Incidence and risk of diabetes mellitus associated with depressive symptoms in adults: evidence from longitudinal studies

Association between dietary patterns and depression symptoms among adults with or without diabetes in Qatar: a population-based study

BACKGROUND

Diabetes is a major public health problem in Qatar and is associated with an increased risk of depression. However, no study has been conducted in Qatar on the relationship between dietary patterns and depression symptoms in adults. The aim of this study was to assess the association between dietary patterns and depression symptoms among adults with or without diabetes in Qatar.

METHODS

A total of 1000 participants from the Qatar Biobank (QBB) were included in this cross-sectional study. Food intake was assessed using a computer-administered food frequency questionnaire (FFQ), and dietary patterns were identified using factor analysis. Depression symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9).

RESULTS

Depression symptoms were present in 13.5% of the sample. Two dietary patterns were identified: "unhealthy" (high consumption of fast food, biryani, mixed dish (chicken/meat/fish), croissant) and "prudent" (high consumption of fresh fruit, salads/raw vegetables, canned/dried fruit, and dates). After adjusting for sociodemographic, lifestyle factors (smoking and physical activity), diabetes and medication use for diabetes and hypertension, a high intake of "unhealthy" pattern was associated with an increased prevalence of depressive symptoms in individuals with diabetes (prevalence ratio, PR = 1.41; 95% CI = 1.28, 1.56; p-value < 0.001), while there was no statistically significant association between depressive symptoms and the "prudent" dietary pattern. The "prudent" pattern was inversely and significantly associated with depressive symptoms in individuals with a normal body weight (PR = 0.21; 95% CI = 0.06, 0.76; p-value = 0.018).

CONCLUSION

The "unhealthy" dietary pattern was positively associated with depression symptoms in those with diabetes, whereas the "prudent" dietary pattern was inversely associated with depression symptoms in those with a normal body weight. Promoting healthy eating habits should be considered in the prevention and management of depression.

Effects of elevated emotional symptoms on metabolic disease development: a 10-year follow-up study

Background

In recent decades, the relationship between emotional disorders (i.e., depression and anxiety) and alterations in physiological functions (i.e., inflammation or metabolism) have been well supported. However, studies on a symptom-based approach have provided mixed results. Our study aims to gain insight into how subclinical statuses, featured by elevated depressive and/or anxious symptoms, may influence immunometabolic alterations in the concurrent relationship; and the development of metabolic diseases at 10-year follow-up: diabetes, hypertension and hypercholesterolemia.

Methods

Data from 758 Greek adults [394 men (aged 41 ± 10 years) and 364 women (aged 37 ± 12 years)] were used. Four groups were created according to the levels of depressive and anxiety symptoms: (1) control group (CG), (2) depressive group (DG), (3) anxiety group (AG) and (4) depressive and anxiety group (DAG). Multi-indicator multi-causes (MIMIC) modeling was used to estimate metabolic function and inflammatory response scores, on a wide selection of blood biomarkers. Finally, a binary logistic regression was carried out to study the influence of symptoms on the development of the aforementioned metabolic diseases on a 10-year follow-up.

Results

Group membership was not associated with metabolic function score. Conversely, DAG membership was related with higher inflammatory response score (B = 0.20, CI95 = 0.01, 0.40), with respect to the CG (p < 0.05). Both age and sex were significant variables in the calculation of both scores. Regarding disease at 10-year follow-up effect, risk of developing diabetes, hypertension and hypercholesterolemia was associated with age and socioeconomic status. Moreover, DG membership was significant for diabetes risk (OR = 2.08, CI95 = 1.00, 4.22) and DAG for hypercholesterolemia (OR = 1.68, CI95 = 1.16, 2.43).

Limitations

Data on anti-inflammatory drugs and psychopharmacological medication were not collected in this study.

Conclusions

Elevated symptoms of depression and anxiety accounts for inflammatory alterations at concurrent relationship and a higher risk of 10-year follow-up metabolic diseases.

Symptoms of depression, perceived social support, and medical coping modes among middle-aged and elderly patients with type 2 diabetes

Objective: To understand the prevalence of depression in diabetes population, explore the relationship between diabetes and depression, and the impact of comprehensive psychological and behavioral intervention on depression related to diabetes and glucose metabolism.

Methods: 71 middle-aged and elderly patients with type 2 diabetes were investigated and evaluated with Self Rating Depression Scale (SDS), Medical Coping Scale (MCWQ) and Social Support Scale (PSSS). Patients who met the research criteria were randomly divided into an experimental group and a control group. The number of effective cases in the two groups was 36 and 35 respectively. In addition to conventional diabetes drug treatment, the experimental group was supplemented with comprehensive psychological and behavioral intervention, while the control group was only given conventional treatment. The fasting blood glucose, 2-h postprandial blood glucose, body weight and depression index were measured before and after treatment in the two groups.

Results: The prevalence of depression in patients with diabetes was as high as 60%, and that in the elderly control group was 5%; In type 2 diabetes population, depression is negatively related to the total score of social support and medical coping surface, and positively related to avoidance, blood sugar, women, course of disease, education level below junior high school, body mass index, and number of complications in medical coping; The fasting blood glucose, 2-h postprandial blood glucose, body mass index, and depression index of the two groups decreased, and the range and speed of decline in the experimental group were higher than those in the control group; There were significant differences between the two groups in fasting blood glucose, 2-h postprandial blood glucose and depression index; During the follow-up period, the blood glucose and depression index of the experimental group increased.

Conclusion: Depression has a high prevalence rate in middle-aged and elderly people with type 2 diabetes, and has a negative impact on blood sugar control in diabetes patients; Psychological and behavioral comprehensive intervention can improve the glucose metabolism and depressive symptoms of middle-aged and elderly patients with type 2 diabetes.

Longitudinal bidirectional associations between internalizing mental disorders and cardiometabolic disorders in the general adult population

PURPOSE

This prospective population-based study investigated whether having any internalizing mental disorder (INT) was associated with the presence and onset of any cardiometabolic disorder (CM) at 3-year follow-up; and vice versa. Furthermore, we examined whether observed associations differed when using longer time intervals of respectively 6 and 9 years.

METHODS

Data were used from the four waves (baseline and 3-, 6- and 9-year follow-up) of the Netherlands Mental Health Survey and Incidence Study-2, a prospective study of a representative cohort of adults. At each wave, the presence and first onset of INT (i.e. any mood or anxiety disorder) were assessed with the Composite International Diagnostic Interview 3.0; the presence and onset of CM (i.e. hypertension, diabetes, heart disease, and stroke) were based on self-report. Multilevel logistic autoregressive models were controlled for previous-wave INT and CM, respectively, and sociodemographic, clinical, and lifestyle covariates.

RESULTS

Having any INT predicted both the presence (OR 1.28, p = 0.029) and the onset (OR 1.46, p = 0.003) of any CM at the next wave (3-year intervals). Having any CM was not significantly related to the presence of any INT at 3-year follow-up, while its association with the first onset of any INT reached borderline significance (OR 1.64, p = 0.06), but only when examining 6-year intervals.

CONCLUSIONS

Our findings indicate that INTs increase the risk of both the presence and the onset of CMs in the short term, while CMs may increase the likelihood of the first onset of INTs in the longer term. Further research is needed to better understand the mechanisms underlying the observed associations.

Prognostic value of long-term trajectories of depression for incident diabetes mellitus in patients with stable coronary heart disease

Background

Diabetes mellitus (DM) and depression are bidirectionally interrelated. We recently identified long-term trajectories of depression symptom severity in individuals with coronary heart disease (CHD), which were associated with the risk for subsequent cardiovascular events (CVE). We now investigated the prognostic value of these trajectories of symptoms of depression with the risk of incident DM in patients with stable coronary heart disease.

Methods

The KAROLA cohort included CHD patients participating in an in-patient rehabilitation program (years 1999/2000) and followed for up to 15 years. We included 1048 patients (mean age 59.4 years, 15% female) with information on prevalent DM at baseline and follow-up data. Cox proportional hazards models were used to model the risk for incident DM during follow-up by depression trajectory class adjusted for age, sex, education, smoking status, body mass index, and physical activity. In addition, we modeled the excess risk for subsequent CVE due to incident DM during follow-up for each of the depression trajectories.

Results

DM was prevalent in 20.7% of patients at baseline. Over follow-up, 296 (28.2%) of patients had a subsequent CVE. During follow-up, 157 (15.0%) patients developed incident DM before experiencing a subsequent CVE. Patients following a high-stable depression symptom trajectory were at substantially higher risk of developing incident DM than patients following a low-stable depression symptom trajectory (hazard ratio (HR) = 2.50; 95% confidence interval (CI) (1.35, 4.65)). A moderate-stable and an increasing depression trajectory were associated with HRs of 1.48 (95%-CI (1.10, 1.98)) and 1.77 (95%-CI (1.00, 3.15)) for incident DM. In addition, patients in the high-stable depression trajectory class who developed incident DM during follow-up were at 6.5-fold risk (HR = 6.51; 95%-CI (2.77, 15.3)) of experiencing a subsequent cardiovascular event.

Conclusions

In patients with CHD, following a trajectory of high stable symptoms of depression was associated with an increased risk of incident DM. Furthermore, incident DM in these patients was associated with a substantially increased risk of subsequent CVE. Identifying depressive symptoms and pertinent treatment offers might be an important and promising approach to enhance outcomes in patients with CHD, which should be followed up in further research and practice.

Increased Serum Cystatin C Levels Were Associated with Depressive Symptoms in Patients with Type 2 Diabetes

BACKGROUND

Existing studies have reported that patients with diabetes mellitus (DM) have an increased risk of depressive symptoms. We aimed to evaluate the association between serum cystatin C levels and depressive symptoms in DM patients.

METHODS

Serum levels of cystatin C were measured in 254 patients with DM at baseline. Cox proportional hazard analysis was used to evaluate the value of serum cystatin C in predicting depressive symptoms in patients with DM.

RESULTS

Multivariate linear regression analysis showed that serum cystatin C levels were independently associated with Centre for Epidemiological Studies Depression (CES-D) scores after adjusting for age, sex, body mass index (BMI), current smoking status, current drinking, admission systolic and diastolic blood pressure (BP), cardiovascular disease (CVD) history and laboratory measurements in patients with DM at baseline (Sβ= -0.127; 95% CI, - 0.185- - 0.083; P=0.002). The multivariate Cox proportional hazard analysis revealed that serum cystatin C (HR=2.360, 95% CI 1.500-3.891, P-trend <0.001) was an independent prognostic factor for cognitive decline in these patients with DM during the follow-up period.

CONCLUSION

Our results showed that increased serum cystatin C levels were significantly and independently associated with depressive symptoms and had independent predictive value for depressive symptoms in patients with DM. Serum cystatin C might enable early recognition of depressive symptoms among DM patients.

Measures of depression and risk of type 2 diabetes: A systematic review and meta-analysis

BACKGROUND

Depression is associated with an increased risk of type 2 diabetes. This study aimed to determine whether the association between depression and incident type 2 diabetes differs by measure of depression.

METHODS

Data sources included MEDLINE, EMBASE, PsycINFO, CINAHL, ProQuest Dissertations & Theses Global, Web of Science Emerging Sources Citation Index and Conference Proceedings Citation Index, Cochrane Library, the University of York Center for Reviews and Dissemination, abstracts from the PsychoSocial Aspects of Diabetes conference.

INCLUSION CRITERIA

comparison of participants with and without depression, depression measured at age 18 or older, longitudinal follow-up with an outcome of type 2 diabetes, effect estimate adjusted for important confounders, full-text available in English or French, and study at overall low or moderate risk of bias. Two reviewers extracted data and assessed study quality.

RESULTS

Twenty-one studies reporting twenty-five effect estimates were included. Depressive symptom scales, clinical interviews, physician diagnoses, and use of antidepressants were all associated with an increased risk of incident type 2 diabetes. When all measures of depression were combined, the meta-analyzed risk ratio for type 2 diabetes was 1.18 (95% CI 1.12-1.24, I²=45.4%). Results did not provide conclusive evidence that the association between depression and incident diabetes differs by measure of depression.

LIMITATIONS

Results showed heterogeneity and evidence of publication bias.

CONCLUSIONS

Results suggest that various measures of depression may be used to identify individuals at higher risk of type 2 diabetes.

A Systematic Review and Delphi Study to Ascertain Common Risk Factors for Type 2 Diabetes Mellitus and Dementia and Brain-Related Complications of Diabetes in Adults

OBJECTIVES

Both type 2 diabetes (T2DM) and dementia have multifactorial etiologies. Both are associated with aging and have well-recognized lifestyle, cardiovascular and psychosocial risk factors. However, uncertainty exists in the literature with regard to: 1) the potentially modifiable risk factors common to both dementia and T2DM, and 2) the risk of brain-related complications in those with established diabetes. In this study, we address this uncertainty and inform design of a survey questionnaire to assess knowledge about diabetes and brain health among at-risk groups.

METHODS

This investigation consisted of a mixed-methods approach, including a Delphi consensus study preceded by a systematic literature review. The review was conducted using MEDLINE, EMBASE and Cochrane Library databases. A 2-round online Delphi study, informed by the review, invited international experts to rate their agreement with proposed risk factors and complications.

RESULTS

Of 7,337 abstracts retrieved, 13 were included in the final review. Among 46 international experts invited to take part in the Delphi study, 14 (32%) responded. In the Delphi study, hypertension, obesity, physical inactivity and heavy alcohol consumption reached consensus as risk factors common to both T2DM and dementia. Proposed brain-related diabetes complications, depression and dementia were also identified.

CONCLUSIONS

Results revealed expert consensus and literature review agreement on a number of common modifiable risk factors for T2DM and dementia, as well as agreement on brain-related complications of diabetes. A number of other proposed shared risk factors did not reach consensus agreement, suggesting a need for more high-quality studies to add to the evidence base.

Validation of a Psychosocial Chronic Stress Model in the Pig Using a Multidisciplinary Approach at the Gut-Brain and Behavior Levels

Psychological chronic stress is an important risk factor for major depressive disorder, of which consequences have been widely studied in rodent models. This work aimed at describing a pig model of chronic stress based on social isolation, environmental impoverishment and unpredictability. Three groups of animals of both sexes were constituted. Two were exposed to the psychosocial stressors while receiving (SF, n = 12) or not (SC, n = 22) the antidepressant fluoxetine, and a third group (NSC, n = 22) remained unstressed. Animals were observed in home pens and during dedicated tests to assess resignation and anxiety-like behaviors. Brain structure and function were evaluated via proton MRS and fMRI. Hippocampal molecular biology and immunodetection of cellular proliferation (Ki67⁺) and neuron maturation (DCX⁺) in the dentate gyrus were also performed. Salivary cortisol, fecal short-chain fatty acids (SCFAs), and various plasmatic and intestinal biomarkers were analyzed. Compared to NSC, SC animals showed more resignation (p = 0.019) and had a higher level of salivary cortisol (p = 0.020). SC brain responses to stimulation by a novel odor were lower, similarly to their hippocampal neuronal density (p = 0.015), cellular proliferation (p = 0.030), and hippocampal levels of BDNF and 5-HT_1AR (p = 0.056 and p = 0.007, respectively). However, the number of DCX⁺ cells was higher in the ventral dentate gyrus in this group (p = 0.025). In addition, HOMA-IR was also higher (p < 0.001) and microbiota fermentation activity was lower (SCFAs, SC/NSC: p < 0.01) in SC animals. Fluoxetine partially or totally reversed several of these effects. Exposure to psychosocial stressors in the pig model induced effects consistent with the human and rodent literature, including resignation behavior and alterations of the HPA axis and hippocampus. This model opens the way to innovative translational research exploring the mechanisms of chronic stress and testing intervention strategies with good face validity related to human.

Brain education-based meditation for patients with hypertension and/or type 2 diabetes: A pilot randomized controlled trial

BACKGROUND

Hypertension and type 2 diabetes are chronic diseases, which generally require lifetime care. Meditation and yoga can be complementary to pharmacological therapies according to the scientific evidences so far. Brain education-based meditation (BEM) is a technique, which has been known to change brain structure, psychology, and physiology of healthy adult participants. This randomized, nonblinded pilot trial aimed to examine whether BEM affects the conditions of patients with hypertension and/or type 2 diabetes compared with health education classes.

METHODS

We randomly allocated 48 patients with hypertension and/or type 2 diabetes to BEM (n = 24) or health education (n = 24) classes in the Ulsan Junggu Public Health Center in Korea, where the classes were run during the same period and explored the impact of 8-week practice on the serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, gamma glutamyl transpeptidase, creatinine, high-density lipoprotein cholesterol, and low-density lipoprotein (LDL) cholesterol. Total RNA was extracted to examine inflammatory gene expressions from the whole blood using PAXgene blood RNA System. In addition, self-reports on mental/physical health were evaluated. The Student's t test, chi-squared test, and analysis of covariance were used for statistical analysis.

RESULTS

The number of people who participated until the completion of the study was 14 in the control and 21 in the BEM group. After 8 weeks, LDL cholesterol level was significantly decreased in the BEM group after the intervention (13.82 mg/dL reduction, P < .05), while it was not significantly altered in the control group. The expression of inflammatory genes was significantly reduced after 8 weeks of the BEM training (0.3-, 0.5-, and 0.2-fold change for NFKB2, RELA, and IL1B, respectively, all P < .05). In the item analysis of mental/physical health self-reports, a significant improvement was confirmed as follows: increases in focus, confidence, relaxation, and happiness; decreases in fatigue, anger, and loneliness (all P < .05). There were no important adverse events or side-effects by BEM intervention.

CONCLUSION

Compared to health education, BEM helps lower LDL cholesterol level and the inflammatory gene expression in the patients with hypertension and/or type 2 diabetes. Moreover, BEM induces positive effects on the self-reported mental/physical states, warranting further study.

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.

Environmental/lifestyle factors in the pathogenesis and prevention of type 2 diabetes

BACKGROUND

Environmental and lifestyle changes, in addition to the ageing of populations, are generally believed to account for the rapid global increase in type 2 diabetes prevalence and incidence in recent decades.

DISCUSSION

In this review, we present a comprehensive overview of factors contributing to diabetes risk, including aspects of diet quality and quantity, little physical activity, increased monitor viewing time or sitting in general, exposure to noise or fine dust, short or disturbed sleep, smoking, stress and depression, and a low socioeconomic status. In general, these factors promote an increase in body mass index. Since loss of β-cell function is the ultimate cause of developing overt type 2 diabetes, environmental and lifestyle changes must have resulted in a higher risk of β-cell damage in those at genetic risk. Multiple mechanistic pathways may come into play.

CONCLUSIONS

Strategies of diabetes prevention should aim at promoting a 'diabetes-protective lifestyle' whilst simultaneously enhancing the resistance of the human organism to pro-diabetic environmental and lifestyle factors. More research on diabetes-protective mechanisms seems warranted.

Environmental/lifestyle factors in the pathogenesis and prevention of type 2 diabetes

BACKGROUND

Environmental and lifestyle changes, in addition to the ageing of populations, are generally believed to account for the rapid global increase in type 2 diabetes prevalence and incidence in recent decades.

DISCUSSION

In this review, we present a comprehensive overview of factors contributing to diabetes risk, including aspects of diet quality and quantity, little physical activity, increased monitor viewing time or sitting in general, exposure to noise or fine dust, short or disturbed sleep, smoking, stress and depression, and a low socioeconomic status. In general, these factors promote an increase in body mass index. Since loss of β-cell function is the ultimate cause of developing overt type 2 diabetes, environmental and lifestyle changes must have resulted in a higher risk of β-cell damage in those at genetic risk. Multiple mechanistic pathways may come into play.

CONCLUSIONS

Strategies of diabetes prevention should aim at promoting a 'diabetes-protective lifestyle' whilst simultaneously enhancing the resistance of the human organism to pro-diabetic environmental and lifestyle factors. More research on diabetes-protective mechanisms seems warranted.

Cortisol dysregulation: the bidirectional link between stress, depression, and type 2 diabetes mellitus

Controversy exists over the role of stress and depression in the pathophysiology of type 2 diabetes mellitus. Depression has been shown to increase the risk for progressive insulin resistance and incident type 2 diabetes mellitus in multiple studies, whereas the association of stress with diabetes is less clear, owing to differences in study designs and in forms and ascertainment of stress. The biological systems involved in adaptation that mediate the link between stress and physiological functions include the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous and immune systems. The HPA axis is a tightly regulated system that represents one of the body's mechanisms for responding to acute and chronic stress. Depression is associated with cross-sectional and longitudinal alterations in the diurnal cortisol curve, including a blunted cortisol awakening response and flattening of the diurnal cortisol curve. Flattening of the diurnal cortisol curve is also associated with insulin resistance and type 2 diabetes mellitus. In this article, we review and summarize the evidence supporting HPA axis dysregulation as an important biological link between stress, depression, and type 2 diabetes mellitus.

Cardiovascular risk factors among patients with schizophrenia, bipolar, depressive, anxiety, and personality disorders

BACKGROUND

The evidence informing the management of cardiovascular risk in patients with psychiatric disorders is weak.

METHODS

This cohort study used data from all patients, aged≥30, registered in 140 primary care practices (n=524,952) in London to estimate the risk of developing diabetes, hypertension, hyperlipidemia, tobacco consumption, obesity, and physical inactivity, between 2005 and 2015, for patients with a previous diagnosis of schizophrenia, depression, anxiety, bipolar or personality disorder. The role of antidepressants, antipsychotics and social deprivation in these associations was also investigated. The age at detection of cardiovascular risk factor was compared between patients with and without psychiatric disorders. Variables, for exposures and outcomes, defined from general practitioners records, were analysed using multivariate regression.

RESULTS

Patients with psychiatric disorders had an increased risk for cardiovascular risk factors, especially diabetes, with hazard ratios: 2.42 (2.20-2.67) to 1.31 (1.25-1.37), hyperlipidemia, with hazard ratios: 1.78 (1.60-1.97) to 1.25 (1.23-1.28), and obesity. Antidepressants, antipsychotics and social deprivation did not change these associations, except for smoking and physical inactivity. Antidepressants were associated with higher risk of diabetes, hypertension and hyperlipidemia. Antipsychotics were associated with a higher risk of diabetes. Antidepressants and antipsychotics were associated with lower risk of other risk factors. Patients with psychiatric conditions have later detection of cardiovascular risk factors. The interpretation of these results should acknowledge the lower rates of detection of risk factors in mentally ill patients.

CONCLUSIONS

Cardiovascular risk factors require special clinical attention among patients with psychiatric disorders. Further research could study the effect of antidepressants and antipsychotics on cardiovascular risk factors.