A review of the association between depression and insulin resistance: pitfalls of secondary analyses or a promising new approach to prevention of type 2 diabetes?

Impact of insulin and insulin resistance on brain dopamine signalling and reward processing- an underexplored mechanism in the pathophysiology of depression?

Type 2 diabetes and major depressive disorder (MDD) are the leading causes of disability worldwide and have a high comorbidity rate with fatal outcomes. Despite the long-established association between these conditions, the underlying molecular mechanisms remain unknown. Since the discovery of insulin receptors in the brain and the brain's reward system, evidence has accumulated indicating that insulin modulates dopaminergic (DA) signalling and reward behaviour. Here, we review the evidence from rodent and human studies, that insulin resistance directly alters central DA pathways, which may result in motivational deficits and depressive symptoms. Specifically, we first elaborate on the differential effects of insulin on DA signalling in the ventral tegmental area (VTA) - the primary DA source region in the midbrain - and the striatum as well as its effects on behaviour. We then focus on the alterations induced by insulin deficiency and resistance. Finally, we review the impact of insulin resistance in DA pathways in promoting depressive symptoms and anhedonia on a molecular and epidemiological level and discuss its relevance for stratified treatment strategies.

Achievement of glycemic control and antidepressant medication use in comorbid depression and type 2 diabetes

BACKGROUND

Existing studies designed to determine if depression treatment in patients with type 2 diabetes (T2D) is associated with improved glycemic control have produced inconsistent results. The present study investigated the link between acute phase antidepressant medication treatment and achievement of glycemic control in patients with T2D using nationally distributed electronic health record data.

METHODS

A retrospective cohort study (n = 7332) was conducted using nationally distributed Optum® de-identified electronic health record data from 2010 to 2018. Eligible patients were 18-64 years old and had T2D, depression, and poor glycemic control. Antidepressant medication treatment was categorized into acute phase treatment (≥12 weeks), less than acute phase (<12 weeks) or no treatment. Glycemic control was defined as HbA1c < 7.0 % (53 mmol/mol). Propensity scores (PS) and inverse probability of treatment weighting (IPTW) controlled for confounding. Extended Cox models measured the association between duration of antidepressant medication treatment and glycemic control at 0 to 36 months, 36 to 72 months and ≥72 months.

RESULTS

After controlling for confounding, compared to no treatment, acute phase treatment was significantly associated with achieving glycemic control within 36 months (HR 1.17, 95 % CI 1.02-1.34). No association was observed beyond 36 months. There was no association between acute vs. less than acute phase treatment and glycemic control.

LIMITATIONS

We were unable to measure decreased depression severity which could contribute to glycemic control.

CONCLUSIONS

For patients with T2D and hyperglycemia, acute phase antidepressant medication may enable glycemic control. Further research is needed to establish mechanisms for this association.

Association between impaired glucose metabolism and long-term prognosis at the time of diagnosis of depression: Impaired glucose metabolism as a promising biomarker proposed through a machine-learning approach

BACKGROUND

Predicting the course of depression is necessary for personalized treatment. Impaired glucose metabolism (IGM) was introduced as a promising depression biomarker, but no consensus was made. This study aimed to predict IGM at the time of depression diagnosis and examine the relationship between long-term prognosis and predicted results.

METHODS

Clinical data were extracted from four electronic health records in South Korea. The study population included patients with depression, and the outcome was IGM within 1 year. One database was used to develop the model using three algorithms. External validation was performed using the best algorithm across the three databases. The area under the curve (AUC) was calculated to determine the model's performance. Kaplan-Meier and Cox survival analyses of the risk of hospitalization for depression as the long-term outcome were performed. A meta-analysis of the long-term outcome was performed across the four databases.

RESULTS

A prediction model was developed using the data of 3,668 people, with an AUC of 0.781 with least absolute shrinkage and selection operator (LASSO) logistic regression. In the external validation, the AUCs were 0.643, 0.610, and 0.515. Through the predicted results, survival analysis and meta-analysis were performed; the hazard ratios of risk of hospitalization for depression in patients predicted to have IGM was 1.20 (95% confidence interval [CI] 1.02-1.41, p = 0.027) at a 3-year follow-up.

CONCLUSIONS

We developed prediction models for IGM occurrence within a year. The predicted results were related to the long-term prognosis of depression, presenting as a promising IGM biomarker related to the prognosis of depression.

Association of metabolic syndrome with depression in US adults: A nationwide cross-sectional study using propensity score-based analysis

Background

The association of metabolic syndrome (MetS) with depression has been previously reported; however, the results are ambiguous due to imbalanced confounding factors. Propensity score-based analysis is of great significance to minimize the impact of confounders in observational studies. Thus, the current study aimed to clarify the influence of MetS on depression incidence in the U.S. adult population by using propensity score (PS)-based analysis.

Methods

Data from 11,956 adults aged 20-85 years from the National Health and Nutrition Examination Survey (NHANES) database between 2005 and 2018 were utilized. Using 1:1 PS matching (PSM), the present cross-sectional study included 4,194 participants with and without MetS. A multivariate logistic regression model and three PS-based methods were applied to assess the actual association between MetS and depression incidence. Stratified analyses and interactions were performed based on age, sex, race, and components of MetS.

Results

After PSM, the risk of developing depression in patients with MetS increased by 40% in the PS-adjusted model (OR = 1.40, 95% confidence interval [CI]: 1.202-1.619, P < 0.001), and we could still observe a positive association in the fully adjusted model (OR = 1.37, 95% CI: 1.172-1.596, P < 0.001). Regarding the count of MetS components, having four and five conditions significantly elevated the risk of depression both in the PS-adjusted model (OR = 1.78, 95% CI: 1.341-2.016, P < 0.001 vs. OR = 2.11, 95% CI: 1.626-2.699, P < 0.001) and in the fully adjusted model (OR = 1.56, 95 CI%: 1.264-1.933, P < 0.001 vs. OR = 1.90, 95% CI: 1.458-2.486, P < 0.001). In addition, an elevation in MetS component count was associated with a significant linear elevation in the mean score of PHQ-9 (F =2.8356, P < 0.001). In the sensitivity analysis, similar conclusions were reached for both the original and weighted cohorts. Further interaction analysis revealed a clear gender-based difference in the association between MetS and depression incidence.

Conclusion

MetS exhibited the greatest influence on depression incidence in US adults, supporting the necessity of early detection and treatment of depressive symptoms in patients with MetS (or its components), particularly in female cases.

A pathway phenotype linking metabolic, immune, oxidative, and opioid pathways with comorbid depression, atherosclerosis, and unstable angina

BACKGROUND

There is strong comorbidity between atherosclerosis (ATS) and depression which is attributed to increased atherogenicity, insulin resistance (IR), and immune and oxidative stress.

AIM OF THE STUDY

To examine the role of the above pathways and mu-opioid receptor (MOR), β-endorphin levels, zinc, copper, vitamin D3, calcium, and magnesium in depression due to ATS/unstable angina (UA).

METHODS

Biomarkers were assayed in 58 controls and 120 ATS patients divided into those with moderate and severe depression according to the Beck Depression Inventory-II (BDI-II) scores >19 and >29, respectively.

RESULTS

Neural network and logistic regression models showed that severe depression due to ATS/UA was best predicted by interleukin-6 (IL-6), UA, MOR, zinc, β-endorphin, calcium and magnesium, and that moderate depression was associated with IL-6, zinc, MOR, β-endorphin, UA, atherogenicity, IR, and calcium. Neural networks yielded a significant discrimination of severe and moderate depression with an area under the receiver operating curves of 0.831 and 0.931, respectively. Using Partial Least Squares path analysis, we found that 66.2% of the variance in a latent vector extracted from ATS/UA clinical features, and the BDI-II scores, atherogenicity, and IR could be explained by the regression on IL-6, IL-10, zinc, copper, calcium, MOR, and age. The BDI-II scores increased from controls to ATS to UA class III to UA class IV.

CONCLUSIONS

Immune activation, the endogenous opioid system, antioxidants, trace elements, and macrominerals modulate a common core shared by increased depressive symptoms, ATS, UA, atherogenicity, and IR.

The Association of Metabolic Dysfunction and Mood Across Lifespan Interacts With the Default Mode Network Functional Connectivity

Background: Numerous studies suggest a relationship between depression and metabolic syndrome, which is likely influenced by age. Interestingly, functional imaging analysis has shown an association between functional connectivity in the default mode network (DMN-FC) and components of metabolic syndrome, which is explored in this study.

Methods: From a larger longitudinal cohort study on healthy aging, 943 individuals were extensively characterized for mood and cognition. Among these, 120 individuals who were selected for displaying extreme cognitive performance within the normal range (good and poor performers) were further studied. Here, in a cross-sectional design, using confirmatory factor analysis (CFA), the association between metabolic dysfunction and depressive mood as a function of age and its relationship with DMN-FC was studied.

Results: Metabolic dysfunction was modeled as a second-order latent variable using CFA. First-order latent variables were obesity, glucose dysmetabolism, lipids imbalance, and blood pressure. Using multiple linear regression models, this study observed that metabolic dysfunction, glucose dysmetabolism, and lipids imbalance were linearly associated with depressive mood, and the association with obesity was U-shaped. The association of metabolic dysfunction, obesity, and glucose dysmetabolism with depressive mood is positive for the younger individuals in our sample and vanishes with aging. The FC of the right superior temporal gyrus with the DMN correlated with both obesity and depressive mood. In participants with higher obesity scores, FC increased with higher GDS scores, while in those with lower GDS scores, FC decreased. Age and blood pressure were associated with a more complex pattern of association between FC of the right supramarginal gyrus and GDS score.

Conclusion: The association of metabolic dysfunction with depressive mood is influenced by age and relates with differential patterns of DMN-FC. The combination of the effects of age, mood, and metabolic dysfunction is likely to explain the heterogeneity of DMN-FC, which deserves further investigation with larger and longitudinal studies.

Risk of Depression among Early Onset Type 2 Diabetes Mellitus Patients

<b><i>Methodology:</i></b> Biochemically confirmed type 2 diabetes mellitus (T2DM) patients (<i>n</i> = 1,114) were recruited from the outpatient department of 2 tertiary care hospitals in Dhaka, Bangladesh. Face-to-face interview was conducted using a semi-structured questionnaire containing sociodemographic parameters and relevant information about depression and diabetes. Biochemical test results and treatment-related information were taken from patients’ records. The Hospital Anxiety and Depression Scale (HADS) was used to screen all patients for psychiatric manifestation. Those diagnosed by HADS were subsequently reassessed using structured clinical interview for DSM-5 Disorders – Clinician Version. T2DM diagnosed at age &#x3c;40 years were considered as early onset T2DM. Association between age of onset category and depression was assessed using multivariable mixed-effect logistic regression adjusting for random variation of the area of residence and plausible confounders. <b><i>Results:</i></b> Around a third of the participants (32.5%) were diagnosed with T2DM before the age of 40 years. Early onset T2DM patients were found to have 57% increase in the risk of developing depression (OR 1.57; 95% CI 1.13–2.28; <i>p</i> = 0.011) in comparison to those with usual onset T2DM (≥40 years). Among other factors a positive family history for diabetes (OR 1.33; 95% CI 1.03–1.78; <i>p</i> = 0.038), poor glycemic control (OR 1.31; 95% CI 1.03–1.68; <i>p</i> = 0.028), presence of 1, or more diabetic complications (OR 1.37; 95% CI 1.03–1.78; <i>p</i> = 0.011) also showed increased risk of depression. <b><i>Conclusion:</i></b> Early onset T2DM patients are at greater risk of developing depression. The finding is likely to help in setting preventive strategies aiming to reduce the presence of concomitant depression symptoms among diabetes.

Insulin resistance is associated with deficits in hedonic, self-reported cognitive, and psychosocial functional response to antidepressant treatment in individuals with major depressive disorder

BACKGROUND

To assess the effect of insulin resistance (IR) on treatment response to the antidepressant, vortioxetine, in patients with Major Depressive Disorder (MDD).

METHODS

This is a secondary analysis of an 8-week, open-label clinical trial. Ninety-five adults in a primary care setting experiencing a major depressive episode were included. Response to vortioxetine was measured using the THINC-integrated tool, Montgomery Åsberg Depression Rating Scale (MADRS), the Snaith-Hamilton Pleasure Scale (SHAPS), the Perceived Deficits Questionnaire (PDQ-5), and the Sheehan Disability Scale (SDS). Generalized estimating equation models were utilized for data analysis.

RESULTS

When adjusted for age, gender, dose, and BMI, there was a significant baseline IR by time interaction for SHAPS (p = 0.022), PDQ-5 (p = 0.037), and SDS (p = 0.013). Higher baseline IR predicted decreased early improvements in anhedonia. It also predicted poorer subjective assessments of cognition and increased functional impairment at the endpoint of treatment. For functional capacity (i.e. SDS) other covariates including severity of symptoms, illness course, other metabolic factors (e.g. cholesterol), and physical activity were included with no changes to the moderating effect of baseline IR.

LIMITATIONS

This was a post-hoc analysis of a primarily non-diabetic sample. Also, only one agent was assessed.

CONCLUSIONS

IR was a predictor of response to vortioxetine. This persisted after controlling for other factors including, but not limited to, BMI. These findings strengthen the link between depression and IR and may point to another novel metabolic predictor of response. These findings should be replicated using other antidepressants.

Factors associated with depression, anxiety and stress among patients with diabetes mellitus in primary health care: Many questions, few answers

INTRODUCTION

People with diabetes mellitus (DM) may have concurrent mental health disorders and have been shown to have poorer disease outcomes.

OBJECTIVE

The aim of this study to determine the prevalence of DASS in patients with diabetes mellitus without mental disorders, aged 20 years or more, in primary health care, and to determine any association between DASS and patients' sociodemographic and clinical attributes.

METHODS

This was a cross-sectional study conducted in a primary health care center, in the department of general practice. Patients with DM who visited the doctor and agreed to fill in the questionnaire were included in the study. Data were collected using the questionnaire DASS-21. Descriptive statistics, the Pearson chi-square test, and logistic regression analysis were used to analyze the data.

RESULTS

Out of a total of 102 respondents with DM, 29 (28.4%) had some form of psychological symptoms. The prevalence of DASS was 16.7%, 16.6%, and 23.5%, respectively. There was no significant difference between sociodemographic variables according to stress status. Respondents aged 40-49 years more often showed emotional states of depression and anxiety. There was a significant association between emotional status of DASS and HbA1c values. Logistic regression analysis indicated that age (OR=2.57, 95% CI: 1.59-4.13) was a predictor of depression and anxiety.

CONCLUSION

Unpleasant emotional states DASS are common in patients with DM, depression (16.7%), anxiety (16.6%), and stress (23.5%). Age is the strongest predictor of DASS status. The screening and monitoring of unpleasant emotional states in people with diabetes should be performed from a young age.

Antidepressant Use and Glycemic Control in Diabetic Population: A Meta-analysis

BACKGROUND

Depression is prevalent in the diabetic population. Primary care physician is busy in treating diabetes and depression among them goes unnoticed. According to the American Diabetic Association, two out of three are not able to achieve glycaemic control. Diabetes and depression both share complex cause-effect relationship.

OBJECTIVES

To evaluate the effect of antidepressants on glycaemic control among the adult diabetic population suffering from depression.

METHOD

Cochrane database was systematically searched with search strategy andonly parallel randomized clinical trial with antidepressant and placebo group were considered. Outcome measures were HbA1c, Fasting blood glucose, weight, body mass index, treatment adherence. Data extraction form were adapted from Cochrane. Two researchers identified studies and extracted data independently. Revman was used for meta-analysis and risk of bias. Level of evidence was generated using Gradepro.

RESULTS

Out of 394 studies, six studies fulfilling the eligibility criteria were pooled for analysis. Using mean difference (MD), meta-analysis showed significant evidence of glycaemic control in favor of antidepressant treated diabetic population compared to placebo group (n = 6 studies) (MD = - 0.32%; 95% CI = - 0.57 to 0.08). Weight, BMI does not show a any significant mean difference between two groups.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

There is moderate level of evidence that antidepressants improve the glycaemic control in diabetic population suffering from depression. Understanding and treating the mental and psychological determinant with adequate control of depression should be emphasized for the diabetic population.

Diabetes in Pregnancy and Risk of Antepartum Depression: A Systematic Review and Meta-Analysis of Cohort Studies

Previous literature has reported that patients with diabetes in pregnancy (DIP) are at risk of developing antepartum depression but the results have been inconsistent in cohort studies. We conducted a systematic review and performed a meta-analysis to quantify the association between DIP and risk of antepartum depression in cohort studies. Medline, Cinahl, and PubMed databases were searched for studies investigating DIP involving pregnant women with pre-existing diabetes and gestational diabetes mellitus and their risk of antepartum depression that were published in journals from inception to 27 December 2019. We derived the summary estimates using a random-effects model and reported the findings as pooled relative risks (RR) and confidence interval (CI). Publication bias was assessed using a funnel plot and was quantified by Egger and Begg’s tests. Ten studies, involving 71,036 pregnant women were included in this meta-analysis. The pooled RR to develop antepartum depression was (RR = 1.430, 95% CI: 1.251–1.636) among women with gestational diabetes mellitus. Combining pregnant women with pre-existing diabetes mellitus and gestational diabetes mellitus, they had a significant increased risk of developing antepartum depression (RR = 1.431, 95% CI: 1.205–1.699) compared with those without it. In comparison, we found no association between pre-existing diabetes mellitus in pregnancy (RR = 1.300, 95% CI: 0.736–2.297) and the risk of developing antepartum depression. This study has a few limitations: first, different questionnaire and cut-off points were used in evaluation of depression across the studies. Second, there was a lack of data on history of depression prior to pregnancy, which lead to confounding bias that could not be solved by this meta-analysis. Third, data were dominated by studies in Western countries; this is due to the studies from Eastern countries failing to meet our inclusion criteria for statistical analysis. Women with gestational diabetes mellitus have an increased risk of developing antepartum depression compared to those without the disease. Therefore, more attention on the mental health status should be given on pregnant women diagnosed with pre-existing diabetes mellitus and gestational diabetes mellitus.

Obsessive-compulsive disorder and growth factors: A comparative review

The goal of this article is to clarify the role of various growth factors in the establishment and progression of obsessive-compulsive disorder (OCD). OCD is a chronic mental disorder with recurrent intrusive thoughts and/or repetitive compulsive behaviors that increase during stressful periods. Growth and neurotrophic factors may be contributing factors in the pathophysiology of OCD. Many of them are synthesized and released within the central nervous system and act as trophic agents in neurons; some of them are involved in brain growth, development, neurogenesis, myelination and plasticity, while others take part in the protection of the nervous system following brain injuries. This paper attempts to identify all articles investigating the relationship between OCD and neurotrophic and growth factors, in both animal and human studies, with a focus on adult brain studies. Based on the PubMed and Scopus and Science Direct search tools, the available articles and studies are reviewed. Out of 230 records in total, the ones related to our review topic were taken into account to further understand the pathophysiological mechanism(s) of OCD, providing methods to improve its symptoms via the modification of neurotrophins and growth factor imbalances.

Prevalence of gestational diabetes mellitus and associated factors among women attending antenatal care at Gondar town public health facilities, Northwest Ethiopia

Background

Globally, Gestational Diabetes Mellitus (GDM) is rising, but it is a neglected health threat to mothers and their children in low resource countries. Although, GDM is known in Ethiopia, information regarding it remains scarce by recent diagnostic criteria. Therefore, this study aimed to determine the prevalence of GDM and associated factors among women attending antenatal care at Gondar town public health facilities, Northwest Ethiopia.

Methods

A cross-sectional study was conducted among 1027 pregnant women selected by the systematic random sampling technique. The universal one-step screening and diagnostic strategy was done using a two-hour 75 g oral glucose tolerance test. GDM was diagnosed using updated diagnostic criteria (2017 American Diabetes Association (ADA) or 2013 World Health Organization (WHO) or modified International Association of the Diabetes and Pregnancy Study Groups diagnostic criteria (IADPSG)). Binary logistic regression model was used to identify factors associated with GDM.

Results

Of the total 1027 pregnant women, 12.8% (95% CI: 10.8–14.8) were diagnosed with GDM. Overweight and/or obesity (MUAC ≥28 cm) (AOR = 2.25, 95% CI: 1.18–4.26), previous history of GDM (AOR = 5.82, 95% CI: 2.57–13.18), family history of diabetes (AOR = 4.03, 95% CI: 1.57–10.35), low physical activity (AOR = 3.36, 95% CI: 1.60–7.04), inadequate dietary diversity (AOR = 1.9, 95% CI: 1.02–3.53), and antenatal depression (AOR = 4.12, 95% CI: 1.85–9.20) were significantly associated with GDM.

Conclusions

The prevalence of GDM among women attending antenatal care at Gondar town public health facilities was high. Previous history of GDM, antenatal depression, family history of diabetes, low physical activity, overweight and/or obesity and inadequate dietary diversity were significantly associated with GDM. Routine screening of pregnant women and healthy lifestyle are strongly recommended.

Understanding susceptibility and targeting treatment in non-alcoholic fatty liver disease in children; moving the fulcrum

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of paediatric liver disease, affecting 10% of school-aged children and 44–70% of obese children and young people (CYP) in the western world. Encompassing a spectrum from simple steatosis to steatohepatitis and progressive fibrosis, the disease is rapidly becoming the most common indication for liver transplantation. The molecular pathogenesis of NAFLD remains only partially understood. Development and progression of NAFLD is influenced by genetic and nutritional factors, insulin resistance, oxidative stress, gut microbiome, bile acid metabolism and lipid/glucose handling and is closely associated with overweight and obesity. Lifestyle change is the only proven effective treatment for paediatric NAFLD, however this is difficult to achieve in many. Given that moderate or severe fibrosis is already present in 30–50% of children with NAFLD at the time of presentation, progression in CYP may be more rapid, though adequate outcome data do not yet exist in this cohort. CYP with NAFLD are an excellent population in which to study underlying mechanisms and interventions to correct disease progression as they are largely unaffected by other environmental influences such as alcohol and may represent the more severe end of the spectrum in terms of early onset. Undoubtedly genetic and epigenetic mechanisms determine a large proportion of susceptibility to the disease and potentially, identification of individuals at risk may allow for targeted therapy. This review with give a clinical perspective of paediatric NAFLD focused on identifying those at risk of progressive disease and what to consider in attempting to modify risk.

Diabetes, Depression, and Cognition: a Recursive Cycle of Cognitive Dysfunction and Glycemic Dysregulation

PURPOSE OF REVIEW

The study aims to examine the effects of diabetes and depression on executive functioning (EF) and to review the effects of EF deficits on diabetes management.

RECENT FINDINGS

Both type 2 diabetes and depression influence EF, and in turn, EF has an impact on diabetes management. Individuals with both comorbidities (i.e., diabetes and depression) experience greater deficits in EF than individuals with just one of the morbidities (i.e., depression or diabetes). The disruption in EF results in poor diabetes management and poor emotion regulation which ultimately increases the probability of a recursive cycle of depression and hyperglycemia. This recursive cycle can ultimately lead to diabetes-related complications.

Is There a Relationship Between Gestational Diabetes and Perinatal Depression?

Perinatal depression (PND) is one of the leading complications associated with childbirth. Early detection and treatment of depression, particularly during the perinatal period, is essential for the promotion of positive maternal-child outcomes. Gestational diabetes mellitus (GDM) has been suggested as a confounding factor associated with PND. Concerns associated with PND include interference with maternal-newborn bonding and long-term effects of neurobehavioral consequences. An exemplar case describing one woman's experience with GDM and her subsequent complications associated with PND is presented to discuss maternal depression and its plausible association with GDM. Recommendations include universal screening with the validated Edinburgh Postnatal Depression Scale screening tool during the early perinatal period to reduce incidence of maternal-newborn complications associated with PND and promote underpinnings for best practice.

[Cerebral insulin resistance: current concepts of the pathogenesis and possible therapeutic strategies]

The review presents current concepts about the problem of cerebral insulin resistance (IR). It has now been established that cerebral IR plays a key role in the pathogenesis of degenerative and metabolic diseases of the brain. Based on literature data and own clinical experience, the authors recommend to use the standardized extract of ginkgo biloba EGb761 as a cellular protector, which increases insulin sensitivity of cells and reduces atherogenesis, in order to improve cognitive functions and quality of life in patients with diabetes mellitus.

Depressive symptoms, prediabetes, and incident diabetes in older English adults

OBJECTIVE

The objective of this study was to assess the risk of diabetes in older adults with elevated depressive symptoms, prediabetes, or both.

METHOD

This study included 4129 participants from the English Longitudinal Study of Ageing. Participants were followed from Wave 2 (2004-2005) to Wave 6 (2012-2013). The 8-item Centre for Epidemiologic Studies Depression (CESD) scale was used to measure depressive symptoms in the past week, which were categorized as no/low, mild, or high. Normal glucose levels and prediabetes were defined using baseline haemoglobin A1c measurements. Incident diagnosed diabetes was reported by participants. Cox regression estimated hazard ratios of incident diabetes associated with depressive symptoms and prediabetes.

RESULTS

A total of 157 participants were diagnosed with diabetes over a mean of 6.7 years. Relative to participants with normal glucose levels and no/low depressive symptoms at baseline, the adjusted hazard ratios were 0.85 (95% CI 0.40-1.82) and 1.62 (95% CI 0.84-3.15) for those with normal glucose levels and mild depressive symptoms and normal glucose levels and high depressive symptoms. The adjusted hazard ratios for participants with prediabetes and no/low depressive symptoms, mild depressive symptoms, and high depressive symptoms were 4.84 (95% CI 3.08-7.60), 7.17 (95% CI 4.00-12.88), and 7.77 (95% CI 4.33-13.93), respectively.

CONCLUSIONS

Older adults with elevated depressive symptoms and prediabetes have an increased risk of diabetes compared to those with only one of these risk factors. Copyright © 2016 John Wiley & Sons, Ltd.

Indices of insulin resistance and glucotoxicity are not associated with bipolar disorder or major depressive disorder, but are differently associated with inflammatory, oxidative and nitrosative biomarkers

BACKGROUND

Insulin resistance (IR) is a key factor in diabetes mellitus, metabolic syndrome (MetS) and obesity and may occur in mood disorders and tobacco use disorder (TUD), where disturbances of immune-inflammatory, oxidative and nitrosative stress (IO&NS) pathways are important shared pathophysiological pathways.

METHODS

This study aimed to a) examine IR and β-cell function as measured by the homeostasis model assessment of insulin resistance (HOMA-IR) and insulin sensitivity and β cell function (HOMA-B) and glucotoxicity (conceptualized as increased glucose levels versus lowered HOMA-B values) in 74 participants with major depressive disorder (MDD) and bipolar disorder, with and or without MetS and TUD, versus 46 healthy controls, and b) whether IR is associated with IO&NS biomarkers, including nitric oxide metabolites (NOx), lipid hydroperoxides (LOOH), plasma advanced oxidation protein products (AOPP), C-reactive protein (CRP), haptoglobin (Hp) and uric acid.

RESULTS

Mood disorders are not associated with changes in IR or glucotoxicity, although the number of mood episodes may increase IR. 47.8% of the variance in HOMA-IR is explained by AOPP and body mass index (BMI, both positively) and NOx, Hp and TUD (all inversely). 43.2% of the variance in HOMA-B is explained by NOx, Hp and age (all inversely associated) and higher BMI and sex. The glucotoxic index is strongly associated with NOx, Hp and BMI (positively), male gender and lower education.

LIMITATIONS

This is a cross-sectional study and therefore we cannot draw firm conclusions on causal associations.

CONCLUSIONS

Activated IO&NS pathways (especially increased Hp and NOx) increase glucotoxicity and exert very complex effects modulating IR. Mood disorders are not associated with increased IR.

Insulin resistance, atherogenicity, and iron metabolism in multiple sclerosis with and without depression: Associations with inflammatory and oxidative stress biomarkers and uric acid

Depression is accompanied by metabolic disorders in iron metabolism, lipoproteins, and insulin resistance. We measured plasma levels of ferritin, iron, lipids, insulin, and glucose and computed the homeostasis model assessment (HOMA2IR) and atherogenic index of plasma (AIP) in MS patients with and without depression and healthy controls. Explanatory variables were serum uric acid, interleukin (IL)-6, lipid hydroperoxides (CL-LOOH), albumin, and C-reactive protein (CRP). Depression was assessed using the Hospital Anxiety and Depression Scale (HADS), neurological disability using the Expanded Disability Status Scale (EDSS), and disease progression using ∆EDSS over five years earlier. HOMA2IR and insulin were predicted by diagnosis (increased in MS), age and body mass index (BMI); AIP by diagnosis, sex, BMI, CRP, and uric acid; triglycerides by diagnosis (higher in MS without depression), age, BMI and uric acid; ferritin by diagnosis (higher in MS), sex, CRP, and albumin; and iron by albumin. The HADS score was significantly predicted by ∆EDSS, gastro-intestinal symptoms, iron (inverse), and age. MS is characterized by significantly increased insulin resistance, which is determined by increased insulin levels; and increased ferritin, a biomarker of inflammation. Depression in MS is not associated with increased insulin resistance and atherogenicity but with lowered iron.

Depressive Symptoms Clusters and Insulin Resistance: Race/Ethnicity as a Moderator in 2005-2010 NHANES Data

BACKGROUND

Although depression has been linked to insulin resistance, few studies have examined depressive symptom clusters.

PURPOSE

We examined whether certain depressive symptom clusters are more strongly associated with insulin resistance in a nationally representative sample, and we evaluated potential moderators and mediators.

METHODS

Respondents were 4487 adults from NHANES 2005-2010. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9), and insulin resistance was indexed by the homeostatic model assessment (HOMA) score.

RESULTS

Positive relationships between PHQ-9 total, somatic, and cognitive-affective scores and HOMA score were detected (ps <0.001). In a simultaneous model, the somatic (p = 0.017), but not the cognitive-affective (p = 0.071), score remained associated with HOMA score. We observed evidence of (a) moderation by race/ethnicity (relationships stronger in non-Hispanic Whites) and (b) mediation by body mass and inflammation.

CONCLUSIONS

The depressive symptoms-insulin resistance link may be strongest among non-Hispanic Whites and may be driven slightly more by the somatic symptoms.

First trimester depression scores predict development of gestational diabetes mellitus in pregnant rural Appalachian women

Gestational diabetes (GDM) occurs in up to 9% of pregnancies. Perinatal depression affects up to 20% of women during pregnancy, and can extend into the postpartum period. A number of studies have linked depression and diabetes, however, whether this applies to GDM or which might come first is less understood. The purpose of this study was to examine the potential relationship between depression identified in the first trimester of pregnancy and the subsequent development of GDM. Women without pre-existing Type I/II diabetes (n = 1021) were evaluated for depression during the first trimester of pregnancy, and medical records were reviewed to identify a positive history of diabetes. Women identified as depressed during the first trimester were more likely to have GDM compared to those not depressed. After controlling for demographic factors and weight-related variables level of depression in the first trimester still predicted later GDM development. Depression identified in early pregnancy may predict increased risk of subsequent GDM development. Due to the numerous maternal, fetal and neonatal complications associated with GDM, early recognition is essential to promote the best possible outcomes for mother and infant. Recognizing depression as a possible risk factor for GDM development could lead to earlier screening and preventative measures.

Insulin in the nervous system and the mind: Functions in metabolism, memory, and mood

BACKGROUND

Insulin, a pleotrophic hormone, has diverse effects in the body. Recent work has highlighted the important role of insulin's action in the nervous system on glucose and energy homeostasis, memory, and mood.

SCOPE OF REVIEW

Here we review experimental and clinical work that has broadened the understanding of insulin's diverse functions in the central and peripheral nervous systems, including glucose and body weight homeostasis, memory and mood, with particular emphasis on intranasal insulin.

MAJOR CONCLUSIONS

Implications for the treatment of obesity, type 2 diabetes, dementia, and mood disorders are discussed in the context of brain insulin action. Intranasal insulin may have potential in the treatment of central nervous system-related metabolic disorders.

Role of Sirtuins in Linking Metabolic Syndrome with Depression

Depression is now widely regarded as a common disabling disorder that affects negatively the social functioning all over the world. Depression is associated with diverse phenomenon in brain such as neuroinflammation, synaptic dysfunction, and cognitive deficit. Recent studies reported that depression occurs by various metabolic changes, leading to metabolic syndrome. Sirtuins (SIRTs) are NAD⁺-dependent class III histone deacetylases, known to regulate diverse biological mechanism such as longevity, genomic stability, and inflammation. The modulation of sirtuin activity has been highlighted as a promising approach to reduce neurodegenerative processes. In this review, we summarize the recent discoveries regarding the potential relationship between SIRTs and depression caused by metabolic disorders (Mets). Ultimately, we suggest the possibility that SIRTs will be novel targets to alleviate neuropathogenesis induced by depression.

Promising link between selenium and peroxisome proliferator activated receptor gamma in the treatment protocols of obesity as well as depression

Considerable interest has been given to the significance of peroxisome proliferator activated receptors (PPARs) in macronutrient metabolism, however, there is not sufficient data concerning the interactions between PPARs and micronutrients. Investigations performed on PPARγ and one of the essential micronutrients selenium (Se) have shown that both parameters may lead to alterations in obesity-related or mood disorders. Therefore, it is plausible to consider PPARγ and Se together as a powerful combination during the treatment of two associated diseases; obesity and depression. PPARγ has been shown to be involved in the antidepressant-like activity. It is also an important parameter to be considered in obesity as the master regulator of adipogenesis. The mechanism of action of PPARγ is initiated by ligand binding which induces a conformational change in the receptor. Se is capable of alleviating inflammatory signaling pathways. Obesity is associated with chronic low-grade inflammation. Depression is also defined as an inflammatory disorder. Inflammatory mediators such as tumor necrosis factor-alpha (TNFα) participate in the progression of depression. They are also obesity-associated parameters. Due to TNFα induced depressive-like behaviors and the positive association between this proinflammatory cytokine and obesity, TNFα-activated signaling pathways and those inhibiting them have recently gained importance as potential targets and therapeutic tools, respectively. More studies are necessary to develop compounds with therapeutic nature against depressive disorders and obesity. PPARγ is an important signaling pathway that occurs at the crossroads of depression and obesity. Se, aside from its anti-inflammatory, anticarcinogenic and antioxidative nature, affects also the way of PPARγ action. Se supplementation or fortification as well as the development of the partial agonists of PPARγ in which lipophilic Se compounds are used as ligand followed by experimental trials and human studies using the newly developed compounds will be promising approaches for future hope during the treatment of these diseases.

Antidepressant medication use and glycaemic control in co-morbid type 2 diabetes and depression

OBJECTIVE

Depression is prevalent in diabetes and is associated with increased risks of hyperglycaemia, morbidity and mortality. The effect of antidepressant medication (ADM) on glycaemic control is uncertain owing to a paucity of relevant data. We sought to determine whether the use of ADM is associated with glycaemic control in depressed patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

A retrospective cohort study (n = 1399) was conducted using electronic medical record registry data of ambulatory primary care visits from 2008 to 2013. Depression and type 2 diabetes were identified from ICD-9-CM codes; ADM use was determined from prescription orders; and glycaemic control was determined from measures of glycated haemoglobin (A1c). Good glycaemic control was defined as A1c < 7.0% (53 mmol/mol). Generalized estimating equations were used to determine the effect of depression and ADM use on glycaemic control.

RESULTS

Good glycaemic control was achieved by 50.9% of depressed subjects receiving ADM versus 34.6% of depressed subjects without ADM. After adjusting for covariates, depressed patients receiving ADM were twice as likely as those not receiving ADM to achieve good glycaemic control (odds ratio = 1.95; 95% confidence interval: 1.02-3.71).

CONCLUSIONS

In this retrospective cohort study of a large sample of primary care patients with type 2 diabetes, ADM use was associated with improved glycaemic control.

Exploring the Link between the Components of Metabolic Syndrome and the Risk of Depression

BACKGROUND

Metabolic syndrome (MetS) has been reported with an increased risk of depression. MetS was also associated with insulin resistance. This study aimed to evaluate whether MetS components might contribute to depression in participants with insulin resistance (IR) or not.

METHODS

This study included 3,331 participants ≥18 years in the NHANES 2009-2010. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). MetS components were measured using blood chemistry and body measurements. IR was identified using the homeostasis model assessment method.

RESULTS

Predicted PHQ-9 scores significantly increased as the number of MetS components increased in patients with IR. The adjusted β coefficients of the predicted PHQ-9 score with 2, 4, and 5 MetS components were 1.803, 2.081, and 3.048, respectively (P for trend < 0.05). Low HDL-C levels were significantly associated with higher predicted total PHQ-9 scores in fully adjusted models in the IR group (P < 0.05).

CONCLUSION

The results indicated that the presence of a greater number of components of MetS was significantly associated with higher predicted total PHQ-9 scores in participants with IR. Among the components of MetS, the most apparent association was observed between low HDL and higher predicted total PHQ-9 scores.

Accumulation of Major Life Events in Childhood and Adult Life and Risk of Type 2 Diabetes Mellitus

Background

The aim of the study was to estimate the effect of the accumulation of major life events (MLE) in childhood and adulthood, in both the private and working domains, on risk of type 2 diabetes mellitus (T2DM). Furthermore, we aimed to test the possible interaction between childhood and adult MLE and to investigate modification of these associations by educational attainment.

Methods

The study was based on 4,761 participants from the Copenhagen City Heart Study free of diabetes at baseline and followed for 10 years. MLE were categorized as 0, 1, 2, 3 or more events. Multivariate logistic regression models adjusted for age, sex, education and family history of diabetes were used to estimate the association between MLE and T2DM.

Results

In childhood, experiencing 3 or more MLE was associated with a 69% higher risk of developing T2DM (Odds Ratio (OR) 1.69; 95% Confidence Interval (CI) 1.60, 3.27). The accumulation of MLE in adult private (p-trend = 0.016) and work life (p-trend = 0.049) was associated with risk of T2DM in a dose response manner. There was no evidence that experiencing MLE in both childhood and adult life was more strongly associated with T2DM than experiencing events at only one time point. There was some evidence that being simultaneously exposed to childhood MLE and short education (OR 2.28; 95% C.I. 1.45, 3.59) and work MLE and short education (OR 2.86; 95% C.I. 1.62, 5.03) was associated with higher risk of T2DM, as the joint effects were greater than the sum of their individual effects.

Conclusions

Findings from this study suggest that the accumulation of MLE in childhood, private adult life and work life, respectively, are risk factors for developing T2DM.

Ondansetron attenuates co-morbid depression and anxiety associated with obesity by inhibiting the biochemical alterations and improving serotonergic neurotransmission

In our earlier study we reported the antidepressant activity of ondansetron in obese mice. The present study investigates the effect of ondansetron on depression and anxiety associated with obesity in experimental mice with biochemical evidences. Male Swiss albino mice were fed with high fat diet (HFD) for 14weeks to induce obesity. Then the subsequent treatment with ondansetron (0.5 and 1mg/kg, p.o.), classical antidepressant escitalopram (ESC) (10mg/kg, p.o.) and vehicle (distilled water 10ml/kg, p.o.) was given once daily for 28days. Behavioral assay for depression including sucrose preference test, forced swim test (FST) and anxiety such as light dark test (LDT) and hole board test (HBT) were performed in obese mice. Furthermore, in biochemical estimations oral glucose tolerance test (OGTT), plasma leptin, insulin, corticosterone, brain oxidative stress marker malonaldehyde (MDA), antioxidant reduced glutathione (GSH) and serotonin assays were performed. Results indicated that HFD fed obese mice showed severe depressive and anxiety-like behaviors. Chronic treatment with ondansetron inhibited the co-morbid depression and anxiety in obese mice by increasing sucrose consumption in sucrose preference test and reducing the immobility time in FST, increasing time and transitions of light chamber in LDT, improving head dip and crossing scores in HBT compared to HFD control mice. Ondansetron in obese mice inhibited glucose sensitivity in OGTT, improved plasma leptin and insulin sensitivity, reversed hypothalamic pituitary adrenal (HPA) axis hyperactivity by reducing the corticosterone concentration, restored brain pro-oxidant/anti-oxidant balance by inhibiting MDA and elevating GSH concentrations and facilitated serotonergic neurotransmission. In conclusion, ondansetron reversed the co-morbid depression and anxiety associated with obesity in experimental mice by attenuating the behavioral and biochemical abnormalities.

Factors influencing insulin resistance in relation to atherogenicity in mood disorders, the metabolic syndrome and tobacco use disorder

OBJECTIVE

This study examines the effects of malondialdehyde (MDA) and uric acid on insulin resistance and atherogenicity in subjects with and without mood disorders, the metabolic syndrome (MetS) and tobacco use disorder (TUD).

METHODS

We included 314 subjects with depression and bipolar depression, with and without the MetS and TUD and computed insulin resistance using the updated homeostasis model assessment (HOMA2IR) and atherogenicity using the atherogenic index of plasma (AIP), that is log10 (triglycerides/high density lipoprotein (HDL) cholesterol.

RESULTS

HOMA2IR is correlated with body mass index (BMI) and uric acid levels, but not with mood disorders and TUD, while the AIP is positively associated with BMI, mood disorders, TUD, uric acid, MDA and male sex. Uric acid is positively associated with insulin and triglycerides and negatively with HDL cholesterol. MDA is positively associated with triglyceride levels. Comorbid mood disorders and TUD further increase AIP but not insulin resistance. Glucose is positively associated with increasing age, male gender and BMI.

DISCUSSION

The results show that mood disorders, TUD and BMI together with elevated levels of uric acid and MDA independently contribute to increased atherogenic potential, while BMI and uric acid are risk factors for insulin resistance. The findings show that mood disorders and TUD are closely related to an increased atherogenic potential but not to insulin resistance or the MetS. Increased uric acid is a highly significant risk factor for insulin resistance and increased atherogenic potential. MDA, a marker of lipid peroxidation, further contributes to different aspects of the atherogenic potential. Mood disorders and TUD increase triglyceride levels, lower HDL cholesterol and are strongly associated with the atherogenic, but not insulin resistance, component of the MetS.

Toxic stress, inflammation and symptomatology of chronic complications in diabetes

Diabetes affects at least 382 million people worldwide and the incidence is expected to reach 592 million by 2035. The incidence of diabetes in youth is skyrocketing as evidenced by a 21% increase in type 1 diabetes and a 30.5% increase in type 2 diabetes in the United States between 2001 and 2009. The effects of toxic stress, the culmination of biological and environmental interactions, on the development of diabetes complications is gaining attention. Stress impacts the hypothalamus-pituitary-adrenal axis and contributes to inflammation, a key biological contributor to the pathogenesis of diabetes and its associated complications. This review provides an overview of common diabetic complications such as neuropathy, cognitive decline, depression, nephropathy and cardiovascular disease. The review also provides a discussion of the role of inflammation and stress in the development and progression of chronic complications of diabetes, associated symptomatology and importance of early identification of symptoms of depression, fatigue, exercise intolerance and pain.

Bidirectional longitudinal study of type 2 diabetes and depression symptoms in black and white church going adults

BACKGROUND

There is a need to longitudinally examine depression and DM2 relationship in a population that values positive health behaviors. The aim of this study was to prospectively investigate the bidirectional relationship between depression and DM2.

METHODS

A cohort sample of 4,746 Black (28.4%) and White (71.6%) Seventh-day Adventist adults who participated in the Biopsychosocial Religion and Health Study (BRHS) completed a short form of the Center for Epidemiologic Studies Depression Scale (CES-D) 11 along with self-report of lifetime physician diagnosis of type 2 diabetes (DM2) and treatment of DM2 and/or depression in the last 12 months in 2006-7 and 2010-11. Hierarchical logistic regression analyses were completed to predict risk for future disease while controlling for demographic and health related variables.

RESULTS

While there were no direct effects of depression on later DM2, there was an indirect effect mediated by BMI (effect = 0.13; 95% CIs [0.08, 0.20]) even after controlling for demographic variables as covariates using Hayes' PROCESS macro mediation analysis. Similarly, there was also only an indirect effect of DM2 on later depression mediated by BMI (effect = 0.13; 95% CIs [0.05, 0.22]) after controlling for demographic variables.

CONCLUSIONS

The results highlight BMI as a risk factor for both DM2 and depression. The negative consequences of having higher BMI in conjunction at baseline with another disease can increase the risk for other chronic disease even in a span of 2.04 - 5.74 years, the length of study interval.

Incidence and risk of depression associated with diabetes in adults: evidence from longitudinal studies

This meta-analysis examined depression as a consequence of diabetes by conducting a meta-analysis, using data from longitudinal studies. Databases were systematically searched for relevant studies. Incidence of depression is presented as cumulative incident proportion (CIP). Pooled effect sizes were calculated using random-effects model. The data were reconstructed to compute relative risk (RR) and CIP. The 16 studies selected for review generated 16 datasets of which 11 studies reporting binary estimates (RR) and 5 studies reporting time-to-event estimates [hazard ratio (HR)]. Both RR and HR were significant at 1.27 (95% CI 1.17-1.38) and 1.23 (95% CI 1.08-1.40) for incident depression associated with diabetes mellitus. Our observations also revealed greater cumulative incidence of depression in diabetes than in non diabetes groups. Our study shows that diabetes is a significant risk factor for the onset of depression.

Influência da diabetes e a prática de exercício físico e atividades cognitivas e recreativas sobre a função cognitiva e emotividade em grupos de terceira idade

OBJETIVO: Neste estudo buscou-se verificar a influência da participação em atividades de grupos de terceira idade (GTI), envolvendo a prática de exercícios físicos e atividades cognitivas e recreativas, sobre a função cognitiva e aspectos emocionais, como ansiedade e depressão, de idosos diabéticos e não diabéticos. MÉTODOS: Participaram deste estudo descritivo transversal 158 idosos, subdivididos em quatro grupos: (1) idosos não participantes de GTI e não diabéticos; (2) idosos não participantes de GTI e diabéticos; (3) idosos participantes de GTI e não diabéticos; e (4) idosos participantes de GTI e diabéticos. Todos os idosos foram submetidos a um protocolo de avaliação cognitiva (Miniexame do Estado Mental-MEEM, Teste de Recordação Imediata e Tardia Livre de Palavras - RIP e RTP, respectivamente, e Teste de Reconhecimento de Faces Famosas-FF), ansiedade (IDATE) e depressão (Escala de Depressão Geriátrica-EGD). Para comparação entre os grupos, utilizou-se ANOVA de uma via para os dados paramétricos e teste de Kruskal-Wallis para os não paramétricos. RESULTADOS: Os idosos participantes do estudo tinham idade média de 72,63±6,84 anos (75% mulheres e 25% homens). Os resultados demonstraram que os idosos do grupo 2 (diabéticos e não participantes de GTI) apresentaram menores escores cognitivos do que os do grupo 3 (não diabéticos e participantes de GTI) (p=0,012 no MEEM; p=0,028 na RIP; p=0,011 na EGD). CONCLUSÃO: Pode-se afirmar que a associação da diabetes mellitus com um estilo de vida menos ativo, sem a prática de exercícios físicos e atividades recreativas e cognitivas, possivelmente representa um fator de risco para a aceleração das perdas cognitivas que acompanham o processo de envelhecimento.

Depression among older adults with diabetes mellitus

Older adults with Diabetes Mellitus (DM) experience greater risk for comorbid depression compared to those who do not have DM. Undetected, untreated or under-treated depression impinges an individual's ability to manage their DM successfully, hinders their adherence to treatment regime, and undermines provider-patient relationships. Thus, in the context of caring for older adults with DM, comorbid depression presents special challenges and opportunities for clinicians. In this article, we summarize the clinical presentation of late-life depression, potential mechanisms of comorbidity of depression and DM, importance of depression in the successful management of DM, and available best practice models for depression treatment.

Differential association of insulin resistance with cognitive and somatic symptoms of depression

AIM

To examine the associations of depressive symptoms with insulin resistance, evaluating somatic and cognitive depressive symptoms separately.

METHODS

A total of 328 individuals (mean age 60 years) referred for exercise stress testing, taking part in the Mechanisms and Outcomes of Silent Myocardial Ischemia study, completed the Beck Depression Inventory II. A fasting venous blood sample was collected for assessments of insulin and glucose level; the HOMA-IR (homeostatic model assessment of insulin resistance) was calculated. In principal component analysis, Beck Depression Inventory II items were forced to load onto two components (somatic and cognitive depressive symptoms). Adjusting for age, sex, BMI, medication use, smoking, physical activity, diabetes and cardiovascular disease, general linear model analyses were conducted to examine the associations between the components and log HOMA-IR .

RESULTS

Principal component analysis showed that nine items loaded onto a cognitive depressive symptoms component and 10 items loaded onto a somatic depressive symptoms component. When examined separately, both components were significantly associated with log HOMA-IR however, when including both components simultaneously in the model, only somatic depressive symptoms remained significantly associated with log HOMA-IR. Back-transformed, a one-unit change in somatic depressive symptoms was associated with a 1.07 (95% CI 1.002, 1.14) change in HOMA-IR and a one-unit change in cognitive depressive symptoms was associated with a 1.03 (95% CI 0.97, 1.14) change in HOMA-IR.

CONCLUSION

Somatic depressive symptoms seem to be more strongly associated with insulin resistance than do cognitive depressive symptoms. Monitoring somatic depressive symptoms may be more appropriate than monitoring cognitive depressive symptoms among depressed individuals with high insulin resistance.

Sleep duration and insulin resistance in individuals without type 2 diabetes: the PPP-Botnia study

INTRODUCTION

Both short and long sleep duration may increase risk of type 2 diabetes (diabetes). We studied if short and long sleep durations were associated with insulin resistance (IR) and insulin secretion in individuals without diabetes, and if the associations remained after we excluded individuals who reported more frequent and severe complaints of sleep apnea and insomnia.

PARTICIPANTS AND METHODS

An oral glucose tolerance test (OGTT) was performed for 722 adults without diabetes. Indices of IR and insulin secretion were calculated. Sleep duration and complaints of sleep apnea and insomnia were self-reported.

RESULTS

In comparison to average sleepers (6-9 h/night), short sleepers (< 6 h/night) had higher 120-min insulin and AUC glucose, and long sleepers (≥ 9 h/night) had higher fasting and 120-min insulin, 120-min glucose, and HOMAIR and lower Insulin Sensitivity Index. After adjusting for confounders and after excluding individuals who reported more frequent and severe complaints of sleep apnea and insomnia, long sleep duration remained significantly associated with IR and insulin secretion.

DISCUSSION

Long but not short sleep duration is associated with IR and insulin secretion in individuals without diabetes whether or not accompanied by sleep complaints. Long sleepers may benefit from targeted preventions and interventions that aim at reducing risk of future diabetes.

Potential benefits of mindfulness-based interventions in mild cognitive impairment and Alzheimer's disease: an interdisciplinary perspective

The present article is based on the premise that the risk of developing Alzheimer's disease (AD) from its prodromal phase (mild cognitive impairment; MCI) is higher when adverse factors (e.g., stress, depression, and metabolic syndrome) are present and accumulate. Such factors augment the likelihood of hippocampal damage central in MCI/AD aetiology, as well as compensatory mechanisms failure triggering a switch toward neurodegeneration. Because of the devastating consequences of AD, there is a need for early interventions that can delay, perhaps prevent, the transition from MCI to AD. We hypothesize that mindfulness-based interventions (MBI) show promise with regard to this goal. The present review discusses the associations between modifiable adverse factors and MCI/AD decline, MBI's impacts on adverse factors, and the mechanisms that could underlie the benefits of MBI. A schematic model is proposed to illustrate the course of neurodegeneration specific to MCI/AD, as well as the possible preventive mechanisms of MBI. Whereas regulation of glucocorticosteroids, inflammation, and serotonin could mediate MBI's effects on stress and depression, resolution of the metabolic syndrome might happen through a reduction of inflammation and white matter hyperintensities, and normalization of insulin and oxidation. The literature reviewed in this paper suggests that the main reach of MBI over MCI/AD development involves the management of stress, depressive symptoms, and inflammation. Future research must focus on achieving deeper understanding of MBI's mechanisms of action in the context of MCI and AD. This necessitates bridging the gap between neuroscientific subfields and a cross-domain integration between basic and clinical knowledge.

Depressive symptom clusters as predictors of 6-year increases in insulin resistance: data from the Pittsburgh Healthy Heart Project

OBJECTIVE

To examine longitudinal bidirectional associations between two depressive symptom clusters-the cognitive-affective and somatic-vegetative clusters--and insulin resistance, a marker of prediabetes.

METHODS

Participants were 269 adults aged 50 to 70 years without diabetes enrolled in the Pittsburgh Healthy Heart Project, a prospective cohort study. At baseline and 6-year visits, participants completed the Beck Depression Inventory-II (BDI-II) and underwent a blood draw to quantify fasting insulin and glucose. We examined baseline BDI-II total, cognitive-affective, and somatic-vegetative scores as predictors of 6-year change in the homeostatic model of assessment (HOMA) score, an estimate of insulin resistance computed from fasting insulin and glucose. We also examined baseline HOMA score as a predictor of 6-year change in BDI-II total and subscale scores.

RESULTS

Regression analyses, adjusted for demographic factors and baseline HOMA score, revealed that the baseline BDI-II somatic-vegetative score (β = 0.14, p = .025), but not the cognitive-affective (β = 0.001, p = .98) or total (β = 0.10, p = .11) scores, predicted 6-year HOMA change. This result persisted in models controlling for anxiety symptoms and hostility. Several factors were examined as candidate mediators; however, only change in body mass index was a significant mediator (p = .042), accounting for 23% of the observed association. Baseline HOMA score did not predict 6-year change in BDI-II total or subscale scores (all p values >.56).

CONCLUSIONS

Among adults aged 50 to 70 years, the somatic-vegetative symptoms of depression (e.g., fatigue, sleep disturbance, and appetite changes) may worsen insulin resistance and increase diabetes risk, partly, by increasing body mass index.

Prevalence of anxiety and depression among diabetic African patients in Guinea: association with HbA1c levels

AIM

The prevalence and risk factors associated with symptoms of anxiety and depression were determined in African people with diabetes.

METHODS

This cross-sectional study involved 491 outpatients with type 2 diabetes (T2D) recruited from four diabetes clinics (Conakry, Labé, Boké and Kankan) in Guinea. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate symptoms of anxiety and depression. Logistic regression analysis stratified by gender was performed to identify the associated risk factors.

RESULTS

Anxiety and depression symptoms were present in 58.7% and 34.4%, respectively, of the 491 patients with T2D (62.7% women, mean±SD age: 57.9±10.2years). Odds ratios (95% CI) of risk factors independently associated with anxiety were urban residence [2.98 (1.81-4.89)] in women, and low socioeconomic status [0.19 (0.05-0.70)] and HbA1c≥9.0% [2.61 (1.0-6.39)] in men. Factors associated with depression were urban residence [2.13 (1.27-3.58)], older age [1.03 (1.01-1.06)], low socioeconomic status [2.21 (1.34-3.66)] and no previous measurement of HbA1c [12.45 (1.54-100.34)] in women, and insulin therapy [2.28 (1.05-4.92)] and HbA1c≥9.0% [3.85 (1.02-14.48)] in men.

CONCLUSION

Anxiety and depression symptoms in people with type T2D are common in Guinea. Urban residence, low socioeconomic status and high levels of HbA1c were significantly associated with a greater risk of anxiety and depression, highlighting the psychological burden related to diabetes in Africa.

A decline in inflammation is associated with less depressive symptoms after a dietary intervention in metabolic syndrome patients: a longitudinal study

Background

Metabolic syndrome (MetS) and depression have become two prevalent diseases worldwide, whose interaction needs further investigation. Dietary treatment for weight loss in patients with MetS may improve depressive manifestations, however, the precise interactive pathways remain uncertain. Therefore, the aim of this study was to examine the effects of a hypocaloric diet designed to reduce MetS features on self-perceived depression and the possible underlying factors.

Methods

Sixty subjects (Age: 50 ± 1 y; BMI: 36.1 ± 0.6 kg/m²) with MetS were selected from the RESMENA study (control and intervention) after they completed the 6-months hypocaloric treatment and rated for depressive symptoms using the Beck Depression Inventory (BDI). Anthropometric and biochemical measurements including leptin, C-reactive protein (CRP) and insulin levels were evaluated.

Results

Depressive symptoms decreased during the weight loss intervention, with no differences between both dietary groups (control group −4.2 ± 0.8 vs RESMENA group −3.2 ± 0.6, P = 0.490). The number of criteria of the MetS was higher among subjects with more somatic-related depressive symptoms at baseline (B = 1.032, P-trend = 0.017). After six months of dietary treatment, body weight decreased in all subjects (−8.7%; confidence interval (95% CI) = 7.0-9.7) and also self-perceived depression (−37.9%; 95% CI = 2.7-4.9), as well as circulating leptin (−20.1%; 95% CI = 1.8-6.8), CRP (−42.8%; 95% CI = 0.6-3.0) and insulin (−37.7%; 95% CI = 4.1-7.2) concentrations. The decrease in BDI was significantly associated with declines in body fat mass (B = 0.34, 95% CI = 0.11-0.56) and also with the decrease in leptin (B = 0.16, 95% CI = 0.04-0.28) and CRP (B = 0.24, 95% CI = 0.01-0.46) concentrations.

Conclusions

The decrease in depressive manifestations after a weight loss intervention was related with adiposity, CRP and leptin in subjects with MetS.

Trial registration

ClinicalTrials.gov: NCT01087086.

Differential anti-diabetic effects and mechanism of action of charantin-rich extract of Taiwanese Momordica charantia between type 1 and type 2 diabetic mice

Momordica charantia Linn. (Cucurbitaceae), also called bitter melon, has traditionally been used as a natural anti-diabetic agent for anti-hyperglycemic activity in several animal models and clinical trials. We investigated the differences in the anti-diabetic properties and mechanism of action of Taiwanese M. charantia (MC) between type 1 diabetic (T1D) and type 2 diabetic (T2D) mice. To clarify the beneficial effects of MC, we measured non-fasting glucose, oral glucose tolerance, and plasma insulin levels in KK/HIJ mice with high-fat diet-induced diabetes (200 mg/kg/day of charantin-rich extract of MC [CEMC]) and in ICR mice with STZ-induced diabetes. After 8 weeks, all the mice were exsanguinated, and the expression of the insulin-signaling-associated proteins in their tissue was evaluated, in coordination with the protective effects of CEMC against pancreatic β-cell toxicity (in vitro). Eight weeks of data indicated that CEMC caused a significant decline in non-fasting blood glucose, plasma glucose intolerance, and insulin resistance in the KK/HIJ mice, but not in the ICR mice. Furthermore, CEMC decreased plasma insulin and promoted the sensitivity of insulin by increasing the expression of GLUT4 in the skeletal muscle and of IRS-1 in the liver of KK/HIJ mice; however, CEMC extract had no effect on the insulin sensitivity of ICR mice. In vitro study showed that CEMC prevented pancreatic β cells from high-glucose-induced cytotoxicity after 24 h of incubation, but the protective effect was not detectable after 72 h. Collectively, the hypoglycemic effects of CEMC suggest that it has potential for increasing insulin sensitivity in patients with T2D rather than for protecting patients with T1D against β-cell dysfunction.

Longitudinal changes in health-related quality of life in normal glucose tolerance, prediabetes and type 2 diabetes: results from the KORA S4/F4 cohort study

PURPOSE

The aim of this study was to examine how transition between normal glucose tolerance, prediabetes and diabetes over a 7 year period is associated with change in health-related quality of life (HRQL) in an elder German population-based cohort.

METHODS

We used data from 1,046 participants of the KORA S4/F4 cohort study aged 55-74 years at baseline. Based on an oral glucose tolerance test, prediabetes was defined as impaired fasting glucose and/or impaired glucose tolerance. HRQL was assessed with the SF-12 questionnaire. Using linear regression, we estimated mean change in HRQL over time, depending on glucose status at baseline and follow-up, adjusted by demographic and lifestyle variables.

RESULTS

Individuals progressing to prediabetes or diabetes experienced a greater loss in the physical component score than patients with persistent normal glucose tolerance (-2.31 and -7.44 vs. -1.08), but the difference was only significant for subjects converting to diabetes. Subjects with prediabetes at baseline and diabetes at follow-up had a significant loss in mental health compared to subjects with persistent prediabetes.

CONCLUSIONS

There is first evidence that worsening of glucose metabolism over time is associated with deteriorating HRQL, however, further and larger longitudinal studies are needed to confirm these findings.

State of the science: depression and type 2 diabetes

Depression is a significant comorbid condition in diabetes. Individuals with type 2 diabetes (T2DM) are 2 times more likely to experience depression or elevated depressive symptoms compared to those without T2DM. The aims of this state of the science review were to summarize the putative links between diabetes and depression and review empirically supported treatments of depression in diabetes. Findings suggest that a bidirectional association between depression and T2DM exists and that several biological and psychosocial mediators underlie these conditions. Available data indicate that conventional treatments (antidepressant medication, cognitive behavioral therapy, and collaborative care) reduce depression and symptoms of depression; however more controlled studies and development of novel therapies are needed. Glycemic outcomes have most frequently been examined, but findings have been mixed. Self-care and adherence outcomes have been less well studied. Emerging evidence suggests that these outcomes may be important targets for future depression research in T2DM.

Food-based strategies for depression management from Iranian traditional medicine resources

Background:

Considering the increasing prevalence of depression in contemporary societies, general tendency for safer treatments with fewer side effects has recently been a subject of interest.

Objectives:

Food-based strategies, which are one of the outstanding medical solutions in Complementary and Alternative Medicine including Iranian Traditional Medicine have been investigated.

Materials and Methods:

In this review study, firstly some important sources of Iranian Traditional Medicine including Kamel al-Sanaat al-Tibbyyah, Al-Qanun fi al-Tibb and Zakhireh Kharazmshahi were reviewed. Next, a literature search was performed on PubMed and Magiran databases with the keywords “depression”, “depressive”, “mood”, “antidepressant”, “antidepressive”, “nutrition”, “nutritional”, “diet”, “meal”, “food”, “functional food”, “healthy food”, “healthy diet”, “medicinal food” and scientific and English terms of all singular foodstuff and some combined foodstuff which are introduced in this paper.

Results:

Food-based strategies for depression management in Iranian Traditional Medicine resources involving both prevention and treatment parts have been classified under three headings singular foodstuffs, combined foodstuffs, and nutrition rules with the separation of prohibition and prescription items. Among the prescribed or the prohibited singular and combined foodstuffs in Iranian Traditional Medicine manuscripts, only the effectiveness of fish, garlic, milk, oregano, mint, and spinach on depression has been examined by modern medicine methods.

Conclusions:

The presented food-based strategies in this study introduce a precise management for depression benefiting from Iranian Traditional Medicine Resources.

Population impact of depression either as a risk factor or consequence of type 2 diabetes in adults: a meta-analysis of longitudinal studies

This meta-analysis examined the reciprocal relationship between depression and diabetes mellitus type 2 (T2DM) by conducting a bias adjusted meta-analysis of longitudinal studies using relative and absolute risk estimates. Specifically, the data were reconstructed to compute relative risk (RR), risk difference (RD), and the number needed to be exposed for one additional person to be harmed (NNEH) or benefited (NNEB). The 25 studies selected for review generated 29 datasets of which 15 examined endpoint A (depression as a risk factor for T2DM), and 14 examined endpoint B (T2DM as a risk factor for depression). For both endpoints, there was a small relative risk increase (for both the RR and hazard ratio (HR)) though with significant heterogeneity between studies. This however translated to a non-significant NNEH of 87 (NNEB 161 to ∞ to NNEH 35) and NNEH of 233 (NNEB 28 to ∞ to NNEH 23) for studies examining endpoint A and endpoint B respectively. This study suggests that the magnitude of the relative risk increase for depression as a risk factor or consequence of T2DM is small without significant impact on absolute risk indices. While these risks may be considered in terms of individual patient management, they are unlikely to have an impact on a population perspective.

Elevated alanine aminotransferase independently predicts new onset of depression in employees undergoing health screening examinations

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of elevated alanine aminotransferase (ALT). NAFLD is associated with insulin resistance and hepatic inflammation. Similarly, patients with depression exhibit insulin resistance and increased inflammatory markers. However, no study has shown a clear association between elevated ALT and the development of depression. The aim of the study was to test whether elevated ALT, a surrogate marker for NAFLD, predicts the development of depression.

METHOD

The present prospective cohort study investigated 12 180 employed adults referred for health examinations that included fasting blood tests and anthropometric measurements between 2003 and 2010. Exclusion criteria were: baseline minor/major depression, excessive alcohol consumption and other causes for ALT elevation. Depression was evaluated by the eight-item Patient Health Questionnaire (PHQ-8) score.

RESULTS

The final cohort included 5984 subjects [69.4% men, aged 45.0 (s.d. = 10.24) years]. The incidence rate of minor and major depression was 3.8% and 1.4%, respectively. Elevated ALT was a significant independent predictor for the occurrence of minor [odds ratio (OR) 2.02, 95% confidence interval (CI) 1.40-2.92] and major (OR 3.132, 95% CI 1.81-5.40) depression after adjusting for age, gender, body mass index, education level, serum levels of lipids, glucose, smoking and physical activity. Adding subjective health and affective state parameters (sleep disturbances, self-rated health, anxiety and burnout) as potential mediators only slightly ameliorated the association. Persistently elevated ALT was associated with the greatest risk for minor or major depression as compared with elevation only at baseline or follow-up (p for trend < 0.001).

CONCLUSIONS

Elevated ALT was associated with developing depressive symptoms, thus suggesting that NAFLD may represent an independent modifiable risk factor for depression.

Antenatal depression and gestational diabetes: a review of maternal and fetal outcomes

Depression and gestational diabetes are common and serious problems during pregnancy. While information exists regarding maternal and fetal outcomes in women who have either depression or gestational diabetes, there is a paucity of data regarding outcomes in women who have both. This article reviews and summarizes studies examining depression during pregnancy as well as an analysis of six studies examining depression in women with gestational diabetes, and discusses implications for clinicians and future research needs.