Burroughs, London NW4 4BT, United Kingdom
- School of Health, Wellbeing and Social Care, The Open University, Walton Hall, Milton Keynes MK7 6AA, United Kingdom
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Steno Diabetes Center Odense (SDCO), Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Jörg W Huber
- School of Sport and Health Sciences, University of Brighton, Westlain House, Brighton BN1 9PH, United Kingdom
| | - Miranda T Schram
- Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, MHeNs School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
- Heart and Vascular Centre, Maastricht University Medical Center, Professor Debyelaan 25, 6229HX Maastricht, The Netherlands
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Rhee SJ, Min S, Hong M, Lee H, Lee HS, Kang DH, Ahn YM. The association between insulin resistance and depressive symptoms - A national representative cross-sectional study. J Psychosom Res 2023; 175:111502. [PMID: 37812941 DOI: 10.1016/j.jpsychores.2023.111502] [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: 08/12/2023] [Revised: 09/24/2023] [Accepted: 09/24/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Increasing evidence suggests a positive association between insulin resistance (IR) and depression. However, whether sex-or body mass index-specific differences exist remains controversial, and only few studies have analyzed specific symptom domains. Thus, the present study aimed to analyze the association between IR and depressive symptom domains and to clarify the effects of sex and body mass index. METHODS The study sample comprised 4007 participants, aged 19-79, from the Korea National Health and Nutrition Examination Study 2020. Participants completed health interviews and examinations, providing data on circulating insulin and glucose levels, the Patient Health Questionnaire-9 (PHQ-9), and related covariates. IR was calculated using the homeostasis model assessment of insulin resistance. Associations between IR and PHQ-9 were analyzed using negative binomial regression with adjustments for the complex survey design. RESULTS The association between log-transformed IR and PHQ-9 total scores was statistically significant (incidence rate ratio [IRR] = 1.17, 95% confidence interval [CI] = 1.07-1.29, p = 0.001). Only body mass index specific differences were statistically significant, as the association was only significant in those without obesity (IRR = 1.21, 95% CI = 1.06-1.38, p = 0.005). IR was associated with cognitive/affective (IRR = 1.23, 95% CI = 1.08-1.41, p = 0.002) and somatic (IRR = 1.14, 95% CI = 1.04-1.25, p = 0.005) depressive symptom domains. Sensitivity analyses revealed similar results. CONCLUSIONS IR was positively associated with cognitive/affective and somatic depressive symptoms in non-obese individuals.
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Affiliation(s)
- Sang Jin Rhee
- Biomedical Research Institute, Seoul National University Hospital, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea
| | - Sooyeon Min
- Department of Neuropsychiatry, Seoul National University Hospital, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea
| | - Minseok Hong
- Department of Neuropsychiatry, Seoul National University Hospital, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea
| | - Hyunju Lee
- Department of Neuropsychiatry, Seoul National University Hospital, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea
| | - Han-Sung Lee
- Department of Neuropsychiatry, Seoul National University Hospital, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea
| | - Dae Hun Kang
- Department of Neuropsychiatry, Seoul National University Hospital, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, 103, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea.
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Wu CY, Cogo-Moreira H, MacIntosh BJ, Edwards JD, Krance SH, Eid M, Schreiner PJ, Launer LJ, Swardfager W. Dynamic relationships between depressive symptoms and insulin resistance over 20 years of adulthood. Psychol Med 2023; 53:1458-1467. [PMID: 36470626 PMCID: PMC10009397 DOI: 10.1017/s0033291721003032] [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: 03/26/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Bidirectional longitudinal relationships between depression and diabetes have been observed, but the dominant direction of their temporal relationships remains controversial. METHODS The random-intercept cross-lagged panel model decomposes observed variables into a latent intercept representing the traits, and occasion-specific latent 'state' variables. This permits correlations to be assessed between the traits, while longitudinal 'cross-lagged' associations and cross-sectional correlations can be assessed between occasion-specific latent variables. We examined dynamic relationships between depressive symptoms and insulin resistance across five visits over 20 years of adulthood in the population-based Coronary Artery Risk Development in Young Adults (CARDIA) study. Possible differences based on population group (Black v. White participants), sex and years of education were tested. Depressive symptoms and insulin resistance were quantified using the Center for Epidemiologic Studies Depression (CES-D) scale and the homeostatic model assessment for insulin resistance (HOMA-IR), respectively. RESULTS Among 4044 participants (baseline mean age 34.9 ± 3.7 years, 53% women, 51% Black participants), HOMA-IR and CES-D traits were weakly correlated (r = 0.081, p = 0.002). Some occasion-specific correlations, but no cross-lagged associations were observed overall. Longitudinal dynamics of these relationships differed by population groups such that HOMA-IR at age 50 was associated with CES-D score at age 55 (β = 0.076, p = 0.038) in White participants only. Longitudinal dynamics were consistent between sexes and based on education. CONCLUSIONS The relationship between depressive symptoms and insulin resistance was best characterized by weak correlations between occasion-specific states and enduring traits, with weak evidence that insulin resistance might be temporally associated with subsequent depressive symptoms among White participants later in adulthood.
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Affiliation(s)
- Che-Yuan Wu
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Hugo Cogo-Moreira
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Education, ICT and Learning, Østfold University College, Halden, Norway
| | - Bradley J. MacIntosh
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jodi D. Edwards
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | - Saffire H. Krance
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Michael Eid
- Department of Educational Science and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Pamela J. Schreiner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minnesota, USA
| | - Lenore J. Launer
- Laboratory of Epidemiology and Population Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Walter Swardfager
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE UHN Toronto Rehabilitation Institute, Toronto, Ontario, Canada
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van Gennip ACE, Schram MT, Köhler S, Kroon AA, Koster A, Eussen SJPM, de Galan BE, van Sloten TT, Stehouwer CDA. Association of type 2 diabetes according to the number of risk factors within the recommended range with incidence of major depression and clinically relevant depressive symptoms: a prospective analysis. THE LANCET. HEALTHY LONGEVITY 2023; 4:e63-e71. [PMID: 36738746 DOI: 10.1016/s2666-7568(22)00291-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Type 2 diabetes is associated with an increased risk of depression, but the extent to which risk factor modification can mitigate this risk is unclear. We aimed to examine the association between the incidence of major depression and clinically relevant depressive symptoms among individuals with type 2 diabetes, according to the number of risk factors within the recommended target range, compared with individuals without diabetes. METHODS We did a prospective analysis of population-based data from the UK Biobank and the Maastricht Study. Individuals with type 2 diabetes were categorised according to the number of risk factors within the recommended target range (non-smoking, guideline-recommended levels of glycated haemoglobin (HbA1c), blood pressure, BMI, albuminuria, physical activity, and diet). The primary outcome, based on data from the UK Biobank, was the incidence of major depression ascertained from hospital records; the secondary outcome, based on data from the UK Biobank and the Maastricht Study, was clinically relevant depressive symptoms based on a score of 10 or higher on the Patient Health Questionnaire (PHQ-9). FINDINGS The study population of the UK Biobank comprised 77 786 individuals (9047 with type 2 diabetes and 68 739 without diabetes; median age 59 years [IQR 51-64]; 34 136 [43·9%] women and 43 650 [56·1%] men). A median of 12·7 years (IQR 11·8-13·4) after recruitment (between March 13, 2006, and Oct 1, 2010), 493 (5·5%) of 9047 individuals with type 2 diabetes and 2574 (3·7%) of 68 739 individuals without diabetes developed major depression. Compared with individuals without diabetes, those with type 2 diabetes had a higher risk of major depression (hazard ratio [HR] 1·61 [95% CI 1·49-1·77]). Among individuals with type 2 diabetes, the excess risk of depression decreased stepwise with an increasing number of risk factors within the recommended target range (HR 2·04 [95% CI 1·65-2·52] for up to two risk factors within the recommended target range; 1·95 [1·65-2·30] for three risk factors within the recommended target range; 1·38 [1·16-1·65] for four risk factors within the recommended target range; and 1·34 [1·12-1·62] for five to seven risk factors within the recommended target range). In the UK Biobank dataset, a median of 7·5 years (IQR 6·8-8·2) after the baseline examination, 147 (7·5%) of 1953 individuals with type 2 diabetes and 954 (4·5%) of 21 413 individuals without diabetes had developed clinically relevant depressive symptoms. The study population of the Maastricht Study comprised 4530 individuals (1158 with type 2 diabetes and 3372 without diabetes; median age 60 years [IQR 53-66]; 2244 [49·5%] women and 2286 [50·1%] men). A median of 5·1 years (IQR 4·1-6·1) after recruitment (between Sept 1, 2010, and Dec 7, 2017), 170 (14·7%) of 1158 individuals with type 2 diabetes and 227 (6·7%) of 3372 individuals without diabetes developed clinically relevant depressive symptoms. Similarly, in both the UK Biobank dataset and the Maastricht Study cohort, among individuals with type 2 diabetes, the excess risk of clinically relevant depressive symptoms decreased stepwise with an increasing number of risk factors within the recommended target range. INTERPRETATION Among individuals with type 2 diabetes, the excess risk of major depression and clinically relevant depressive symptoms decreased stepwise with an increasing number of risk factors within the recommended target range. This study provides further evidence to promote risk factor modification strategies in individuals with type 2 diabetes and to encourage the adoption of a healthy lifestyle. FUNDING ZonMW, Hartstichting, and Diabetes Fonds.
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Affiliation(s)
- April C E van Gennip
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands; School for Mental Health and Neuroscience MHENS, Maastricht University, Maastricht, Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience MHENS, Maastricht University, Maastricht, Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, Netherlands; Department of Social Medicine, Maastricht University, Maastricht, Netherlands
| | - Simone J P M Eussen
- School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands; Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, Netherlands; Department of Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands; Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, Netherlands.
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands
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Rohner M, Schwarz PEH, Bornstein SR. Treating Insulin Resistance with Intermittent Personalized Nutrition to Sustain Metabolic Health and Functioning Immune System for Risk Reduction of Viral Diseases Especially COVID-19 and Long-COVID. Horm Metab Res 2022; 54:567-570. [PMID: 35636457 DOI: 10.1055/a-1864-8234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Covid-19 pandemic has provided new and strong evidence for poor outcomes of viral infection in patients with poor metabolic health. Insulin resistance is at the root of many metabolic conditions and a key driver of their progression as it promotes ineffectual inflammation whilst impairing immune functions. In a vicious circle, insulin resistance facilitates SARS-CoV-2 infection, whilst infection drives insulin resistance. We discuss the underlying mechanisms and explore ways to improve metabolic health and prevent insulin resistance through early detection and targeted nutritional interventions. With proven efficacy in prediabetes, type 2 diabetes, and their cardiovascular and organ complications, as much as non-alcoholic liver disease, we argue to extend such approaches to ensure resilience to the current pandemic and viral challenges beyond.
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Affiliation(s)
- Markus Rohner
- EpiGeneticBalance AG, EpiGeneticBalance AG, CH-4310 Rheinfelden, Rheinfelden, Switzerland
| | - Peter E H Schwarz
- Department of Medicine, Carl Gustav Carus, Prevention and Care of Diabetes, Technical University Dresden, Dresden, Germany
- Paul Langerhans Institute Dresden, German Center for Diabetes Research (DZD), Dresden, Germany
| | - Stefan R Bornstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Division of Endocrinology, Diabetes and Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
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9
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Beran M, Muzambi R, Geraets A, Albertorio‐Diaz JR, Adriaanse MC, Iversen MM, Kokoszka A, Nefs G, Nouwen A, Pouwer F, Huber JW, Schmitt A, Schram MT. The bidirectional longitudinal association between depressive symptoms and HbA 1c : A systematic review and meta-analysis. Diabet Med 2022; 39:e14671. [PMID: 34407250 PMCID: PMC9292323 DOI: 10.1111/dme.14671] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/17/2021] [Accepted: 08/16/2021] [Indexed: 12/11/2022]
Abstract
AIM To investigate whether there is a bidirectional longitudinal association of depression with HbA1c . METHODS We conducted a systematic literature search in PubMed, PsycINFO, CINAHL and EMBASE for observational, longitudinal studies published from January 2000 to September 2020, assessing the association between depression and HbA1c in adults. We assessed study quality with the Newcastle-Ottawa-Scale. Pooled effect estimates were reported as partial correlation coefficients (rp ) or odds ratios (OR). RESULTS We retrieved 1642 studies; 26 studies were included in the systematic review and eleven in the meta-analysis. Most studies (16/26) focused on type 2 diabetes. Study quality was rated as good (n = 19), fair (n = 2) and poor (n = 5). Of the meta-analysed studies, six investigated the longitudinal association between self-reported depressive symptoms and HbA1c and five the reverse longitudinal association, with a combined sample size of n = 48,793 and a mean follow-up of 2 years. Higher levels of baseline depressive symptoms were associated with subsequent higher levels of HbA1c (partial r = 0.07; [95% CI 0.03, 0.12]; I2 38%). Higher baseline HbA1c values were also associated with 18% increased risk of (probable) depression (OR = 1.18; [95% CI 1.12,1.25]; I2 0.0%). CONCLUSIONS Our findings support a bidirectional longitudinal association between depressive symptoms and HbA1c . However, the observed effect sizes were small and future research in large-scale longitudinal studies is needed to confirm this association. Future studies should investigate the role of type of diabetes and depression, diabetes distress and diabetes self-management behaviours. Our results may have clinical implications, as depressive symptoms and HbA1c levels could be targeted concurrently in the prevention and treatment of diabetes and depression. REGISTRATION PROSPERO ID CRD42019147551.
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Affiliation(s)
- Magdalena Beran
- School for Cardiovascular Disease (CARIM)Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
| | - Rutendo Muzambi
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Anouk Geraets
- School for Cardiovascular Disease (CARIM)Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
- Department of Psychiatry and NeuropsychologyMHeNs School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | | | - Marcel C. Adriaanse
- Department of Health Sciences and Amsterdam Public Health Research InstituteFaculty of ScienceVrije UniversiteitAmsterdamThe Netherlands
| | - Marjolein M. Iversen
- Department of Health and Caring SciencesFaculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Andrzej Kokoszka
- II Department of PsychiatryMedical University of WarsawWarszawaPoland
| | - Giesje Nefs
- Department of Medical PsychologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
- Center of Research on Psychology in Somatic Diseases (CoRPS)Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
- DiabeterNational Treatment and Research Center for Children, Adolescents and Young Adults with Type 1 DiabetesRotterdamThe Netherlands
| | - Arie Nouwen
- Department of PsychologyMiddlesex UniversityLondonUnited Kingdom
- School of Health, Wellbeing and Social CareThe Open UniversityMilton KeynesUnited Kingdom
| | - Frans Pouwer
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
- STENO Diabetes CenterOdense University HospitalOdenseDenmark
| | - Jörg W. Huber
- School of Health SciencesUniversity of BrightonBrightonUnited Kingdom
| | - Andreas Schmitt
- German Center for Diabetes Research (DZDMünchen‐NeuherbergGermany
- Research Institute of the Diabetes Academy Mergentheim (FIDAMBad MergentheimGermany
| | - Miranda T. Schram
- School for Cardiovascular Disease (CARIM)Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
- Department of Psychiatry and NeuropsychologyMHeNs School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
- Heart and Vascular CentreMaastricht University Medical Center+MaastrichtThe Netherlands
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10
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LIMA CHR, DA PAZ SMRS, LAVÔR LCDC, FROTA KDMG, PAIVA ADA. Prevalence of prediabetes in adults and its association with sociodemographic, nutritional, metabolic and mental disorders factors: Home Health Survey, Piauí, Brazil. REV NUTR 2022. [DOI: 10.1590/1678-9865202235e220046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ABSTRACT Objective To estimate prevalence of prediabetes and to investigate its associated factors in adults living in Teresina, Piauí, Brazil Methods Cross-sectional, home-based study, with both genders adults in Teresina, Piauí. The prevalence of prediabetes was estimated using the fasting glucose test, and was classified according to the American Diabetes Association standards (≥100mg/dL; <126mg/dL). The associations between prediabetes and the variables: sociodemographic, anthropometric, food consumption, blood pressure levels, triglycerides and common mental disorders were tested. In addition, a variable was created to verify the association of the simultaneous presence of risk factors in the same individual. Data were reviewed using Pearson’s chi-square test and Poisson regression for crude and adjusted prevalence ratios, considering a significance level of 5%. Results A total of 224 adults participated in the study, of which 154 (68.7%) were female, aged between 20 and 39 years (53.1%). An 8.04% prevalence of prediabetes was observed. A statistically significant association (p<0.05) was found between lower education (0 to 8 years of study; 17.3%) and increased triglycerides levels (≥150mg/dL; 13.7%). Higher gross prevalence (PR: 2.53; CI 95%: 1.05-6.05) prediabetes ratios were observed with 5 or more simultaneous risk factors when compared to individuals who had up to 4 simultaneous risk factors. Conclusion Low schooling, hypertriglyceridemia and the presence of five or more simultaneous risk factors were associated with prediabetes; however, these risk factors are subject to intervention. Therefore, this study points to the need for changes in lifestyle habits as a strategy for glycemic control and diabetes prevention.
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11
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Jones BDM, Farooqui S, Kloiber S, Husain MO, Mulsant BH, Husain MI. Targeting Metabolic Dysfunction for the Treatment of Mood Disorders: Review of the Evidence. Life (Basel) 2021; 11:819. [PMID: 34440563 PMCID: PMC8401631 DOI: 10.3390/life11080819] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/28/2022] Open
Abstract
Major depressive disorder (MDD) and bipolar disorder (BD) are often chronic with many patients not responding to available treatments. As these mood disorders are frequently associated with metabolic dysfunction, there has been increased interest in novel treatments that would target metabolic pathways. The objectives of this scoping review were to synthesize evidence on the impact on mood symptoms of lipid lowering agents and anti-diabetics drugs, while also reviewing current knowledge on the association between mood disorders and dyslipidemia or hyperglycemia. We propose that metabolic dysfunction is prevalent in both MDD and BD and it may contribute to the development of these disorders through a variety of pathophysiological processes including inflammation, brain structural changes, hormonal alterations, neurotransmitter disruptions, alteration on brain cholesterol, central insulin resistance, and changes in gut microbiota. Current evidence is conflicting on the use of statins, polyunsaturated fatty acids, thiazolidinediones, glucagon-like peptide agonists, metformin, or insulin for the treatment of MDD and BD. Given the paucity of high-quality randomized controlled trials, additional studies are needed before any of these medications can be repurposed in routine clinical practice. Future trials need to enrich patient recruitment, include evaluations of mechanism of action, and explore differential effects on specific symptom domains such as anhedonia, suicidality, and cognition.
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Affiliation(s)
- Brett D. M. Jones
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada; (B.D.M.J.); (S.K.); (M.O.H.); (B.H.M.)
- Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Salman Farooqui
- Department of Biology, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Stefan Kloiber
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada; (B.D.M.J.); (S.K.); (M.O.H.); (B.H.M.)
- Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Muhammad Omair Husain
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada; (B.D.M.J.); (S.K.); (M.O.H.); (B.H.M.)
- Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Benoit H. Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada; (B.D.M.J.); (S.K.); (M.O.H.); (B.H.M.)
- Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Muhammad Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada; (B.D.M.J.); (S.K.); (M.O.H.); (B.H.M.)
- Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
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12
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Rohner M, Heiz R, Feldhaus S, Bornstein SR. Hepatic-Metabolite-Based Intermittent Fasting Enables a Sustained Reduction in Insulin Resistance in Type 2 Diabetes and Metabolic Syndrome. Horm Metab Res 2021; 53:529-540. [PMID: 34192792 PMCID: PMC8360708 DOI: 10.1055/a-1510-8896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/12/2021] [Indexed: 11/03/2022]
Abstract
Insulin resistance is the hallmark of Type 2 Diabetes and is still an unmet medical need. Insulin resistance lies at the crossroads of non-alcoholic fatty liver disease, obesity, weight loss and exercise resistance, heart disease, stroke, depression, and brain health. Insulin resistance is purely nutrition related, with a typical molecular disease food intake pattern. The insulin resistant state is accessible by TyG as the appropriate surrogate marker, which is found to lead the personalized molecular hepatic nutrition system for highly efficient insulin resistance remission. Treating insulin resistance with a molecular nutrition-centered approach shifts the treatment paradigm of Type 2 Diabetes from management to cure. This allows remission within five months, with a high efficiency rate of 85%. With molecular intermittent fasting a very efficient treatment for prediabetes and metabolic syndrome is possible, improving the non-alcoholic fatty liver disease (NAFL) state and enabling the body to lose weight in a sustainable manner.
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Affiliation(s)
| | - Robert Heiz
- Zentrum für Komplementärmedizin AG, Uster,
Switzerland
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13
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Peter RS, Jaensch A, Mons U, Schöttker B, Schmucker R, Koenig W, Brenner H, Rothenbacher D. Prognostic value of long-term trajectories of depression for incident diabetes mellitus in patients with stable coronary heart disease. Cardiovasc Diabetol 2021; 20:108. [PMID: 33985516 PMCID: PMC8120929 DOI: 10.1186/s12933-021-01298-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/05/2021] [Indexed: 11/15/2022] Open
Abstract
Background Diabetes mellitus (DM) and depression are bidirectionally interrelated. We recently identified long-term trajectories of depression symptom severity in individuals with coronary heart disease (CHD), which were associated with the risk for subsequent cardiovascular events (CVE). We now investigated the prognostic value of these trajectories of symptoms of depression with the risk of incident DM in patients with stable coronary heart disease. Methods The KAROLA cohort included CHD patients participating in an in-patient rehabilitation program (years 1999/2000) and followed for up to 15 years. We included 1048 patients (mean age 59.4 years, 15% female) with information on prevalent DM at baseline and follow-up data. Cox proportional hazards models were used to model the risk for incident DM during follow-up by depression trajectory class adjusted for age, sex, education, smoking status, body mass index, and physical activity. In addition, we modeled the excess risk for subsequent CVE due to incident DM during follow-up for each of the depression trajectories. Results DM was prevalent in 20.7% of patients at baseline. Over follow-up, 296 (28.2%) of patients had a subsequent CVE. During follow-up, 157 (15.0%) patients developed incident DM before experiencing a subsequent CVE. Patients following a high-stable depression symptom trajectory were at substantially higher risk of developing incident DM than patients following a low-stable depression symptom trajectory (hazard ratio (HR) = 2.50; 95% confidence interval (CI) (1.35, 4.65)). A moderate-stable and an increasing depression trajectory were associated with HRs of 1.48 (95%-CI (1.10, 1.98)) and 1.77 (95%-CI (1.00, 3.15)) for incident DM. In addition, patients in the high-stable depression trajectory class who developed incident DM during follow-up were at 6.5-fold risk (HR = 6.51; 95%-CI (2.77, 15.3)) of experiencing a subsequent cardiovascular event. Conclusions In patients with CHD, following a trajectory of high
stable symptoms of depression was associated with an increased risk of incident
DM. Furthermore, incident DM in these patients was associated with a
substantially increased risk of subsequent CVE. Identifying depressive symptoms
and pertinent treatment offers might be an important and promising approach to
enhance outcomes in patients with CHD, which should be followed up in further
research and practice.
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Affiliation(s)
- Raphael S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ute Mons
- Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Cologne, Heart Center, University of Cologne, Cologne, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Ageing Research, University of Heidelberg, Heidelberg, Germany
| | | | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Ageing Research, University of Heidelberg, Heidelberg, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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14
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Associations of Dietary Patterns with Incident Depression: The Maastricht Study. Nutrients 2021; 13:nu13031034. [PMID: 33806882 PMCID: PMC8004955 DOI: 10.3390/nu13031034] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022] Open
Abstract
Our aim was to assess the association between a priori defined dietary patterns and incident depressive symptoms. We used data from The Maastricht Study, a population-based cohort study (n = 2646, mean (SD) age 59.9 (8.0) years, 49.5% women; 15,188 person-years of follow-up). Level of adherence to the Dutch Healthy Diet (DHD), Mediterranean Diet, and Dietary Approaches To Stop Hypertension (DASH) were derived from a validated Food Frequency Questionnaire. Depressive symptoms were assessed at baseline and annually over seven-year-follow-up (using the 9-item Patient Health Questionnaire). We used Cox proportional hazards regression analyses to assess the association between dietary patterns and depressive symptoms. One standard deviation (SD) higher adherence in the DHD and DASH was associated with a lower hazard ratio (HR) of depressive symptoms with HRs (95%CI) of 0.78 (0.69–0.89) and 0.87 (0.77–0.98), respectively, after adjustment for sociodemographic and cardiovascular risk factors. After further adjustment for lifestyle factors, the HR per one SD higher DHD was 0.83 (0.73–0.96), whereas adherence to Mediterranean and DASH diets was not associated with incident depressive symptoms. Higher adherence to the DHD lowered risk of incident depressive symptoms. Adherence to healthy diet could be an effective non-pharmacological preventive measure to reduce the incidence of depression.
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15
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van der Feltz‐Cornelis C, Allen SF, Holt RIG, Roberts R, Nouwen A, Sartorius N. Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: Systematic review and meta-analysis. Brain Behav 2021; 11:e01981. [PMID: 33274609 PMCID: PMC7882189 DOI: 10.1002/brb3.1981] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/02/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To provide an estimate of the effect of interventions on comorbid depressive disorder (MDD) or subthreshold depression in type 1 and type 2 diabetes. METHODS Systematic review and meta-analysis. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomized controlled trials evaluating the outcome of depression treatments in diabetes and comorbid MDD or subthreshold symptoms published before August 2019 compared to care as usual (CAU), placebo, waiting list (WL), or active comparator treatment as in a comparative effectiveness trial (CET). Primary outcomes were depressive symptom severity and glycemic control. Cohen's d is reported. RESULTS Forty-three randomized controlled trials (RCTs) were selected, and 32 RCTs comprising 3,543 patients were included in the meta-analysis. Our meta-analysis showed that, compared to CAU, placebo or WL, all interventions showed a significant effect on combined outcome 0,485 (95% CI 0.360; 0.609). All interventions showed a significant effect on depression. Pharmacological treatment, group therapy, psychotherapy, and collaborative care had a significant effect on glycemic control. High baseline depression score was associated with a greater reduction in HbA1 c and depressive outcome. High baseline HbA1 c was associated with a greater reduction in HbA1 c. CONCLUSION All treatments are effective for comorbid depression in type 1 diabetes and type 2 diabetes. Over the last decade, new interventions with large effect sizes have been introduced, such as group-based therapy, online treatment, and exercise. Although all interventions were effective for depression, not all treatments were effective for glycemic control. Effective interventions in comorbid depressive disorder may not be as effective in comorbid subthreshold depression. Baseline depression and HbA1 c scores modify the treatment effect. Based on the findings, we provide guidance for treatment depending on patient profile and desired outcome, and discuss possible avenues for further research.
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Affiliation(s)
| | - Sarah F. Allen
- Department of Health SciencesHull York Medical SchoolUniversity of YorkYorkUK
| | - Richard I. G. Holt
- Human Development and HealthFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Richard Roberts
- Department of Family Medicine & Community HealthUniversity of WisconsinMadisonWIUSA
| | - Arie Nouwen
- Department of PsychologyMiddlesex UniversityLondonUK
| | - Norman Sartorius
- Association for the Improvement of Mental Health ProgrammesGenevaSwitzerland
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16
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Wang J, Zhou D, Dai Z, Li X. Association Between Systemic Immune-Inflammation Index and Diabetic Depression. Clin Interv Aging 2021; 16:97-105. [PMID: 33469277 PMCID: PMC7810592 DOI: 10.2147/cia.s285000] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background Depression is highly prevalent in patients with diabetes mellitus (DM). Diabetic depression has been shown to be associated with low-grade systemic inflammation. In recent years, the systemic immune-inflammation (SII) index has been developed as an integrated and novel inflammatory indicator. The aims of this study were to investigate the relationship between diabetic depression and SII levels, adjusting for a wide range of potential confounding factors, to examine the potential of SII in predicting diabetic depression. Methods The present cross-sectional study was conducted among adults with DM in the National Health and Nutrition Examination Survey between 2009 and 2016, the SII level was calculated as the platelet counts × neutrophil counts/lymphocyte counts. Patient Health Questionnaire‐9 was used to measure depression in patients with DM. Multivariable logistic regression and propensity score-matched analysis were used to analyze the association between SII levels and depression. Results A total of 2566 patients with DM were included in the study, of which 370 (13.3%) were diagnosed with depression. Multivariable logistic regression showed that high SII level was an independent risk factor for diabetic depression (OR = 1.347, 95% CI: 1.031–1.760, P = 0.02882) after adjusting for covariates. The relationship between SII and diabetic depression was further verified by propensity score-matched analysis. Conclusion Our data suggest that SII is a risk factor for depression in patients with DM. The SII may be an easily accessible and cost-effective strategy for identifying depression in patients with DM. More studies are warranted to further analyze the role of SII in depression in diabetic patients.
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Affiliation(s)
- Jie Wang
- Department of Endocrinology, Yanbian University Hospital, Yanji, Jilin, People's Republic of China
| | - Depu Zhou
- Department of Endocrinology, Yanbian University Hospital, Yanji, Jilin, People's Republic of China
| | - Zhijuan Dai
- Department of Endocrinology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiaokun Li
- Department of Endocrinology, Yanbian University Hospital, Yanji, Jilin, People's Republic of China
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17
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Cox DJ, Banton T, Moncrief M, Conaway M, Diamond A, Holmes V, Green Pastors J, Wolf A, Fang K, McCall A. Glycemic excursion minimization in the management of type 2 diabetes: a novel intervention tested in a randomized clinical trial. BMJ Open Diabetes Res Care 2020; 8:8/2/e001795. [PMID: 33328160 PMCID: PMC7745682 DOI: 10.1136/bmjdrc-2020-001795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION This study of adults with type 2 diabetes employed a non-inferiority hypothesis to investigate whether an innovative lifestyle focused on minimizing postnutrient blood glucose (BG) excursions (glycemic excursion minimization (GEM)) would be equivalent or superior to conventional weight loss (WL) therapy in regard to reducing HbA1c, and superior to WL when investigating physical, behavioral and psychological secondary outcomes. The impact of BG feedback on GEM efficacy was also investigated. RESEARCH DESIGN AND METHODS 178 adults with type 2 diabetes for ≤10 years, HbA1c ≥6.8%, and not using insulin were randomized to WL (n=40) or one of three versions of GEM. Didactic (GEM-D, n=39) taught participants to choose low-glycemic load foods, reduce sedentary time and increase moderate routine physical activity. GEM-S (n=51) received GEM-D and systematically measured BG before and after meals and physical activity to educate and motivate food and activity choices. GEM-C (n=48) received GEM-D with continuous glucose monitoring feedback. All participants received 6 hours of group training and BG and activity monitors. Before and 3 months after treatment, participants were assessed for HbA1c, lipids, weight, routine physical activity, nutrition, depression, diabetes empowerment and distress. RESULTS GEM versions did not differ in primary or secondary outcomes, so they were combined for analyses. While WL reduced body mass index (BMI) (p=0.005), GEM demonstrated a greater reduction in HbA1c (p=0.005), BMI (p=0.013), carbohydrate intake (p=0.001), BG response to a glucose challenge (p=0.02), and cardiovascular risk (p=0.003). Only GEM participants significantly improved diabetes empowerment, diabetes distress, depressive symptoms, steps/day, and active hours and reduced calories/day. Neither intervention had negative side effects. CONCLUSIONS GEM is an effective alternative to WL with respect to physical, behavioral and psychosocial outcomes. TRIAL REGISTRATION NUMBER NCT03196895.
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Affiliation(s)
- Daniel J Cox
- Center for Behavioral Medicine Research, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Tom Banton
- Center for Behavioral Medicine Research, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Matthew Moncrief
- Center for Behavioral Medicine Research, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Mark Conaway
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Anne Diamond
- Center for Behavioral Medicine Research, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Viola Holmes
- Virginia Center for Diabetes Prevention and Education, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Joyce Green Pastors
- Virginia Center for Diabetes Prevention and Education, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Anne Wolf
- Virginia Center for Diabetes Prevention and Education, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Kun Fang
- Center for Behavioral Medicine Research, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Anthony McCall
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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