Association between depressive symptoms and dietary intake in patients with type 1 diabetes

Risk of depression and anxiety disorders according to long-term glycemic variability

BACKGROUND

Poor glycemic control has been linked to psychiatric symptoms. However, studies investigating the relationship between glycemic variability (GV) and depression and anxiety disorders are limited. We investigated the association of GV with depression and anxiety disorders. In addition, the relationship between trends in fasting plasma glucose (FPG) levels and these disorders were explored.

METHODS

We analyzed the National Health Insurance Service-National Sample Cohort database (2002-2013) with 151,814 participants who had at least three health screenings between 2002 and 2010. Visit-to-visit FPG variability was measured as variability independent of the mean (VIM). Depression and anxiety disorders were diagnosed using ICD-10 codes (F41 for anxiety and F32 or F33 for depression) after index date. We analyzed the association between GV and incidences of these disorders using Kaplan-Meier and Cox proportional hazards methods. Trajectory analysis was conducted to explore the relationship between FPG trends and these disorders.

RESULTS

During follow-up, 7166 and 14,149 patients were newly diagnosed with depression and anxiety disorders, respectively. The highest quartile group of FPG-VIM had a greater incidence of depression and anxiety than the lowest quartile group, with adjusted hazard ratios of 1.09 (95 % confidence interval [CI]: 1.02-1.17) and 1.08 (95 % CI: 1.03-1.14). Group with persistent hyperglycemia, identified through trajectory clustering of FPG levels, had a 1.43-fold increased risk of depression compared to those with consistently low FPG levels.

LIMITATIONS

Potential selection bias by including participants with at least three health screenings.

CONCLUSIONS

High GV and persistent hyperglycemia are associated with increased incidence of depression and anxiety disorders.

Glucose variability and mood in people with type 1 diabetes using ecological momentary assessment

OBJECTIVE

Mood fluctuations related to blood glucose excursions are a commonly reported source of diabetes-distress, but research is scarce. We aimed to assess the relationship between real-time glucose variability and mood in adults with type 1 diabetes (T1D) using ecological momentary assessments.

METHODS

In this prospective observational study, participants wore a masked continuous glucose monitor and received prompts on their smartphone 6 times a day to answer questions about their current mood (Profile Of Mood States (POMS)-SF (dimensions: Anxiety, Depressive symptoms, Anger, Fatigue, Vigor)) for 14 days. Mixed model analyses examined associations over time between daily Coefficient of Variation (CV) of blood glucose and mean and variability (CV) of POMS scores. Further, within-person differences in sleep and nocturnal hypoglycemia were explored.

RESULTS

18 people with T1D (10 female, mean age 44.3 years) participated. A total of 264 out of 367 days (70.2%) could be included in the analyses. No overall significant associations were found between CV of blood glucose and mean and CV of POMS scores, however, nocturnal hypoglycemia moderated the associations between CV of blood glucose and POMS scales (mean Fatigue Estimate 1.998, p < .006, mean Vigor Estimate -3.308, p < .001; CV Anger Estimate 0.731p = 0.02, CV Vigor Estimate -0.525, p = .006).

CONCLUSION

We found no overall relationship between real-time glycemic variability and mood per day. Further research into within-person differences such as sleep and nocturnal hypoglycemia is warranted.

Dietary protein intake affects the association between urinary iodine and clinically relevant depression: Evidence from NHANES 2007-2018

Both iodine concentration and protein intake are important nutritional factors that may influence the development of depressive symptoms. However, there are no studies on the effect of protein intake on the relationship between iodine concentration and the risk of depression. The study aimed to explore the relationship between iodine and the risk of clinically relevant depression (CRD) according to protein intake. This study analyzed the adults (≥18 years) who participated in the 2007-2018 National Health and Nutrition Cross-sectional Survey (N = 10,462). CRD was assessed using the Patient Health Questionnaire (PHQ-9). Protein intake was assessed using two 24-h dietary recalls and urinary iodine concentration (UIC) was measured using inductively coupled plasma dynamic response cell mass spectrometry. Weighted multivariate logistic regression and restrictive cubic splines were performed to assess the relationship between UIC and CRD according to protein category (low protein intake <0.8 g/kg/day; high protein intake: ≥0.8 g/kg/day). After controlling for sociodemographic, behavioral, chronic diseases, and dietary factors, a positive correlation was observed between UIC (log10) and CRD (OR: 1.36, 95% CI: 1.026, 1.795). Low UIC (<100 μg/L) was associated with a lower prevalence of CRD (OR: 0.73, 95% CI: 0.533, 0.995) in high protein intake individuals, whereas this relationship did not exist in those with low protein intake. Moreover, restrictive cubic splines confirmed a near L-shaped relationship between UIC and CRD in the low-protein group (nonlinear p = .042) and a linear relationship between them in the high-protein group (nonlinear p = .392). This study illustrates that protein intake affects the relationship between UIC and CRD. Combining lower UIC and high protein intake may help reduce the prevalence of CRD, which would have significant implications for managing patients with depressive CRD in the clinical setting.

Exercise and nutrition in type 1 diabetes: Insights from the FinnDiane cohort

Type 1 diabetes is a challenging disease, characterized by dynamic changes in the insulin need during life periods, seasons of the year, but also by everyday situations. In particular, changes in insulin need are evident before, during and after exercise and having meals. In the midst of different life demands, it can be very burdensome to achieve tight glycemic control to prevent late diabetes complications, and at the same time, to avoid hypoglycemia. Consequently, many individuals with type 1 diabetes are faced with diabetes distress, decreasing profoundly their quality of life. Today, the nationwide Finnish Diabetic Nephropathy (FinnDiane) Study, launched in 1997, has gathered data from more than 8,000 well-characterized individuals with type 1 diabetes, recruited from 93 centers all over Finland and has established its position as the world's leading project on studying complications in individuals with type 1 diabetes. Studying risk factors and mechanisms of diabetes complications is inconceivable without trying to understand the effects of exercise and nutrition on glycemic control and the development of diabetes complications. Therefore, in this paper we provide findings regarding food and exercise, accumulated during the 25 years of studying lives of Finnish people with type 1 diabetes.

Glucose variability and mood in adults with diabetes: A systematic review

Aims

To systematically review the literature regarding the association between glucose variability (GV) and mood in adults with diabetes, appraise the used methods and make suggestions for future research.

Methods

A systematic review of literature published up to May 2019 was performed. Abstracts and full texts were screened independently in duplicate. Experimental and observational studies reporting the association between GV and mood in adults with type 1 diabetes or type 2 diabetes were evaluated. A descriptive analysis of the extracted data was conducted, along with a quality assessment.

Results

Out of the 2.316 studies screened, eight studies met our criteria. Studies used a variety of measures and metrics to determine GV and mood. Four studies used continuous glucose monitoring (CGM). An association between GV and mood was found in four studies when correlating either postprandial glucose rate of increase with current mood or multiday GV with mood measured retrospectively. The other four studies did not find any association.

Conclusions

There is no clear empirical support for a link between GV and mood in adults with type 1 and type 2 diabetes. More rigorous research is warranted using CGM and ecological momentary assessment of mood to assess if and under what conditions an association between GV and mood exists.

Depressive and anxiety symptoms and following of the Dutch Dietary Guidelines 2015 in adults with diabetes: Results from Diabetes MILES-The Netherlands

OBJECTIVE

This study aims to examine the associations between following of the Dutch dietary guidelines 2015 and elevated depressive and anxiety symptoms in adults with diabetes.

METHODS

Cross-sectional data of 3174 people (47% men, mean age 55 ± 14 years) with type 1 diabetes (n = 1369) and type 2 diabetes (n = 1805) participating in Diabetes MILES-The Netherlands were analysed. Following of the Dutch dietary guidelines 2015 was quantified using the Dutch Healthy Diet 2015 (DHD15)-index (12 food components; total score range 0-120 points), calculated from a 32-item food frequency questionnaire. Cases with elevated depressive and anxiety symptoms (cutoff ≥ 10) were measured using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. Cox regression models were used to estimate the prevalence ratios (PRs) adjusted for demographical, lifestyle related, clinical and biomedical factors.

RESULTS

Elevated depressive and anxiety symptoms were present in 167 (12%) and 89 (7%) of participants with type 1 diabetes and 215 (12%) and 97 (5%) of those with type 2 diabetes, respectively. In the total sample (n = 3174), a DHD15-index score in the highest quartile was associated with lower prevalence of elevated depressive symptoms, compared to the lowest quartile with an adjusted PR [95% CI] of 0.73 [0.55-0.98]. The inverse association was more pronounced among participants with type 2 diabetes and among non-smokers. There was no association with elevated anxiety symptoms (adjusted PR [95% CI]: 1.03 [0.68-1.55]).

CONCLUSION

Closer following of the Dutch dietary guidelines 2015 was associated with a lower likelihood of elevated depressive symptoms in adults with type 2 diabetes.

Depressive symptoms and disorders in type 2 diabetes mellitus

PURPOSE OF REVIEW

To examine developments in the understanding of certain aspects of depression in diabetes mellitus patients with a special focus on diabetes distress, screening of depression and its management in persons with type 2 diabetes mellitus.

RECENT FINDINGS

Recent studies reviewed indicate an increasing trend of both major and minor depression in patients with diabetes. Depression is also reported to be persistent and chronic in diabetes patients. There is a bidirectional link between depression and diabetes. Diabetes-related distress independently increases the diabetes-related complications. Collaborative care is both applicable and helpful in managing depression in diabetes.

SUMMARY

Although a significant number of patients with diabetes suffer from depression or diabetes-related distress, majority of them remain undiagnosed and untreated. This treatment gap suggests the need for routine screening for depression and distress in patients with diabetes. Studies have confirmed that treatment focussing on diabetes may alleviate depressive symptoms. Diabetes-specific psychological interventions may prove useful in improving diabetes self-management in depressed diabetes patients. Effect of specific psychopharmacological and psychological interventions in treating depression in diabetes patients should be examined in future studies.

Association between dietary protein intake and the risk of depressive symptoms in adults

Depression is an important public health problem. The aim of the study is to explore the associations of total protein intake and protein sources with the risk of depressive symptoms. This cross-sectional study used data from the National Health and Nutrition Examination Survey for the years 2007–2014. Dietary protein intake was obtained from two 24-h dietary recall interviews. Depressive symptoms were assessed by a nine-item Patient Health Questionnaire. Logistic regression models and restricted cubic spline models were used to estimate the associations of total protein intake (g/kg per d) and protein sources with the risk of depressive symptoms. A total of 17 845 individuals aged 18 years and older were included in this study. Total protein intake was inversely associated with the risk of depressive symptoms. The full-adjusted OR of depressive symptoms was 0·34 (95 % CI 0·17, 0·68) for quartile (Q) 4 v. Q1 of total protein intake. For protein intake from milk and milk products, the association with depressive symptoms was significant both for Q2 v. Q1 (OR 0·61; 95 % CI 0·41, 0·93) and Q3 v. Q1 (OR 0·37; 95 % CI 0·24, 0·59) in the full-adjusted model. In the dose–response analysis, the shape of the associations of total protein intake and protein intake from milk and milk products with the risk of depressive symptoms was approximately L-shaped and U-shaped, respectively. The present study demonstrated that total protein intake and protein intake from milk and milk products might reduce the risk of depressive symptoms in US adults.

Is there any association between dietary patterns, food security status and psychiatric disorders among Iranian earthquake victims?

BACKGROUND

Diet changes through disasters may affect psychological health as well as general health. The present study aimed to find food security status-that is defined by having enough food for an active, healthy life-dietary patterns and their relationship with probable psychiatric disorders in earthquake survivors.

METHODS

This cross-sectional study conducted on 350 women who survived in East Azarbaijan earthquake (At 4:53 am on 11 August 2012). Food frequency questionnaire, Depression, Anxiety and Stress Scale and food security questionnaire of the US Department of Agriculture were used to assess dietary patterns, psychological and food security status, respectively. P values were considered significant at <0.05.

RESULTS

Four major dietary patterns were defined based on factor analysis. These four dietary patterns explained of 37.09% variation of food intakes. Ten per cent of the population was food secure. There was no significant association between tertiles of major dietary patterns and risk of all psychological disorders (p values>0.05).

CONCLUSION

There was no statistically significant association between major dietary patterns and psychiatric disorders. Further well-designed studies need to find any significant association.

Diabetes Distress, Depressive Symptoms, and Cardiovascular Health in Adults With Type 1 Diabetes

BACKGROUND

The prevalence of adults with Type 1 diabetes (T1D) is increasing, and their risk of cardiovascular disease is high. Comorbid diabetes distress and depressive symptoms may affect their cardiovascular health.

OBJECTIVES

The purpose of this study was to describe the relationship between diabetes distress and depressive symptoms with cardiovascular health factors.

METHODS

This was a cross-sectional survey of a sample of adults with T1D. Valid and reliable instruments were used to collect the data on sociodemographics, diabetes-related complications, psychological factors, and cardiovascular health factors. Independent-sample t tests, analysis of variance, chi-square analyses, and linear regression were used to compare the cardiovascular health factors among the three levels of diabetes distress scores and the two levels of depressive symptom scores.

RESULTS

Our sample included 83 adults with a mean age of 45.2 years and a mean duration of T1D of 20 years. The majority scored low in the Diabetes Distress Scale, whereas 18% scored moderate and 18% scored high. Twenty-two percent had increased levels of depressive symptoms. There were significant correlations between diabetes distress and fear of hypoglycemia, depressive symptom scores, hemoglobin A1c, and total cholesterol. Depressive symptom scores were significantly correlated with hemoglobin A1c. Hemoglobin A1c and total cholesterol were significantly higher in those with higher levels of diabetes distress. There were no significant differences in cardiovascular health between those who scored below or above the cut point for depressive symptoms, but there was a finding toward higher mean body mass index, hemoglobin A1c, and a lower weekly step count in those who had elevated depressive symptoms. In the linear regression, only diabetes distress was significantly associated with hemoglobin A1c.

DISCUSSION

This is a sample with elevated diabetes distress and depressive symptoms, both of which may affect their risk of cardiovascular disease.