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Zeng N, Li C, Mei H, Wu S, Liu C, Wang X, Bao Y. Temporal Relationship between HbA1c and Depressive Symptom Trajectories in a Longitudinal Cohort Study: The Mediating Role of Healthy Lifestyles. Brain Sci 2024; 14:780. [PMID: 39199473 PMCID: PMC11353008 DOI: 10.3390/brainsci14080780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/24/2024] [Accepted: 07/27/2024] [Indexed: 09/01/2024] Open
Abstract
This study analyzed China Health and Retirement Longitudinal Study data to explore the HbA1c-depression link, including depressive trajectories, while considering the mitigating impact of healthy lifestyles. Cross-lagged panel models and group-based trajectory modeling were performed to investigate the temporal relationship between HbA1c levels and depressive symptoms, as well as the depressive trajectories. Structural equation models were used to assess the mediating effects of healthy lifestyles. The mean age of the participants was 57.66 ± 9.04 years, with 53.68% being female. Analyzing 8826 participants across three waves, we observed a significant prediction of subsequent depressive symptoms by the preceding HbA1c levels (β = 0.296; p < 0.001). Four distinct trajectories of depressive symptoms were distinguished: stable low, stable moderate, increasing, and stable high. Elevated HbA1c levels were associated with a higher risk of developing stable high (OR 1.12 and 95% CI 1.02-1.23), increasing (OR 1.21 and 95% CI 1.11-1.32), and stable moderate depressive symptoms (OR 1.07 and 95% CI 1.01-1.13). Engaging in two healthy life behaviors reduced stable high and increasing depressive pattern risks by 32% and 30%, respectively. Adherence to a healthy lifestyle lessened 7.2% of the impact of high HbA1c levels on the subsequent depressive symptoms. These findings highlight the potential benefits of incorporating adequate sleep and light physical activities, which might reduce the adverse impact of elevated HbA1c levels on depressive symptoms.
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Affiliation(s)
- Na Zeng
- School of Public Health, Peking University, Beijing 100191, China; (N.Z.); (H.M.); (S.W.); (C.L.); (X.W.)
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China
| | - Chao Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China;
| | - Huan Mei
- School of Public Health, Peking University, Beijing 100191, China; (N.Z.); (H.M.); (S.W.); (C.L.); (X.W.)
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China
| | - Shuilin Wu
- School of Public Health, Peking University, Beijing 100191, China; (N.Z.); (H.M.); (S.W.); (C.L.); (X.W.)
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China
| | - Chang Liu
- School of Public Health, Peking University, Beijing 100191, China; (N.Z.); (H.M.); (S.W.); (C.L.); (X.W.)
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China
| | - Xiaokun Wang
- School of Public Health, Peking University, Beijing 100191, China; (N.Z.); (H.M.); (S.W.); (C.L.); (X.W.)
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China
| | - Yanping Bao
- School of Public Health, Peking University, Beijing 100191, China; (N.Z.); (H.M.); (S.W.); (C.L.); (X.W.)
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China
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Liu YT, Wu WH, Tseng WT, Lin HC, Wu MS, Chen PF, Wu IC. Lower HbA1C of glycemic control is associated with higher risk of depressive symptoms in elderly with type 2 diabetes mellitus-A Nationwide Community-based study. J Psychosom Res 2023; 174:111492. [PMID: 37708592 DOI: 10.1016/j.jpsychores.2023.111492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE We investigated the correlation between glycemic control status and depressive symptoms in type 2 diabetes elderly. METHODS A total of 1527 participants with type 2 diabetes aged 55 years and older from the Healthy Aging Longitudinal Study in Taiwan study were included in this cross-sectional study. The Center for Epidemiologic Studies Depression Scale (CESD) (20 items) score of ≥16 was indicative of depressive symptoms. The participants were divided into HbA1c ≥ 6.5% and < 6.5% representing the glycemic control. Multiple logistic regression (MLR) and Generalized linear model (GLM) were used. RESULTS The MLR analysis showed that the low HbA1c group had significant two-fold increased odds of depressive symptoms compared to the high HbA1c group (OR 1.89, 95% CI 1.17-3.05). The risk of depressive symptoms was lower among males (OR 0.49, 95% CI 0.30-0.80) and those with higher BMI (OR 0.93, 95% CI 0.86-1.00); whereas the risk was higher among those who lived alone (OR 2.37, 95% CI 1.31-4.27) and with ADL disability (OR 3.01, 95% CI 1.85-4.89). The GLM showed that the dimension of depressive affect reached statistical significance with lower HbA1c. CONCLUSION This nationwide community-based study shows that depressive symptoms are associated with lower HbA1C, reminding us that more attention should be paid to the presence of depressive symptoms in those with lower HbA1C. Further research is needed to clarify the causal relationship.
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Affiliation(s)
- Yen-Tze Liu
- Department of Family Medicine, Changhua Christian Hospital, Changhua, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Big Data Center, Changhua Christian Hospital, Changhua, Taiwan.
| | - Wan-Hui Wu
- Department of Family Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Wei-Ting Tseng
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Hsien-Chih Lin
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Ming-Shiang Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan
| | - Pei-Fen Chen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
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Bu F, Deng XH, Zhan NN, Cheng H, Wang ZL, Tang L, Zhao Y, Lyu QY. Development and validation of a risk prediction model for frailty in patients with diabetes. BMC Geriatr 2023; 23:172. [PMID: 36973658 PMCID: PMC10045211 DOI: 10.1186/s12877-023-03823-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Frailty is the third most common complication of diabetes after macrovascular and microvascular complications. The aim of this study was to develop a validated risk prediction model for frailty in patients with diabetes. METHODS The research used data from the China Health and Retirement Longitudinal Study (CHARLS), a dataset representative of the Chinese population. Twenty-five indicators, including socio-demographic variables, behavioral factors, health status, and mental health parameters, were analyzed in this study. The study cohort was randomly divided into a training set and a validation set at a ratio of 70 to 30%. LASSO regression analysis was used to screen the variables for the best predictors of the model based on a 10-fold cross-validation. The logistic regression model was applied to explore the associated factors of frailty in patients with diabetes. A nomogram was constructed to develop the prediction model. Calibration curves were applied to evaluate the accuracy of the nomogram model. The area under the receiver operating characteristic curve and decision curve analysis were conducted to assess predictive performance. RESULTS One thousand four hundred thirty-six patients with diabetes from the CHARLS database collected in 2013 (n = 793) and 2015 (n = 643) were included in the final analysis. A total of 145 (10.9%) had frailty symptoms. Multivariate logistic regression analysis showed that marital status, activities of daily living, waist circumference, cognitive function, grip strength, social activity, and depression as predictors of frailty in people with diabetes. These factors were used to construct the nomogram model, which showed good concordance and accuracy. The AUC values of the predictive model and the internal validation set were 0.912 (95%CI 0.887-0.937) and 0.881 (95% CI 0.829-0.934). Hosmer-Lemeshow test values were P = 0.824 and P = 0.608 (both > 0.05). Calibration curves showed significant agreement between the nomogram model and actual observations. ROC and DCA indicated that the nomogram had a good predictive performance. CONCLUSIONS Comprehensive nomogram constructed in this study was a promising and convenient tool to evaluate the risk of frailty in patients with diabetes, and contributed clinicians to screening the high-risk population.
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Affiliation(s)
- Fan Bu
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China
| | - Xiao-Hui Deng
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China
| | - Na-Ni Zhan
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China
| | - Hongtao Cheng
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China
| | - Zi-Lin Wang
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China
| | - Li Tang
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China
| | - Yu Zhao
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China
| | - Qi-Yuan Lyu
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China.
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Chen HM, Su BY. Factors Related to the Continuity of Care and Self-Management of Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Taiwan. Healthcare (Basel) 2022; 10:2088. [PMID: 36292535 PMCID: PMC9602078 DOI: 10.3390/healthcare10102088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Most diabetic patients suffer from chronic diseases affecting their self-management status. This study aims to explore the relationship between the CoC and the self-management of patients with Type 2 Diabetes Mellitus (T2DM) and analyze the predictive factors affecting their self-management. METHODS Structured questionnaires were used for data collection. Convenient sampling was adopted to recruit inpatients diagnosed with T2DM in the endocrine ward of a medical hospital in central Taiwan. RESULTS A total of 160 patients were recruited. The average age of the patients is 66.60 ± 14.57 years old. Among the four dimensions of the self-management scale, the average score of the problem-solving dimension was the highest, and that of the self-monitoring of blood glucose was the lowest. The analysis results showed that the overall regression model could explain 20.7% of the total variance in self-management. CONCLUSIONS Healthcare providers should attach importance to the CoC of T2DM patients and encourage patients to maintain good interaction with healthcare providers during their hospitalization. It is recommended to strengthen CoC for patients with diabetes who are single or with low educational levels in clinical practice to enhance their blood glucose control and improve diabetes self-management.
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Affiliation(s)
- Hsiao-Mei Chen
- Department of Nursing, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Nursing, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Bei-Yi Su
- Department of Psychology, Chung Shan Medical University, Taichung 40201, Taiwan
- Clinical Psychological Room, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
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Development and Validation of the Depression Inventory for Type 1 Diabetes (DID-1). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312529. [PMID: 34886259 PMCID: PMC8657055 DOI: 10.3390/ijerph182312529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
People with type 1 diabetes (T1D) are more likely to have depression than the general population and their prognosis is worse. Unfortunately, the characteristics of persons with T1D lead to inadequate screening for depression in this population. To aid in the detection of depression in this population, this study was undertaken to develop a depressive symptoms assessment instrument specific to patients with T1D and to examine its psychometric properties. A total of 207 people with T1D participated in this study. The reliability of the new scale was assessed using Cronbach’s alpha and the Spearman-Brown split-half coefficient. The Depression Inventory for type 1 Diabetes (DID-1), composed of 45 items on a Likert scale (1–7), shows high internal and temporal consistency, as well as adequate concurrent, convergent and discriminant validity. Factor analysis identified 7 factors (Symptoms of depression, Diminished interest, Hopelessness and dissatisfaction, Guilt, Fear, frustration and irritability, Defenselessness, and Interference in daily life) that explained 61.612% of the total variability. The cut-off score for diagnosis was set at 155 points. It was concluded that the DID-1 scale is a reliable, valid and useful tool for the assessment of depressive symptoms, eliminating the bias of other nonspecific diabetes scales.
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Alhussein NA, Mahzari MM, Aljumaie NM, Alosaimi MI, Almansouf AS, Alkahtani FK. Diabetes Self-Management Among Healthcare Providers in King Abdulaziz Medical City, Riyadh: A Cross-Sectional Pilot Study. Cureus 2021; 13:e18155. [PMID: 34703691 PMCID: PMC8529938 DOI: 10.7759/cureus.18155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/05/2022] Open
Abstract
Background Diabetes mellitus (DM), a chronic metabolic disease, is a rising global concern with significant social, economic, and health implications. Proper glycemic control is crucial to guarantee protection against these implications such as micro and macrovascular complications. To achieve proper glycemic control, patients' self-management is probably the most essential component, and the development of appropriate self-management behaviors which include medication adherence and lifestyle modifications improves the prognosis and the incidence of DM complications. Objective The aim of the study is to examine diabetes self-management and control of diabetic healthcare providers from different specialties working at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Design and setting This is a cross-sectional pilot study carried out in King Abdulaziz Medical City, Riyadh, Saudi Arabia, using a pre-validated self-administered questionnaire that was "Diabetes Self-Management Questionnaire" (DSMQ), which examined diabetes management and control within the last two months. The questionnaire was distributed to the healthcare providers of all specialties at the site of the study. Correlations and descriptive analyses were carried out using the Statistical Package for Social Science (SPSS) software version 23 (IBM Corp, Armonk, USA). Results The total number of participants was 370 healthcare providers (100% response rate). It was found that 26 (7%) of them had diabetes (92.3% of them with type 2 diabetes). The diabetic participants' mean age was 48.58±7.3 years old. 42.3% were applied medical sciences specialists, with 38.5% having years of experience between 16 to 20 years old. 26.3% were Saudi nationals. The mean HbA1c levels among diabetic patients were 6±1.03%, ranging between (5.1%-9%). There was a significant inverse relationship between each section's scores and total scores with the HbA1c levels (p-value<0.05). Total scores for adherence were significantly higher among the age group (51 to 60) (p-value=0.03) and physicians (p-value=0.035). Dietary control was significantly better among age group (51 to 60) (p-value=0.015), and type 2 diabetes (p-value=0.022). Physician contact was significantly higher in the age group (51 to 60) (p-value=0.027). Physical activity was significantly higher among physicians (p-value=0.030). Blood glucose monitoring was significantly better among the age group (above 60) (p-value=0.026), males (p-value=0.03), and physicians (p-value=0.039). Conclusion The findings suggest the glycemic control and adherence to treatment among diabetic healthcare providers in KAMC-Riyadh are adequate the findings suggest the glycemic control and adherence to treatment among diabetic healthcare providers in KAMC-Riyadh are adequate. Future studies with an adequate sample size are essential to assess diabetes self-management and identify if there is any obstacle toward better compliance in healthcare providers.
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Affiliation(s)
- Naif A Alhussein
- Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Nader M Aljumaie
- Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Meshari I Alosaimi
- Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Faisal K Alkahtani
- Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Wang YC, Wang C, Shih PW, Tang PL. Analysis of the relationship between lifestyle habits and glycosylated hemoglobin control based on data from a Health Management Plan. Nutr Res Pract 2020; 14:218-229. [PMID: 32528629 PMCID: PMC7263898 DOI: 10.4162/nrp.2020.14.3.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/20/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/OBJECTIVES Type 2 Diabetes mellitus (T2DM) is a hereditary disease that is also strongly dependent on environmental factors, lifestyles, and dietary habits. This study explored the relationship between lifestyle habits and glycosylated hemoglobin management in T2DM patients to provide empirical outcomes to improve T2DM management and patient health literacy. SUBJECTS/METHODS This study enrolled 349 diabetic patients with more than 5 care visits to a Diabetes Mellitus care network under the Health Management Plan led by Taiwan Department of Health (DOH). Based on relevant literature, an Outpatient Record Form of Diabetes Mellitus Care was designed and lipid profile tests were conducted for data collection and analysis. RESULTS When modeling the data, the results showed that the odds for HbA1c > 7.5% in T2DM patients duration over 10 years was 3.785 (P = 0.002) times that in patients with disease duration of fewer than 3 years. The odds of HbA1c > 7.5% in illiterate patients was 3.128 (P = 0.039) times that in patients with senior high school education or above. The odds of HbA1c > 7.5% in patients with other chronic illness was 2.207 (P = 0.019) times that in participants without chronic illness. Among 5 beneficial lifestyle habits, the odds of HbA1c > 7.5% in patients with 2 or 3 good habits were 3.243 (P = 0.003) and 3.424 (P = 0.001) times that in patients with more than 3 good habits, respectively. CONCLUSION This empirical outcome shows that maintaining a good lifestyle improves T2DM management and patients' knowledge, motivation, and ability to use health information. Patients with longer disease duration, education, or good lifestyle habits had optimal HbA1c management than those in patients who did not. Thus, effective self-management and precaution in daily life and improved health literacy of diabetic patients are necessary to increase the quality of T2DM care.
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Affiliation(s)
- Ya-Chun Wang
- Nutrition and Food Service Department, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC).,Department of Food Science and Nutrition, Meiho University, Pingtung 91202, Taiwan (ROC)
| | - Chi Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC)
| | - Ping-Wen Shih
- Nutrition and Food Service Department, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC)
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC).,Department of Health-Business Administration, Fooyin University, Kaohsiung City 83102, Taiwan (ROC).,College of Nursing, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan (ROC)
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