1
|
Wu W, Zeng C, Wu C, Wu T, Pang J, Zhou P, Cao Y. Antidepressant effect of carvedilol on streptozotocin-induced diabetic peripheral neuropathy mice by altering gut microbiota. Biochem Biophys Res Commun 2024; 730:150374. [PMID: 38986219 DOI: 10.1016/j.bbrc.2024.150374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/12/2024]
Abstract
RATIONALE Although diabetic peripheral neuropathic pain (DPNP) and depression have been recognized for many years, their co-morbidity relationship and effective treatment choices remain uncertain. OBJECTIVES To evaluate the antidepressant effect of carvedilol on streptozotocin-induced DPNP mice, and the relationship with gut microbiota. METHODS The hyperalgesia and depressive behaviors of mice with comorbidity of DPNP and depression were confirmed by pain threshold of the mechanical sensitivity test (MST), immobility time of the tail suspension test (TST) and the forced swimming test (FST). The anti-depressive effect and fecal gut microbiota composition were studied in DPNP mice treated with carvedilol (10 mg/kg/day), and the relationships between them were analyzed by Spearman's correlation. RESULTS Depression was successfully induced in DPNP mice. Carvedilol can reverse the decreased mechanical pain threshold and relieve the depressive behaviors of DPNP mice, while increasing the abundance of Prevotella, Ruminococcus, Helicobacter and Desulfovibrio, and decreasing the abundance of Akkermansia and Allobaculum. CONCLUSIONS Carvedilol can alleviate the mechanical hyperalgesia and alter gut microbiota to ameliorate the depression-like behaviors which induced by DPNP.
Collapse
Affiliation(s)
- Weifeng Wu
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Chao Zeng
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Caineng Wu
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting Wu
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Jianxin Pang
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Pingzheng Zhou
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China.
| | - Ying Cao
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China; Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
| |
Collapse
|
2
|
Greene CRL, Blackbourn LAK, McGurnaghan SJ, Mercer SW, Smith DJ, Wild SH, Wu H, Jackson CA. Antidepressant and antipsychotic prescribing in patients with type 2 diabetes in Scotland: A time-trend analysis from 2004 to 2021. Br J Clin Pharmacol 2024. [PMID: 38981672 DOI: 10.1111/bcp.16171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/13/2024] [Accepted: 06/07/2024] [Indexed: 07/11/2024] Open
Abstract
AIMS Prescribing of antidepressant and antipsychotic drugs in general populations has increased in the United Kingdom, but prescribing trends in people with type 2 diabetes (T2D) have not previously been investigated. The aim of this study was to describe time trends in annual prevalence of antidepressant and antipsychotic drug prescribing in adult patients with T2D. METHODS We conducted repeated annual cross-sectional analysesof a population-based diabetes registry with 99% coverage, derived from primary and secondary care data in Scotland, from 2004 to 2021. For each cross-sectional calendar year time period, we calculated the prevalence of antidepressant and antipsychotic drug prescribing, overall and by sociodemographic characteristics and drug subtype. RESULTS The number of patients with a T2D diagnosis in Scotland increased from 161 915 in 2004 to 309 288 in 2021. Prevalence of antidepressant and antipsychotic prescribing in patients with T2D increased markedly between 2004 and 2021 (from 20.0 per 100 person-years to 33.3 per 100 person-years and from 2.8 per 100 person-years to 4.7 per 100 person-years, respectively). We observed this pattern for all drug subtypes except for first-generation antipsychotics, prescribing of which remained largely stable. The degree of increase, as well as the overall prevalence of prescribing, differed by age, sex, socioeconomic status and subtype of drug class. CONCLUSIONS There has been a marked increase in the prevalence of antidepressant and antipsychotic prescribing in patients with T2D in Scotland. Further research should identify the reasons for this increase, including indication for use and the extent to which this reflects increases in incident prescribing rather than increased duration.
Collapse
Affiliation(s)
| | - Luke A K Blackbourn
- MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | | | | | - Daniel J Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Honghan Wu
- Institute of Health Informatics, University College London, London, UK
| | | |
Collapse
|
3
|
Mulugeta H, Sinclair PM, Wilson A. Comorbid depression among adults with heart failure in Ethiopia: a hospital-based cross-sectional study. BMC Psychiatry 2024; 24:321. [PMID: 38664670 PMCID: PMC11044455 DOI: 10.1186/s12888-024-05748-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/08/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Depression is a common comorbidity in adults with heart failure. It is associated with poor clinical outcomes, including decreased health-related quality of life and increased morbidity and mortality. There is a lack of data concerning the extent of this issue in Ethiopia. Consequently, this study aimed to assess the prevalence of comorbid depression and associated factors among adults living with heart failure in Ethiopia. METHODS A hospital-based cross-sectional study was conducted at the cardiac outpatient clinics of two selected specialist public hospitals in Addis Ababa, Ethiopia: St. Paul's Hospital Millennium Medical College and St. Peter Specialized Hospital. An interviewer-administered questionnaire was used to collect data from 383 adults with heart failure who attended the clinics and met the inclusion criteria. Depression was measured using the Patient Health Questionnaire (PHQ-9). A binary logistic regression model was fitted to identify factors associated with depression. All statistical analyses were conducted using STATA version 17 software. RESULTS The mean age of the participants was 55 years. On average, participants had moderate depression, as indicated by the mean PHQ-9 score of 11.02 ± 6.14, and 217 (56.6%, 95%CI 51.53-61.68) had comorbid depression. Significant associations with depression were observed among participants who were female (AOR: 2.31, 95%CI:1.30-4.08), had comorbid diabetes mellitus (AOR: 3.16, 95%CI: 1.47-6.82), were classified as New York Heart Association (NYHA) class IV (AOR: 3.59, 95%CI: 1.05-12.30), reported poor levels of social support (AOR: 6.04, 95%CI: 2.97-12.32), and took more than five medications per day (AOR: 5.26, 95%CI: 2.72-10.18). CONCLUSIONS This study indicates that over half of all adults with heart failure in Ethiopia have comorbid depression, influenced by several factors. The findings have significant implications in terms of treatment outcomes and quality of life. More research in the area, including interventional and qualitative studies, and consideration of multifaceted approaches, such as psychosocial interventions, are needed to reduce the burden of comorbid depression in this population.
Collapse
Affiliation(s)
- Henok Mulugeta
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Amhara Region, Ethiopia.
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Peter M Sinclair
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Amanda Wilson
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| |
Collapse
|
4
|
Sinclair LI, Mohr A, Morisaki M, Edmondson M, Chan S, Bone-Connaughton A, Turecki G, Love S. Is later-life depression a risk factor for Alzheimer's disease or a prodromal symptom: a study using post-mortem human brain tissue? Alzheimers Res Ther 2023; 15:153. [PMID: 37700368 PMCID: PMC10496415 DOI: 10.1186/s13195-023-01299-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Depression and dementia are both common diseases. Although new cases of depression are more common in younger adults, there is a second peak at the age of 50 years suggesting a different pathological process. Late-life depression (LLD) is associated with dementia. However, it remains unclear whether depression represents a dementia prodrome or is a true risk factor for its development. LLD is thought to have a vascular component and this may be a possible link between depression and dementia. We hypothesised that later-life depression is a prodromal manifestation of dementia and would therefore be associated with more AD, and/or ischaemic brain abnormalities that are present in earlier-life depression or in age- and sex-matched controls. METHODS We assessed post-mortem orbitofrontal cortex and dorsolateral pre-frontal cortex from 145 individuals in 4 groups: 28 18-50-year-olds with depression, 30 older individuals (ages 51-90) with depression, 28 with early AD (Braak tangle stages III-IV) and 57 matched controls (17 early-life, 42 later-life). Levels of Aβ, phospho-tau and α-synuclein were assessed by immunohistochemistry and ELISA. To quantify chronic ischaemia, VEGF, MAG and PLP1 were measured by ELISA. To assess pericyte damage, PDGFRB was measured by ELISA. For blood-brain barrier leakiness, JAM-A, claudin 5 and fibrinogen were measured by ELISA. To quantity endothelial activation, the ratio of ICAM1:collagen IV was assessed by immunohistochemistry. RESULTS There was no evidence of chronic cerebral hypoperfusion or increased Aβ/tau in either depression group. There was also no indication of pericyte damage, increased blood-brain barrier leakiness or endothelial activation in the OFC or DLPFC in the depression groups. CONCLUSIONS Contrary to some previous findings, we have not found evidence of impaired vascular function or increased Aβ in LLD. Our study had a relatively small sample size and limitations in the availability of clinical data. These results suggest that depression is a risk factor for dementia rather than an early manifestation of AD or a consequence of cerebral vascular insufficiency.
Collapse
Affiliation(s)
- Lindsey I Sinclair
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Southmead Hospital, Level 1 Learning & Research Building, Bristol, BS10 5NB, UK.
| | - Asher Mohr
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Southmead Hospital, Level 1 Learning & Research Building, Bristol, BS10 5NB, UK
| | - Mizuki Morisaki
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Southmead Hospital, Level 1 Learning & Research Building, Bristol, BS10 5NB, UK
| | - Martin Edmondson
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Southmead Hospital, Level 1 Learning & Research Building, Bristol, BS10 5NB, UK
| | - Selina Chan
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Southmead Hospital, Level 1 Learning & Research Building, Bristol, BS10 5NB, UK
- Douglas Institute, Department of Psychiatry, McGill University, Montreal, Canada
| | - A Bone-Connaughton
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Southmead Hospital, Level 1 Learning & Research Building, Bristol, BS10 5NB, UK
| | - Gustavo Turecki
- Department of Life Sciences, Warwick University, Warwick, UK
| | - Seth Love
- Dementia Research Group, Faculty of Health Sciences, University of Bristol, Southmead Hospital, Level 1 Learning & Research Building, Bristol, BS10 5NB, UK
| |
Collapse
|
5
|
Shaphe MA, Alshehri MM, Alfaifi B, Aljahni MA, Esht V, Malik S, Bautista MJ, Alqahtani AS, Ahmad A, Khan A, Aafreen A, Khan AR. Assessment of Risk Factors and the Relationship between Hypothyroidism with Hypertension in Diabetes Mellitus Patients: A Cross-Sectional Community-Based Study. J Pers Med 2023; 13:1231. [PMID: 37623480 PMCID: PMC10455546 DOI: 10.3390/jpm13081231] [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: 06/01/2023] [Revised: 07/13/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: hypertension (HTN) and diabetes mellitus (DM) represent two widely noncommunicable diseases that are prevalent globally, and they often correlate with chronic health issues. There has been an acknowledged connection between diabetes, hypertension, and hypothyroidism for quite some time. However, the extent of thyroid dysfunction among the diabetic population is not uniform and significantly differs across different research studies. This study was conducted with the objective of identifying the risk factors associated with hypothyroidism as well as assessing the relationship between hypothyroidism and hypertension in patients with diabetes. (2) Materials and Methods: Participants aged 18 years and above were included in this study, while pregnant women were excluded. Trained health professionals measured sociodemographic, behavioural, food practices, and anthropometric information about the participants. Each respondent sought medical advice regarding their health, and a face-to-face interview enabled them to express concern about the likelihood of being diagnosed with diabetes mellitus and hypertension. (3) Results: The study encompassed 640 participants, with an average age of 49.20 ± 13.0 years. Among these participants, 65.5% were female, and 34.5% were male. Of the total, 31.25% were diagnosed with diabetes mellitus, and 18.75% had hypertension. Interestingly, co-occurrence of both conditions was observed in 9.68% of the population. A comparison of thyroid function and indicators of blood sugar levels yielded consistent results across the different patient groups. Specifically, for diabetes mellitus (DM) patients, the average levels were 3.4 ± 9.8 pg/mL for fT3, 0.9 ± 0.7 ng/dL for fT4, 3.3 ± 6.2 μiU/mL for TSH, 153.1 ± 68.0 mg/dL for fasting plasma glucose (FPG), 213.2 ± 97.2 mg/dL for postprandial glucose (PPG), and 8.3 ± 3.2% for HbA1c. (4) Conclusion: It is concluded that patients with hypertension had a significant prevalence of diabetes mellitus. Subclinical hypothyroid subjects must be frequently screened for hypertension. Of 120 individuals with hypertension, 45 (37.5%) were also diagnosed with diabetes. This co-occurrence was significantly higher in subjects aged over 50 years (26.7%), in the lower socio-economic class (18.5%), and among those who were married (14.7%). Additionally, patients with hypertension exhibited a high prevalence of diabetes across different educational backgrounds and occupations, with the highest prevalence among postgraduates (37.5%) and professionals (24.0%), respectively. These findings highlight the need for an integrated approach to the management of hypertension and diabetes, particularly in high-risk demographics.
Collapse
Affiliation(s)
- Mohammad Abu Shaphe
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.A.S.); (M.M.A.); (B.A.); (V.E.); (S.M.); (M.J.B.)
| | - Mohammed M. Alshehri
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.A.S.); (M.M.A.); (B.A.); (V.E.); (S.M.); (M.J.B.)
| | - Bushra Alfaifi
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.A.S.); (M.M.A.); (B.A.); (V.E.); (S.M.); (M.J.B.)
| | - Mohammed A Aljahni
- Physical Education Department, Jazan University, Jazan 45142, Saudi Arabia;
| | - Vandana Esht
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.A.S.); (M.M.A.); (B.A.); (V.E.); (S.M.); (M.J.B.)
| | - Shazia Malik
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.A.S.); (M.M.A.); (B.A.); (V.E.); (S.M.); (M.J.B.)
| | - Marissa J Bautista
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.A.S.); (M.M.A.); (B.A.); (V.E.); (S.M.); (M.J.B.)
| | - Abdulfattah S. Alqahtani
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Ausaf Ahmad
- Department of Community Medicine, IIMS&R, Integral University, Lucknow 226026, India;
| | - Ashfaque Khan
- Department of Physiotherapy, Integral University, Lucknow 226026, India; (A.K.); (A.A.)
| | - Aafreen Aafreen
- Department of Physiotherapy, Integral University, Lucknow 226026, India; (A.K.); (A.A.)
| | - Abdur Raheem Khan
- Department of Physiotherapy, Integral University, Lucknow 226026, India; (A.K.); (A.A.)
| |
Collapse
|
6
|
Laird E, Herring MP, Carson BP, Woods CB, Walsh C, Kenny RA, Rasmussen CL. Physical activity for depression among the chronically Ill: Results from older diabetics in the Irish longitudinal study on ageing. Psychiatry Res 2023; 326:115274. [PMID: 37270867 DOI: 10.1016/j.psychres.2023.115274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/06/2023]
Abstract
Among chronically-ill older adults, the benefits of moderate-to-vigorous physical activity (MVPA) are established. Comorbid depressive symptoms and Major Depression are prevalent among the chronically-ill, but how different doses of MVPA may protect against depression remains understudied. Thus, using 10 years of data from The Irish Longitudinal Study on Ageing, we quantified longitudinal associations between MVPA doses and depressive symptoms and Major Depression among chronically-ill older adults living with type 2 diabetes (T2DM). Continuous MVPA (MET.min.week-1), three dose and five dose MVPA categories were examined. Depressive symptoms and Major Depression were measured using the center for Epidemiological Studies Depression and the Composite International Diagnostic Interview for Major Depressive Episode. Negative binomial regression and logistic models, adjusted for covariates, quantified associations across time. Among the 2,262 participants, those adhering to the WHO guidelines of 600-<1,200 MET.min.week-1 had 28% lower odds of Major Depression compared to those not achieving the guidelines (OR: 0.72; 95%CI: 0.53-0.98). For depressive symptoms, a higher MVPA dose was required with a 13% (IRR: 0.87; 95%CI: 0.82-0.93) lower rate of symptoms among those exceeding recommendations (1200-<2,400 MET.min.week-1). Interventions should focus on enhancing achievability of and compliance with these MVPA doses among the chronically-ill, including T2DM, to protect against depression.
Collapse
Affiliation(s)
- Eamon Laird
- Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences, University of Limerick, Ireland; The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland.
| | - Matthew P Herring
- Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences, University of Limerick, Ireland; The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland
| | - Brian P Carson
- Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences, University of Limerick, Ireland
| | - Catherine B Woods
- Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences, University of Limerick, Ireland
| | - Cathal Walsh
- Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences, University of Limerick, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland
| | | |
Collapse
|
7
|
Hernar I, Graue M, Igland J, Richards DA, Riise HKR, Haugstvedt A, Kolltveit BCH. Patient activation in adults attending appointments in general practice: a cross-sectional study. BMC PRIMARY CARE 2023; 24:144. [PMID: 37430197 DOI: 10.1186/s12875-023-02102-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 07/03/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Patient activation refers to patients' knowledge, confidence, skills, ability, beliefs, and willingness to manage their health and healthcare. Patient activation is an essential component of self-management and identifying patient activation levels will identify people at risk for health decline at an earlier stage. We aimed to explore patient activation in among adults attending general practice by (1) investigating differences in patient activation according to characteristics and markers of health-related behaviour; (2) examining the associations of quality of life and satisfaction with health with patient activation; and (3) comparing patient activation between persons with or without type 2 diabetes (T2D) and with or without elevated T2D risk. METHODS We performed a cross-sectional study and recruited 1,173 adult patients from four Norwegian general practices between May to December 2019. The participants completed a questionnaire containing sociodemographic and clinical variables, the Patient Activation Measure (PAM-13), the quality of life and satisfaction with health items from the WHO Quality of Life-BREF, three questions about exercise (regularity, intensity and exercise time), the Finnish Diabetes Risk Score (FINDRISC) and Body Mass Index. We tested differences between groups and associations using Chi-squared tests, Fisher's exact tests, t-tests, one-way ANOVAs and Spearman's rho tests. RESULTS The sample's mean PAM-13 score was 69.8 (0-100) (SD 14.8). In the total population, we found that participants reporting higher patient activation scores also reported more favourable health-related behaviours (exercise and healthy eating). We found positive correlations between the PAM-13 scores and, respectively, the quality of life score and the satisfaction with health score. We found no differences in patient activation between people with or without T2D and those with or without elevated T2D risk. CONCLUSIONS We found that higher patient activation was associated with favourable health-related behaviours, a better quality of life and better satisfaction with health among adults attending four general practices in Norway. Assessing patient activation has the potential to help general practitioners identify patients who might benefit from closer follow-up in advance of negative health outcomes.
Collapse
Affiliation(s)
- Ingvild Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway.
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
| | - Jannicke Igland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - David A Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
- Institute for Health Research, College of Medicine and Health,, University of Exeter, Exeter, UK
| | - Hilde Kristin Refvik Riise
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
| | - Beate-Christin Hope Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
- Vossevangen Medical Centre, Voss, Norway
| |
Collapse
|
8
|
Prell T, Stegmann S, Schönenberg A. Social exclusion in people with diabetes: cross-sectional and longitudinal results from the German Ageing Survey (DEAS). Sci Rep 2023; 13:7113. [PMID: 37130924 PMCID: PMC10152415 DOI: 10.1038/s41598-023-33884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/20/2023] [Indexed: 05/04/2023] Open
Abstract
As social exclusion can be linked to worse health and overall reduced quality of life, we describe social exclusion in people with diabetes and assess whether diabetes can be considered as a risk factor for social exclusion. We analyzed two waves (2014, 2017, N = 6604) from a survey of community-dwelling people aged > 40 using linear regression, group comparison and generalized estimating equations to explore the association between diabetes, social exclusion, socioeconomic, physical and psychosocial variables. In the entire cohort, diabetes was cross-sectionally associated with social exclusion after adjusting for covariates (p = 0.001). In people with diabetes, social exclusion was further associated with self-esteem (p < 0.001), loneliness (p = < 0.001), income (p = 0.017), depression (p = 0.001), physical diseases (p = 0.04), and network size (p = 0.043). Longitudinal data revealed that higher levels of social exclusion were already present before the diagnosis of diabetes, and future social exclusion was predicted by self-esteem, loneliness, depression, and income, but not by diabetes (p = .221). We conclude that diabetes is not a driver of social exclusion. Instead, both seem to co-occur as a consequence of health-related and psychosocial variables.
Collapse
Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany
| | | | - Aline Schönenberg
- Department of Geriatrics, Halle University Hospital, Halle, Germany.
| |
Collapse
|
9
|
Yang H, Wu F, Gui M, Cheng Y, Zhang L. The role of medication adherence in the association between depressive symptoms and quality of life in older adults with type 2 diabetes mellitus. BMC Geriatr 2023; 23:196. [PMID: 36997851 PMCID: PMC10064516 DOI: 10.1186/s12877-023-03929-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND At present, the role of medication adherence in the association between depressive symptoms and quality of life (QOL) in older adults with type 2 diabetes mellitus (T2DM) was unclear. The purpose of this study was to explore the associations among depressive symptoms, medication adherence and QOL in older adults with T2DM. METHODS In this cross-sectional study, 300 older adults with T2DM from the First Affiliated Hospital of Anhui Medical University were enrolled. Among them, 115 patients had depressive symptoms and 185 had no depressive symptoms. Univariate linear regression analysis was conducted to identify possible covariates. Univariate and multivariable linear regression analyses were performed to explore the associations between depressive symptoms and medication adherence or QOL in older adults with T2DM. Multiplicative interaction analysis was evaluated whether there was interaction effect between medication adherence and depressive symptoms on QOL of patients. Mediating effect analysis was used to analyze the medication effect of medication adherence on depressive symptoms and QOL in older adults with T2DM. RESULTS Decreased medication adherence was observed in patients with depressive symptoms (β = -0.67, 95%CI: -1.10, -0.24) after adjusting for covariates. Depressive symptoms were associated with decreased QOL in older adults with T2DM (β = -5.99, 95%CI: -7.56, -4.42). The mediating analysis revealed that depressive symptoms were associated with decreased medication adherence (β = -0.67, 95%CI: -1.09, -0.25). Medication adherence was linked with increased QOL of older adults with T2DM (β = 0.65, 95%CI: 0.24, 1.06). Depressive symptoms were correlated with decreased QOL of older adults with T2DM (β = -5.56, 95%CI: -7.10, -4.01). The percentage mediated by medication adherence on depressive symptoms and QOL in older adults with T2DM was 10.61%. CONCLUSION Medication adherence might mediate depressive symptoms and QOL of older adults with T2DM, which might provide a reference for the improvement of QOL of these patients.
Collapse
Affiliation(s)
- Hao Yang
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 of Jixi Road, Shushan District, Hefei, 230032, Anhui, China.
| | - Fangtuan Wu
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 of Jixi Road, Shushan District, Hefei, 230032, Anhui, China
| | - Mingdong Gui
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 of Jixi Road, Shushan District, Hefei, 230032, Anhui, China
| | - Yuwei Cheng
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 of Jixi Road, Shushan District, Hefei, 230032, Anhui, China
| | - Li Zhang
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 of Jixi Road, Shushan District, Hefei, 230032, Anhui, China
| |
Collapse
|
10
|
Witkow S, Liberty IF, Goloub I, Kaminsky M, Otto O, Rabia Y, Boehm IH, Golan R. Simplifying carb counting: A randomized controlled study - Feasibility and efficacy of an individualized, simple, patient-centred carb counting tool. Endocrinol Diabetes Metab 2023; 6:e411. [PMID: 36750449 PMCID: PMC10000617 DOI: 10.1002/edm2.411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/11/2023] [Accepted: 01/28/2023] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION The purpose of this study was to introduce and test a simple, individualized carbohydrate counting tool designed for persons with Type 1 Diabetes Mellitus (T1DM) in order to determine whether the tool improved A1C levels for participants with age, education or language barriers. METHODS In a randomized controlled trial, 85 participants were offered six diabetes instructional sessions free of charge over a six-month period. Forty-one received guidance using the regular carbohydrate counting (RCC) method. Forty-four received guidance using an individualized 'Simple Carb Counting' (SCC), involving two customized tables prepared for participants. RESULTS The simple, individualized SCC tool for carbohydrate counting was non-inferior to the standard method of RCC. The SCC tool was more effective among participants aged 40 and older, while no differences were found when comparing participants by education level. Irrespective of intervention group, all participants improved their A1C level (9.9% = 13.2 mmol/L vs 8.6% = 11.1 mmol/L, p = .001). A greater improvement in A1C level was seen in newly diagnosed participants (-6.1 vs -0.7, p = .005, -3.4 vs 0.9, p = .032) in both the RCC and SCC groups. All participants expressed improved emotional level per their PAID5 questionnaires (Problem Areas in Diabetes Scale-PAID), (10.6 (±5.7) vs 9.5 (±5.7), p = .023), with women reporting greater improvement than men. CONCLUSIONS SCC is a simple, individualized, feasible, low-tech tool for carbohydrate counting, which promotes and enables accurate insulin dosing in people with T1DM. It was found more effective among participants aged 40 and older. Additional studies are needed to corroborate these findings.
Collapse
Affiliation(s)
- Shulamit Witkow
- Diabetes Unit, Soroka University Medical CenterBeer ShevaIsrael
| | - Idit F. Liberty
- Diabetes Unit, Soroka University Medical CenterBeer ShevaIsrael
- Ben‐Gurion University of the NegevBeer ShevaIsrael
| | - Irina Goloub
- Diabetes Unit, Soroka University Medical CenterBeer ShevaIsrael
| | - Malka Kaminsky
- Diabetes Unit, Soroka University Medical CenterBeer ShevaIsrael
| | - Olga Otto
- Diabetes Unit, Soroka University Medical CenterBeer ShevaIsrael
- Clalit HMO of the NegevBeer ShevaIsrael
| | - YonesAbu Rabia
- Diabetes Unit, Soroka University Medical CenterBeer ShevaIsrael
- Clalit HMO of the NegevBeer ShevaIsrael
| | | | - Rachel Golan
- Ben‐Gurion University of the NegevBeer ShevaIsrael
| |
Collapse
|
11
|
Jalilian H, Javanshir E, Torkzadeh L, Fehresti S, Mir N, Heidari‐Jamebozorgi M, Heydari S. Prevalence of type 2 diabetes complications and its association with diet knowledge and skills and self-care barriers in Tabriz, Iran: A cross-sectional study. Health Sci Rep 2023; 6:e1096. [PMID: 36761031 PMCID: PMC9895320 DOI: 10.1002/hsr2.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Background and Aims Diabetes can lead to multiple complications that can reduce the quality of life, impose additional costs on the healthcare systems and ultimately lead to premature death. Proper self-care in diabetic patients can impede or delay the onset of diabetes complications. This study aimed to investigate diabetes complications and their association with diet knowledge, skills, and self-care barriers. Methods This was a cross-sectional study. A total of 1139 patients with Type 2 Diabetes Mellitus (T2DM) referring to health centers in Tabriz, Iran, were included from January to July 2019. Data were collected using two questionnaires: (1) a sociodemographic questionnaire and (2) a Personal Diabetes Questionnaire (PDQ). Data were analyzed using SPSS software version 22. χ 2 test was used to examine the association between the socioeconomic and disease-related variables and the prevalence of diabetes complications. T-test was used to examine the association between diet knowledge and skills, self-care barriers, and the incidence of diabetes complications. Results In this study, 76.1% of patients had at least one complication, and 30.2% had a history of hospitalization due to diabetes complications during the past year. Approximately 49% and 43% were diagnosed with high blood pressure and hyperlipidemia, respectively. Cardiovascular disease was the most common diabetes complication (15.9%) and the cause of hospitalization (11.01%) in patients with diabetes. Barriers to diet adherence, blood glucose monitoring, and exercise were significantly associated with self-reported diabetes complications (p < 0.001). Our results showed no significant association between the number of complications and diet knowledge and skills (p = 0.44). Conclusion This study indicated that the prevalence of diabetes complications was higher among patients with more barriers to self-care. In light of these findings, taking appropriate measures to reduce barriers to self-care can prevent or delay the onset of diabetes complications.
Collapse
Affiliation(s)
- Habib Jalilian
- Department of Health Services Management, School of HealthAhvaz Jundishapur University of Medical SciencesAhvazIran,Social Determinants of Health Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Elnaz Javanshir
- Cardiovascular Research CentreTabriz University of Medical SciencesTabrizIran
| | - Leila Torkzadeh
- Department of Health Policy and Management, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Saeedeh Fehresti
- Department of Health Economics and Management, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Nazanin Mir
- Health Management and Economics Research CenterIran University of Medical SciencesTehranIran
| | | | - Somayeh Heydari
- Social Determinants of Health Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
| |
Collapse
|
12
|
Liu Y, Chen L, Zhou H, Guan H, Feng Y, Yangji B, Liu Q, Liu X, Xia J, Li J, Zhao X. Does awareness of diabetic status increase risk of depressive or anxious symptoms? Findings from the China Multi-Ethnic cohort (CMEC) study. J Affect Disord 2023; 320:218-229. [PMID: 36191641 DOI: 10.1016/j.jad.2022.09.135] [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: 02/09/2022] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION People with diabetes mellitus (DM) have increased risk of depressive symptoms (DS) or anxious symptoms (AS). This study explores whether awareness of DM will contribute to prevalence of DS or AS. METHODS The baseline data including 81,717 adults from Southwest China was analyzed. DS and AS were assessed using PHQ-2 and GAD-2. Exposures were defined as 1) having self-reported physician diagnosis of diabetes (self-reported DM), 2) no prior diagnosis of diabetes but meeting diagnostic criteria (newly diagnosed DM), 3) having self-reported physician diagnosis or meeting criteria of non-diabetic diseases (non-diabetic patients), 4) healthy participants. Generalized linear mixed models were used to assess impact of presence and awareness of DM on DS or AS, adjusting for regional and individual related factors. RESULTS The prevalence of DS in self-reported DM, newly diagnosed DM, non-diabetic patient and healthy participants was 7.08 %, 4.30 %, 5.37 % and 3.17 %. The prevalence of AS was 7.80 %, 5.77 %, 6.37 % and 3.91 %. After adjusting for related factors, compared with healthy participants, self-reported DM and non-diabetic patients were associated with DS [AORDS, self-reported = 1.443(1.218,1.710), AORDS, nondiabetic patients = 1.265(1.143,1.400)], while the association between newly diagnosed DM and DS was not statistically significant. The associations between self-reported DM, newly diagnosed DM, non-diabetic patients and AS were all statistically significant. LIMITATIONS DS and AS were assessed through self-report and may suffer recall or information bias. CONCLUSIONS The association between awareness of diabetes and DS/AS suggests to pay attention to distinguish between self-reported and newly diagnosed DM and screening for DS and AS in diabetic population.
Collapse
Affiliation(s)
- Yuanyuan Liu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liling Chen
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Hanwen Zhou
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Han Guan
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, Guizhou, China
| | - Yuemei Feng
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Baima Yangji
- School of Medicine, Tibet University, Lhasa, Tibet Autonomous Region, China
| | - Qiaolan Liu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiang Liu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jinjie Xia
- Chengdu Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Jingzhong Li
- Tibet Center for Disease Control and Prevention, Lhasa, Tibet Autonomous Region, China
| | - Xing Zhao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
13
|
Rutters F, Nefs G. Sleep and Circadian Rhythm Disturbances in Diabetes: A Narrative Review. Diabetes Metab Syndr Obes 2022; 15:3627-3637. [PMID: 36439294 PMCID: PMC9694979 DOI: 10.2147/dmso.s354026] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Sleep and circadian rhythm disturbances are less-known risk factors for the development and suboptimal outcomes of diabetes. The goal of this narrative review is to highlight the importance of sleep and circadian rhythm disturbances in the development and outcomes of type 1 diabetes (T1D) and type 2 diabetes (T2D), assess current treatment options and the possible mediating mechanisms. We performed a literature search using PubMed and selected relevant English and Dutch papers. Disturbances of sleep and circadian rhythm are common in people with diabetes. They are associated with an increased risk of developing T2D as well as with suboptimal diabetes outcomes (including higher HbA1c levels and reduced quality of life) for T1D and T2D. Preliminary data suggest that treatment of sleep and circadian rhythm disturbances could improve diabetes outcomes in people with T1D and T2D. Finally, the association with medical parameters appears to be mediated by disturbance in hormones, and by suboptimal self-care including forgetting or postponing glucose monitoring or medication use as well as higher consumption of high fat/high sugary foods. Diabetes may also disturb sleep, for example through nocturnal hypoglycemia and nocturia. We concluded that sleep and circadian rhythm disturbances are closely linked with diabetes. More attention to sleep in regular diabetes care is warranted, while further research is needed on treatment of sleep and circadian rhythm disturbances in the prevention of diabetes and its suboptimal outcomes.
Collapse
Affiliation(s)
- Femke Rutters
- Department of Epidemiology and Data Science, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Diabeter, Center for Type 1 Diabetes Care and Research, Rotterdam, the Netherlands
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands
| |
Collapse
|
14
|
Sun XJ, Zhang GH, Guo CM, Zhou ZY, Niu YL, Wang L, Dou GR. Associations between psycho-behavioral risk factors and diabetic retinopathy: NHANES (2005-2018). Front Public Health 2022; 10:966714. [PMID: 36187629 PMCID: PMC9521717 DOI: 10.3389/fpubh.2022.966714] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/19/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Diabetes mellitus (DM) and diabetic retinopathy (DR) increase the global burden. Since their pathogenesis is complex, it is necessary to use the biopsychosocial model to discover the most effective strategies. The study is aimed to investigate the psycho-behavioral factors of DR and confirm the discrepancies from previous studies. Research design and methods The study comprised seven cycles of cross-sectional data of the National Health and Nutrition Examination Survey (NHANES) from 2005-2006 to 2017-2018. Samples of DM were selected from this complex multi-stage probability sample and divided into the non-DR and DR groups, where 4,426 samples represented 18,990,825 individuals after weighting. This study comprehensively explored the biological, social, and psychological risk factors of DR, among which the biological factors included blood pressure, blood routine, HbA1c%, blood glucose, the duration of DM, family history, comorbidities, and treatment methods. Social aspects include gender, education, income, insurance, smoking, drinking, sleep habits, and recreational activities. The Patient Health Questionnaire-9 (PHQ-9) was used to assess the psychological state. Taylor series regression was used to examine the connection between factors and DR. Results Men accounted for 55.5% of the DR group (P = 0.0174). Lymphocyte count, insulin treatment, heart failure, stroke, liver condition, and renal failure showed significant differences in DR (P < 0.05). The incidence of depression in DR was 40.5%. Mild to moderate depression [odds ratio was associated with DR [(OR) = 1.37, 95% confidence interval (CI): 1.06-1.79], but there was no statistical difference in severe depression (OR = 1.34, 95% CI: 0.83-2.17). Although ≤ 6 h of sleep was associated with DR (OR = 1.38, 95% CI: 1.01-1.88), we found no statistical differences in alcohol consumption, recreational activities, or sedentary time between the two groups in our current study (P > 0.05). Conclusions The biological risk factors of DR are significant. It showed that stroke is associated with DR, and retinal exams have the potential value as a screening tool for the brain. Besides, psycho-behavioral risk factors of DR should also be paid attention. Our study highlights that mild and moderate depression and ≤6 h of sleep are distinguishably associated with DM complicated with DR. It indicates that psycho-behavioral risk factors confer a vital influence on diabetic health care and DR.
Collapse
Affiliation(s)
- Xiao-Jia Sun
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Guo-Heng Zhang
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chang-Mei Guo
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zi-Yi Zhou
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ya-Li Niu
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ling Wang
- Department of Health Statistics, Faculty of Preventive Medicine, Fourth Military Medical University, Xi'an, China,Ling Wang
| | - Guo-Rui Dou
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China,*Correspondence: Guo-Rui Dou
| |
Collapse
|
15
|
Upsher R, Yaquetto DA, Stahl D, Ismail K, Winkley K. Prospective study of the association between depressive symptoms at type 2 diabetes diagnosis and time to insulin initiation in the South London diabetes (SOUL-D) cohort. Prim Care Diabetes 2022; 16:502-508. [PMID: 35690551 DOI: 10.1016/j.pcd.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
AIMS Initiation of insulin is usually delayed even when required. We aim to estimate the association between depressive symptoms on time to become insulin requiring and time to insulin initiation. METHODS 8-year follow-up of a cohort of newly diagnosed people with T2D recruited in south-east London, UK (2008-2012). Baseline depressive symptoms were assessed using the Patient Health Questionnaire-9. Time to insulin-requiring was defined when optimal glycaemic levels were not achieved (HbA1c >58 mmol/mol) at least three months after the 2nd oral antidiabetic was prescribed, and time to insulin initiation was defined as first insulin prescription. RESULTS Seventy percent (n = 1166) of the baseline cohort was followed up. Median time to insulin requiring was 84 months (IQR 63-100) and to insulin initiation 93 months (IQR 79-105). Participants with depressive symptoms at baseline required insulin earlier (mean [SD] 73.64 [32.16] vs. 79.05 [29.07] months, p = 0.007) and were prescribed insulin sooner (82.53 [30.19] vs. 89.72 [22.02] months, p < 0.001). In Cox regression, depressive symptoms at baseline were not associated with time to insulin requiring (HR [95 % CI]; 1.16 [0.86-1.57], p = 0.34) nor to insulin initiation (HR = 1.00 [0.99-1.00], p = 0.49). CONCLUSIONS Depressive symptoms were not associated with time to insulin requiring and initiation after adjusting for potential confounding.
Collapse
Affiliation(s)
- Rebecca Upsher
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | - Dulce Alarcon Yaquetto
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, UK
| |
Collapse
|
16
|
Diress G, Endalifer ML, Addisu A, Mengist B. Association between social supports and depression among patients with diabetes mellitus in Ethiopia: a systematic review and meta-analysis. BMJ Open 2022; 12:e061801. [PMID: 35545384 PMCID: PMC9096548 DOI: 10.1136/bmjopen-2022-061801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The adverse effects of poor social support on quality of life and adherence to treatment are established. However, the relationship between social support and depression is not well understood. In this systematic review and meta-analysis, we aim to examine the association between social support and depressive symptoms among type 2 patients with diabetes. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched PubMed, African Journals Online, Web of Science, and the Cochrane Library electronic databases. Some studies were also identified through manual Google search and Google scholar. ELIGIBILITY CRITERIA We systematically searched electronic databases for studies published up to October 2020. Only English-language articles were included. DATA EXTRACTION AND SYNTHESIS Screening, data extraction and quality appraisal were conducted by two independent reviewers. A random-effect model was applied to estimate ORs with 95% CIs. The Higgins I2 test was used to assess the heterogeneity between the studies. The risk of publication bias was estimated using the Egger test. Leave-one-out analysis was done. Data were analysed using Stata V.11. RESULTS Seven studies were included in the meta-analysis. The findings from included studies revealed that poor social support increases the odds of depression among patients with diabetes (adjusted OR=2.14, 95% CI 1.34 to 3.43, p=0.003). There was no risk of publication bias (p=0.064), and heterogeneity was substantial (I2=70.7%). The leave-one-out analysis confirmed the consistency of the findings. CONCLUSIONS Our meta-analysis revealed that patients who had poor social support were significantly associated with an increased level of depression. Additional studies exploring factors that might moderate or mediate this association are needed. Targeted interventions for comorbid depression should be implemented in clinical practice. SYSTEMATIC REVIEW REGISTRATION We have submitted the protocol for registration at the PROSPERO on 9 October 2020. But we have not yet received a registration number.
Collapse
Affiliation(s)
- Gedefaw Diress
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Amhara, Ethiopia
| | - Melese Linger Endalifer
- Department of Nutrition, College of Health Science, Debre Markos University, Debre Markos, Amhara, Ethiopia
| | - Amanuel Addisu
- School of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Belayneh Mengist
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Amhara, Ethiopia
| |
Collapse
|
17
|
Lara-Morales A, Gandarillas-Grande A, Díaz-Holgado A, Serrano-Gallardo P. Psychosocial factors in adherence to pharmacological treatment and diabetes mellitus control in patients over 65. Aten Primaria 2022; 54:102302. [PMID: 35430460 PMCID: PMC9036116 DOI: 10.1016/j.aprim.2022.102302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/26/2021] [Accepted: 01/13/2022] [Indexed: 11/02/2022] Open
Abstract
Aim Design Setting and participants Main measurements Results Conclusions
Collapse
|
18
|
Beran M, Muzambi R, Geraets A, Albertorio‐Diaz JR, Adriaanse MC, Iversen MM, Kokoszka A, Nefs G, Nouwen A, Pouwer F, Huber JW, Schmitt A, Schram MT. The bidirectional longitudinal association between depressive symptoms and HbA 1c : A systematic review and meta-analysis. Diabet Med 2022; 39:e14671. [PMID: 34407250 PMCID: PMC9292323 DOI: 10.1111/dme.14671] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/17/2021] [Accepted: 08/16/2021] [Indexed: 12/11/2022]
Abstract
AIM To investigate whether there is a bidirectional longitudinal association of depression with HbA1c . METHODS We conducted a systematic literature search in PubMed, PsycINFO, CINAHL and EMBASE for observational, longitudinal studies published from January 2000 to September 2020, assessing the association between depression and HbA1c in adults. We assessed study quality with the Newcastle-Ottawa-Scale. Pooled effect estimates were reported as partial correlation coefficients (rp ) or odds ratios (OR). RESULTS We retrieved 1642 studies; 26 studies were included in the systematic review and eleven in the meta-analysis. Most studies (16/26) focused on type 2 diabetes. Study quality was rated as good (n = 19), fair (n = 2) and poor (n = 5). Of the meta-analysed studies, six investigated the longitudinal association between self-reported depressive symptoms and HbA1c and five the reverse longitudinal association, with a combined sample size of n = 48,793 and a mean follow-up of 2 years. Higher levels of baseline depressive symptoms were associated with subsequent higher levels of HbA1c (partial r = 0.07; [95% CI 0.03, 0.12]; I2 38%). Higher baseline HbA1c values were also associated with 18% increased risk of (probable) depression (OR = 1.18; [95% CI 1.12,1.25]; I2 0.0%). CONCLUSIONS Our findings support a bidirectional longitudinal association between depressive symptoms and HbA1c . However, the observed effect sizes were small and future research in large-scale longitudinal studies is needed to confirm this association. Future studies should investigate the role of type of diabetes and depression, diabetes distress and diabetes self-management behaviours. Our results may have clinical implications, as depressive symptoms and HbA1c levels could be targeted concurrently in the prevention and treatment of diabetes and depression. REGISTRATION PROSPERO ID CRD42019147551.
Collapse
Affiliation(s)
- Magdalena Beran
- School for Cardiovascular Disease (CARIM)Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
| | - Rutendo Muzambi
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Anouk Geraets
- School for Cardiovascular Disease (CARIM)Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
- Department of Psychiatry and NeuropsychologyMHeNs School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | | | - Marcel C. Adriaanse
- Department of Health Sciences and Amsterdam Public Health Research InstituteFaculty of ScienceVrije UniversiteitAmsterdamThe Netherlands
| | - Marjolein M. Iversen
- Department of Health and Caring SciencesFaculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Andrzej Kokoszka
- II Department of PsychiatryMedical University of WarsawWarszawaPoland
| | - Giesje Nefs
- Department of Medical PsychologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
- Center of Research on Psychology in Somatic Diseases (CoRPS)Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
- DiabeterNational Treatment and Research Center for Children, Adolescents and Young Adults with Type 1 DiabetesRotterdamThe Netherlands
| | - Arie Nouwen
- Department of PsychologyMiddlesex UniversityLondonUnited Kingdom
- School of Health, Wellbeing and Social CareThe Open UniversityMilton KeynesUnited Kingdom
| | - Frans Pouwer
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
- STENO Diabetes CenterOdense University HospitalOdenseDenmark
| | - Jörg W. Huber
- School of Health SciencesUniversity of BrightonBrightonUnited Kingdom
| | - Andreas Schmitt
- German Center for Diabetes Research (DZDMünchen‐NeuherbergGermany
- Research Institute of the Diabetes Academy Mergentheim (FIDAMBad MergentheimGermany
| | - Miranda T. Schram
- School for Cardiovascular Disease (CARIM)Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
- Department of Psychiatry and NeuropsychologyMHeNs School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
- Heart and Vascular CentreMaastricht University Medical Center+MaastrichtThe Netherlands
| | | |
Collapse
|
19
|
Ramallo-Fariña Y, Rivero-Santana A, García-Pérez L, García-Bello MA, Wägner AM, Gonzalez-Pacheco H, Rodríguez-Rodríguez L, Kaiser-Girardot S, Monzón-Monzón G, Guerra-Marrero C, Daranas-Aguilar C, Roldán-Ruano M, Carmona M, Serrano-Aguilar PG. Patient-reported outcome measures for knowledge transfer and behaviour modification interventions in type 2 diabetes-the INDICA study: a multiarm cluster randomised controlled trial. BMJ Open 2021; 11:e050804. [PMID: 34911711 PMCID: PMC8679133 DOI: 10.1136/bmjopen-2021-050804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study assesses the effectiveness of different interventions of knowledge transfer and behaviour modification to improve type 2 diabetes mellitus patients' (T2DM) reported outcomes measures (PROMs) in the long-term. Design: open, community-based pragmatic, multicentre, controlled trial with random allocation by clusters to usual care (UC) or to one of the three interventions. PARTICIPANTS A total of 2334 patients with uncomplicated T2DM and 211 healthcare professionals were included of 32 primary care centres. SETTING Primary Care Centers in Canary Islands (Spain). INTERVENTION The intervention for patients (PTI) included an educational group programme, logs and a web-based platform for monitoring and automated short message service (SMS). The intervention for professionals (PFI) included an educational programme, a decision support tool embedded into the electronic clinical record and periodic feedback about patients' results. A third group received both PTI and PFI (combined intervention, CBI). OUTCOME MEASURE Cognitive-attitudinal, behavioural, affective and health-related quality of life (HQoL) variables. RESULTS Compared with UC at 24 months, the PTI group significantly improved knowledge (p=0.005), self-empowerment (p=0.002), adherence to dietary recommendations (p<0.001) and distress (p=0.01). The PFI group improved at 24 months in distress (p=0.03) and at 12 months there were improvements in depression (p=0.003), anxiety (p=0.05), HQoL (p=0.005) and self-empowerment (p<0.001). The CBI group improved at 24 months in self-empowerment (p=0.008) and adherence to dietary recommendations (p=0.004) and at 12 months in knowledge (p=0.008), depression (p=0.006), anxiety (p=0.003), distress (p=0.01), HQoL (p<0.001) and neuropathic symptoms (p=0.02). Statistically significant improvements were also observed at 24 months in the proportion of patients who quit smoking for PTI and CBI (41.5% in PTI and 42.3% in CBI vs 21.2% in the UC group). CONCLUSIONS Assessed interventions to improve PROMs in T2DM attain effectiveness for knowledge, self-empowerment, distress, diet adherence and tobacco cessation. PTI produced the most lasting benefits. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT01657227 (6 August 2012) https://clinicaltrials.gov/ct2/show/NCT01657227.
Collapse
Affiliation(s)
- Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | - Lidia García-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | | | - Ana Maria Wägner
- Department of Endocrinology and Nutrition, Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
- University Institute for Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | | | | | | | | | | | - Montserrat Carmona
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Health Technology Assesment Agency, Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro G Serrano-Aguilar
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Services (SCS), Tenerife, Spain
| |
Collapse
|
20
|
Aschner P, Gagliardino JJ, Ilkova H, Lavalle F, Ramachandran A, Mbanya JC, Shestakova M, Bourhis Y, Chantelot JM, Chan JCN. High Prevalence of Depressive Symptoms in Patients With Type 1 and Type 2 Diabetes in Developing Countries: Results From the International Diabetes Management Practices Study. Diabetes Care 2021; 44:1100-1107. [PMID: 33963019 PMCID: PMC8132319 DOI: 10.2337/dc20-2003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/19/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Depression is common in people with diabetes, but data from developing countries are scarce. We evaluated the prevalence and risk factors for depressive symptoms in patients with diabetes using data from the International Diabetes Management Practices Study (IDMPS). RESEARCH DESIGN AND METHODS IDMPS is an ongoing multinational, cross-sectional study investigating quality of care in patients with diabetes in real-world settings. Data from wave 5 (2011), including 21 countries, were analyzed using the 9-item Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. Logistic regression analyses were conducted to identify risk factors of depressive symptoms. RESULTS Of 9,865 patients eligible for analysis, 2,280 had type 1 and 7,585 had type 2 diabetes (treatment: oral glucose-lowering drugs [OGLD] only, n = 4,729; OGLDs plus insulin, n = 1,892; insulin only, n = 964). Depressive symptoms (PHQ-9 score ≥5) were reported in 30.7% of those with type 1 diabetes. In patients with type 2 diabetes, the respective figures were 29.0% for OGLDs-only, 36.6% for OGLDs-plus-insulin, and 46.7% for insulin-only subgroups. Moderate depressive symptoms (PHQ-9 score 10-19) were observed in 8-16% of patients with type 1 or type 2 diabetes. Female sex, complications, and low socioeconomic status were independently associated with depressive symptoms. In type 1 diabetes and in the type 2 diabetes OGLDs-only group, depression was associated with poor glycemic control. CONCLUSIONS Depressive symptoms are common in patients with diabetes from developing countries, calling for routine screening, especially in high-risk groups, to reduce the double burden of diabetes and depression and their negative interaction.
Collapse
Affiliation(s)
- Pablo Aschner
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Juan José Gagliardino
- El Centro de Endocrinología Experimental y Aplicada (CENEXA) (UNLP-CONICET-CEAS CICPBA), Facultad de Ciencias Médicas, Universidad Nacional de La Plata (UNLP), La Plata, Buenos Aires, Argentina
| | - Hasan Ilkova
- Division of Endocrinology Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fernando Lavalle
- Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Ambady Ramachandran
- India Diabetes Research Foundation, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Jean Claude Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | | | | | | | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| |
Collapse
|
21
|
Jung I, Kwon H, Park SE, Han KD, Park YG, Kim YH, Rhee EJ, Lee WY. Increased Risk of Cardiovascular Disease and Mortality in Patients with Diabetes and Coexisting Depression: A Nationwide Population-Based Cohort Study. Diabetes Metab J 2021; 45:379-389. [PMID: 33297602 PMCID: PMC8164944 DOI: 10.4093/dmj.2020.0008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/02/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous studies have suggested that depression in patients with diabetes is associated with worse health outcomes. The aim of this study was to evaluate the risk of cardiovascular disease (CVD) and mortality in patients with diabetes with comorbid depression. METHODS We examined the general health check-up data and claim database of the Korean National Health Insurance Service (NHIS) of 2,668,615 participants with type 2 diabetes mellitus who had examinations between 2009 and 2012. As NHIS database has been established since 2002, those who had been diagnosed with depression or CVD since 2002 were excluded. The 2,228,443 participants were classified into three groups according to the claim history of depression; normal group (n=2,166,979), transient depression group (one episode of depression, n=42,124) and persistent depression group (at least two episodes of depression, n=19,340). The development of CVD and mortality were analyzed from 2009 to 2017. RESULTS Those with depression showed a significantly increased risk for stroke (transient depression group: hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.15 to 1.26) (persistent depression group: HR, 1.54; 95% CI, 1.46 to 1.63). Those with depression had an increased risk for myocardial infarction (transient depression group: HR, 1.25; 95% CI, 1.18 to 1.31) (persistent depression group: HR, 1.38; 95% CI, 1.29 to 1.49). The persistent depression group had an increased risk for all-cause mortality (HR, 1.66; 95% CI, 1.60 to 1.72). CONCLUSION Coexisting depression in patients with diabetes has a deleterious effect on the development of CVD and mortality. We suggest that more attention should be given to patients with diabetes who present with depressive symptoms.
Collapse
Affiliation(s)
- Inha Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Hyemi Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Se Eun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Kyung-Do Han
- Department of Biostatistics, Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Yong-Gyu Park
- Department of Biostatistics, Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Eun-Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| |
Collapse
|
22
|
Roy JF, Lozano Del Hoyo ML, Urcola-Pardo F, Monreal-Bartolomé A, Gracia Ruiz DC, Gómez Borao MM, Artigas Alcázar AB, Martínez Casbas JP, Aceituno Casas A, Andaluz Funcia MT, García-Campayo J, Fernández Rodrigo MT. The TELE-DD project on treatment nonadherence in the population with type 2 diabetes and comorbid depression. Sci Rep 2021; 11:8889. [PMID: 33903605 PMCID: PMC8076287 DOI: 10.1038/s41598-021-87410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
Diabetic patients have increased depression rates, diminished quality of life, and higher death rates due to depression comorbidity or diabetes complications. Treatment adherence (TA) and the maintenance of an adequate and competent self-care are crucial factors to reach optimal glycaemic control and stable quality of life in these patients. In this report, we present the baseline population analyses in phase I of the TELE-DD project, a three-phased population-based study in 23 Health Centres from the Aragonian Health Service Sector II in Zaragoza, Spain. The objectives of the present report are: (1) to determine the point prevalence of T2D and clinical depression comorbidity and treatment nonadherence; (2) to test if HbA1c and LDL-C, as primary DM outcomes, are related to TA in this population; and (3) to test if these DM primary outcomes are associated with TA independently of shared risk factors for DM and depression, and patients' health behaviours. A population of 7,271 patients with type-2 diabetes and comorbid clinical depression was investigated for inclusion. Individuals with confirmed diagnoses and drug treatment for both illnesses (n = 3340) were included in the current phase I. A point prevalence of 1.9% was found for the T2D-depression comorbidity. The prevalence of patients nonadherent to treatment for these diseases was 35.4%. Multivariate analyses confirmed that lower diabetes duration, increased yearly PCS visits, HbA1c and LDL-C levels were independently related to treatment nonadherence. These findings informed the development of a telephonic monitoring platform for treatment of nonadherence for people with diabetes and comorbid depression and further trial, cost-effectiveness, and prognostic studies (phases II and III).
Collapse
Affiliation(s)
| | - María Luisa Lozano Del Hoyo
- Centro de Salud Las Fuentes Norte, Servicio Aragonés de Salud (SALUD), 50002, Zaragoza, Spain
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, 50009, Zaragoza, Spain
| | - Fernando Urcola-Pardo
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, 50009, Zaragoza, Spain
- Water and Environmental Health Research Group (DGA-B43-20R), Zaragoza, Spain
| | - Alicia Monreal-Bartolomé
- Aragon Institute for Health Research, IIS Aragon, 50009, Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029, Madrid, Spain
- Department of Medicine and Psychiatry, Faculty of Medicine, University of Zaragoza, 50009, Zaragoza, Spain
| | | | | | | | | | | | | | - Javier García-Campayo
- Aragon Institute for Health Research, IIS Aragon, 50009, Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029, Madrid, Spain
- Department of Medicine and Psychiatry, Faculty of Medicine, University of Zaragoza, 50009, Zaragoza, Spain
- Miguel Servet University Hospital, Zaragoza, Spain
| | - María Teresa Fernández Rodrigo
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, 50009, Zaragoza, Spain
- Water and Environmental Health Research Group (DGA-B43-20R), Zaragoza, Spain
| |
Collapse
|
23
|
Raja SY, Ghori U, Naqvi HA, Aijaz S, Anwar A, Hashmi AA. Factors for Social Stressors Among Type 2 Diabetics Versus Non-Diabetics Using the Hamilton Depression Rating Scale. Cureus 2020; 12:e11861. [PMID: 33409095 PMCID: PMC7781553 DOI: 10.7759/cureus.11861] [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] [Indexed: 11/05/2022] Open
Abstract
Objective This study aimed to evaluate different factors of social stressors among people with type II diabetes versus non-diabetics by using the Hamilton Depression Rating Scale (HAM-D). Methodology This case-control study was done for one year at Ziauddin University Hospital, Karachi, Pakistan. Diagnosed patients with type II diabetes between 25 and 60 years were included as cases and age-related healthy individuals as controls. Participants on any psychotropic medications, neurodegenerative disorders, or on chemotherapy were excluded. Hamilton Rating Scale for Depression (HRDS-17) was used for recording depressive symptoms. The Statistical Package for the Social Sciences (SPSS) version 26.0 (IBM Corp., Armonk, NY) was used for data analysis. The frequency was calculated for descriptive statistics and depression scores (HRDS-17). A significance level of 0.05 was considered. Results A total of 272 patients were divided into two groups, with 136 patients in the group with diabetes and 136 participants in the control group. The mean age among people with diabetes was 55.13±9.10 years and among non-diabetics was 43.25±12.97 years (p<0.001). The mean duration of illness in people with diabetes was 8.51±7.57 years and in non-diabetics, it was 6.73±4.42 years (p=0.018). The mean social rating in people with diabetes was 164.0±155.60 and in non-diabetics, it was 124.75±99.02 (p=0.014). Insomnia, both in the early and middle part of the night affecting work activities, hypochondriasis, and loss of weight, was significantly present among diabetics as compared to controls (p<0.05). Conclusion Most diabetics reported a significant effect on the quality of life based on social rating and health-care expenditure. They experienced depressive symptoms more frequently than non-diabetics. Insomnia in the middle of the night affected work and activities; hypochondriasis and weight loss were found to be substantially higher among patients with diabetes than in controls.
Collapse
Affiliation(s)
- Saadia Y Raja
- Internal Medicine, Ziauddin University, Karachi, PAK
| | - Uzma Ghori
- Internal Medicine, Ziauddin University, Karachi, PAK
| | | | - Sadaf Aijaz
- Psychiatry, Northern Border University, Arar, SAU
| | - Adnan Anwar
- Physiology, Al-Tibri Medical College, Isra University, Karachi, PAK
| | - Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| |
Collapse
|
24
|
Geraets AFJ, Köhler S, Muzambi R, Schalkwijk CG, Oenema A, Eussen SJPM, Dagnelie PC, Stehouwer CDA, Schaper NC, Henry RMA, van der Kallen CJH, Wesselius A, Koster A, Verhey FRJ, Schram MT. The association of hyperglycaemia and insulin resistance with incident depressive symptoms over 4 years of follow-up: The Maastricht Study. Diabetologia 2020; 63:2315-2328. [PMID: 32757152 PMCID: PMC7527373 DOI: 10.1007/s00125-020-05247-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/22/2020] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS Depression is twice as common in individuals with type 2 diabetes as in the general population. However, it remains unclear whether hyperglycaemia and insulin resistance are directly involved in the aetiology of depression. Therefore, we investigated the association of markers of hyperglycaemia and insulin resistance, measured as continuous variables, with incident depressive symptoms over 4 years of follow-up. METHODS We used data from the longitudinal population-based Maastricht Study (n = 2848; mean age 59.9 ± 8.1 years, 48.8% women, 265 incident depression cases, 10,932 person-years of follow-up). We assessed hyperglycaemia by fasting and 2 h post-load OGTT glucose levels, HbA1c and skin autofluorescence (reflecting AGEs) at baseline. We used the Matsuda insulin sensitivity index and HOMA-IR to calculate insulin resistance at baseline. Depressive symptoms (nine-item Patient Health Questionnaire score ≥10) were assessed at baseline and annually over 4 years. We used Cox regression analyses, and adjusted for demographic, cardiovascular and lifestyle risk factors. RESULTS Fasting plasma glucose, 2 h post-load glucose and HbA1c levels were associated with an increased risk for incident depressive symptoms after full adjustment (HR 1.20 [95% CI 1.08, 1.33]; HR 1.25 [1.08, 1.44]; and HR 1.22 [1.09, 1.37] per SD, respectively), while skin autofluorescence, insulin sensitivity index and HOMA-IR were not (HR 0.99 [0.86, 1.13]; HR 1.02 [0.85, 1.25]; and HR 0.93 [0.81, 1.08], per SD, respectively). CONCLUSIONS/INTERPRETATION The observed temporal association between hyperglycaemia and incident depressive symptoms in this study supports the presence of a mechanistic link between hyperglycaemia and the development of depressive symptoms. Graphical abstract.
Collapse
Affiliation(s)
- Anouk F J Geraets
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- School of Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
- School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- School of Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Rutendo Muzambi
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Casper G Schalkwijk
- Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Anke Oenema
- Department of Health Promotion, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Simone J P M Eussen
- Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Pieter C Dagnelie
- Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Anke Wesselius
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Genetics & Cell Biology, Complex Genetics, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Social Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- School of Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Miranda T Schram
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands.
- Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands.
- School of Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands.
- School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands.
- Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands.
| |
Collapse
|
25
|
Lu Y, Xing P, Cai X, Luo D, Li R, Lloyd C, Sartorius N, Li M. Prevalence and Risk Factors for Diabetic Peripheral Neuropathy in Type 2 Diabetic Patients From 14 Countries: Estimates of the INTERPRET-DD Study. Front Public Health 2020; 8:534372. [PMID: 33194943 PMCID: PMC7606804 DOI: 10.3389/fpubh.2020.534372] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022] Open
Abstract
Aim: Diabetic peripheral neuropathy (DPN) is a common, severe microvascular complication of diabetes. Our study was to assess prevalence and risk factors for DPN in subjects with type 2 diabetes from 14 different countries. Methods: A total of 2,733 subjects with type 2 diabetes aged 18-65 years (45.3% men, mean duration of diabetes = 8.8 years) were included to perform this International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study in 14 countries. After a structured questionnaire was used in face-to-face interviews to collect sociodemographic characteristics and medical records of the participating subjects, laboratory tests were carried out for clinical measurement. Depressive symptoms were diagnosed and measured using the Patient Health Questionnaire-9. The potential risk factors for DPN were determined by multilevel mixed-effects logistic regression, accounting for clustering of participants within the country. Robustness of the estimates was assessed by sensitivity analysis. Results: The overall prevalence of DPN across different countries was 26.71%, whereas country-specific prevalences showed considerable variation. Multivariate analysis revealed that duration of diabetes (OR: 1.08 per 1-year increase, 95% CI: 1.06-1.09), poor glycemic control (OR: 1.11 per 1% increase in HbA1c, 95% CI: 1.05-1.18), and history of hypertension (OR: 1.58, 95% CI: 1.18-2.12), cardiovascular disease (OR: 2.07, 95% CI: 1.55-2.78) and depressive symptoms (OR: 1.92, 95% CI: 1.43-2.58) were independently and positively associated with the risk of DPN. Sensitivity analyses including or excluding patients from countries with extreme low or high prevalence of DPN yielded similar estimates in terms of trend and magnitude. Conclusions: This international study illustrates that more than a quarter of individuals with type 2 diabetes developed DPN. The prevalence was positively associated with the duration of diabetes, poor glycemic control, and history of hypertension, cardiovascular disease and depressive symptoms.
Collapse
Affiliation(s)
- Yanhui Lu
- School of Nursing, Peking University Health Science Center, Beijing, China
| | - Pengbo Xing
- School of Nursing, Peking University Health Science Center, Beijing, China
| | - Xue Cai
- School of Nursing, Peking University Health Science Center, Beijing, China
| | - Dan Luo
- School of Nursing, Peking University Health Science Center, Beijing, China
| | - Ruxue Li
- School of Nursing, Peking University Health Science Center, Beijing, China
| | - Cathy Lloyd
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, United Kingdom
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| | - Mingzi Li
- School of Nursing, Peking University Health Science Center, Beijing, China
| |
Collapse
|
26
|
Liwo ANN, Howard VJ, Zhu S, Martin MY, Safford MM, Richman JS, Cummings DM, Carson AP. Elevated depressive symptoms and risk of all-cause and cardiovascular mortality among adults with and without diabetes: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study. J Diabetes Complications 2020; 34:107672. [PMID: 32684424 PMCID: PMC8451949 DOI: 10.1016/j.jdiacomp.2020.107672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 11/21/2022]
Abstract
AIMS To examine the association of elevated depressive symptoms with all-cause and cardiovascular disease (CVD) mortality and determine whether these associations differ for those with and without diabetes. METHODS We included 22,807 black and white men and women aged 45-98 years at baseline (2003-2007) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study. Elevated depressive symptoms were defined as a score ≥ 4 on the 4-item Centers for Epidemiologic Studies of Depression Scale. Participants were classified as having diabetes, prediabetes, or no prediabetes/diabetes based on glucose levels and diabetes medication use. All-cause mortality events were available through 2018 and adjudicated CVD mortality events were available through 2015. RESULTS During follow-up, there were 5383 all-cause deaths, of which 1585 were adjudicated CVD deaths. The mean survival time was lower for participants with elevated depressive symptoms than those without elevated depressive symptoms for those with diabetes, prediabetes, and no prediabetes/diabetes. In multivariable adjusted models, elevated depressive symptoms increased the risk of all-cause mortality for those with diabetes (HR = 1.15; 95% CI = 1.00-1.32), prediabetes (HR = 1.56; 95% CI = 1.28-1.91), and neither prediabetes/diabetes (HR = 1.34; 95% CI = 1.19-1.50) (p for interaction = 0.0342). Findings were similar for CVD mortality. CONCLUSION Elevated depressive symptoms increased the risk of all-cause and CVD mortality among individuals with and without diabetes, with a stronger magnitude of association observed among those with prediabetes. This underscores the need for assessing depressive symptoms across the glycemic spectrum, including those with prediabetes.
Collapse
Affiliation(s)
- Amandiy N N Liwo
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL, USA.
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL, USA
| | - Sha Zhu
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL, USA
| | - Michelle Y Martin
- College of Medicine, Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN, USA
| | - Monika M Safford
- General Internal Medicine, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Joshua S Richman
- Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, 1922 7th Avenue South, Birmingham, AL, USA
| | - Doyle M Cummings
- Department of Family Medicine, East Carolina University, 101 Heart Drive, Greenville, NC, USA
| | - April P Carson
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL, USA
| |
Collapse
|
27
|
Bo A, Pouwer F, Juul L, Nicolaisen SK, Maindal HT. Prevalence and correlates of diabetes distress, perceived stress and depressive symptoms among adults with early-onset Type 2 diabetes: cross-sectional survey results from the Danish DD2 study. Diabet Med 2020; 37:1679-1687. [PMID: 31335989 DOI: 10.1111/dme.14087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 12/11/2022]
Abstract
AIMS To establish the prevalence of diabetes distress, perceived stress and depressive symptoms among adults with early-onset Type 2 diabetes, and to examine their association with socio-demographic and clinical characteristics. METHODS A cross-sectional survey was performed among individuals with Type 2 diabetes aged 20-45 years who were included in the Danish nationwide Danish Center for Strategic Research in Type 2 Diabetes cohort between 2010 and 2016. The survey assessed diabetes distress (20-item Problem Areas in Diabetes Scale), perceived stress (10-item Perceived Stress Scale) and depressive symptoms (10-item short form of the Center for Epidemiological Studies Depression Scale Revised), as well as socio-demographic characteristics. Clinical data were collected from national health registers. RESULTS In total, 216/460 (47%) individuals (48% women) with Type 2 diabetes completed the survey. The median (IQR) age was 42 (38-44) years and the diabetes duration was 5 (3-7) years. In total, 24% of respondents reported high diabetes distress (Problem Areas in Diabetes Scale ≥ 40), 46% reported high perceived stress (Perceived Stress Scale ≥ 18) and 41% reported elevated symptoms of depression (Center for Epidemiological Studies Depression Scale Revised ≥ 10). The prevalence of emotional problems was higher among women than men. Diabetes distress was higher among those prescribed non-insulin glucose-lowering drugs (vs. no glucose-lowering drugs), but was not associated with other clinical or socio-demographic characteristics. High perceived stress was associated with being unemployed and using antidepressant medication, and elevated depressive symptoms were associated with low education level, unemployment, living alone, having a psychiatric disorder and using antidepressant medication. CONCLUSION We found a high prevalence of emotional problems among adults with early-onset Type 2 diabetes in Denmark. Health care for this group should focus on both physical health and psychosocial circumstances and should also address general as well as diabetes-specific emotional problems.
Collapse
Affiliation(s)
- A Bo
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - F Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
- Steno Diabetes Center Odense, Odense, Denmark
| | - L Juul
- Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Aarhus, Denmark
| | - S K Nicolaisen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - H T Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Centre Copenhagen, Health Promotion, Gentofte, Denmark
| |
Collapse
|
28
|
Ranjan R, Nath S, Sarkar S. Association between depression, anxiety and quality of life among patients with diabetes mellitus and/or hypertension in a tertiary care railway hospital in India: A cross-sectional study. Indian J Psychiatry 2020; 62:555-558. [PMID: 33678837 PMCID: PMC7909011 DOI: 10.4103/psychiatry.indianjpsychiatry_794_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/11/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Comorbid depression and anxiety have been found to be highly present in patients suffering from chronic physical illnesses such as diabetes mellitus (DM) and hypertension (HTN). These comorbid psychiatric conditions further reduce the quality of life (QOL) in the sufferers. The present study aimed to assess the association between depression, anxiety, and QOL among patients with DM and/or HTN. MATERIALS AND METHODS This cross-sectional study was carried out in the outpatient setting of the medicine department of the tertiary care referral hospital of East Central Indian Railways. One hundred and twenty-three individuals of DM and/or HTN of more than 1-month duration were assessed for depression, anxiety, and QOL using the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization QOL Brief (WHOQOL-BREF) version scale. RESULTS The mean age of the sample (53.7% had HTN, 12.2% had diabetes, and 34.1% had both HTN and diabetes) which comprised 87% males was 50.20 (±6.0) years. The mean HADS (anxiety and depression) scores were 3.6 for both (range 0-14). Nearly 10.6% and 17.1% of the samples had scores above the cutoff for HADS anxiety and depression subscales. The WHOQOL-BREF scores were highest for the environmental domain and were lower for psychological, physical, and social domains. The HADS anxiety and depressive scores correlated significantly negatively with the WHOQOL-BREF physical and psychological domains. Female gender and the presence of an additional medical illness were significantly associated with higher HADS depression scores. CONCLUSION Fair proportion of patients with HTN and/or diabetes has been affected with higher anxiety and depressive scores, which predicted a poor QOL. This calls for early identification of these mental health issues in sufferers of depression and HTN, which will facilitate an early holistic management.
Collapse
Affiliation(s)
- Rajeev Ranjan
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Santanu Nath
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Siddharth Sarkar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
29
|
Effectiveness of acceptance and commitment therapy (ACT) on depression and sleep quality in painful diabetic neuropathy: a randomized clinical trial. J Diabetes Metab Disord 2020; 19:1081-1088. [PMID: 33520825 DOI: 10.1007/s40200-020-00609-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
Background Neuropathic pain is a complicated phenomenon in patients with diabetes. These patients have many problems, especially depression and Sleep disturbance. This study aimed to assess the effectiveness of Acceptance and Commitment Therapy on depression and Sleep disturbance in patients with painful diabetic neuropathy. Methods The current paper was conducted according to the clinical trial method with 50 participants. Participants were separated into intervention and control groups randomly. Based on the diagnosis of neurologists, all participants received standard medications to regulate neuropathic pain. The intervention group received ACT for eight sessions. The results were evaluated in the pre-test, post-test, and follow-up. The tools used were the Pittsburgh sleep quality index (PSQI) and Beck's depression inventory. Statistical analysis includes descriptive statistics, and repeated-measures (ANOVA) conducted by SPSS (version 26) software. Results: Results showed that in the intervention group, the treatment led to improved depressive symptoms (F = 6.81, P < 0.05). Besides, for sleep quality, treatment in all subscales, except for the Hypnotic medicine subscale, significantly improved the intervention group's situations. It was also observed that the overall quality of sleep in the ACT group showed a more significant improvement (P < 0.05). All the above results remained the same until the end of the follow-up period (P < 0.05). Conclusion ACT, as a complementary treatment, can improve the psychiatric symptoms and problems in people with neuropathic pain. Therefore, it is necessary to include psychotherapy services along with medical treatment in outpatient and hospitalization units. Trial registration number IRCT201802050388630N4. Registered in 02/05/2018.
Collapse
|
30
|
Speight J, Hendrieckx C, Pouwer F, Skinner TC, Snoek FJ. Back to the future: 25 years of 'Guidelines for encouraging psychological well-being' among people affected by diabetes. Diabet Med 2020; 37:1225-1229. [PMID: 31661183 DOI: 10.1111/dme.14165] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2019] [Indexed: 01/01/2023]
Affiliation(s)
- J Speight
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - C Hendrieckx
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - F Pouwer
- School of Psychology, Deakin University, Geelong, Australia
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- STENO Diabetes Centre, Odense, Denmark
| | - T C Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- STENO Diabetes Centre, Copenhagen, Denmark
| | - F J Snoek
- Department of Medical Psychology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, The Netherlands
| |
Collapse
|
31
|
Defining Major Depressive Disorder Cohorts Using the EHR: Multiple Phenotypes Based on ICD-9 Codes and Medication Orders. ACTA ACUST UNITED AC 2020; 36:18-26. [PMID: 32218644 DOI: 10.1016/j.npbr.2020.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Major Depressive Disorder (MDD) is one of the most common mental illnesses and a leading cause of disability worldwide. Electronic Health Records (EHR) allow researchers to conduct unprecedented large-scale observational studies investigating MDD, its disease development and its interaction with other health outcomes. While there exist methods to classify patients as clear cases or controls, given specific data requirements, there are presently no simple, generalizable, and validated methods to classify an entire patient population into varying groups of depression likelihood and severity. Methods We have tested a simple, pragmatic electronic phenotype algorithm that classifies patients into one of five mutually exclusive, ordinal groups, varying in depression phenotype. Using data from an integrated health system on 278,026 patients from a 10-year study period we have tested the convergent validity of these constructs using measures of external validation, including patterns of psychiatric prescriptions, symptom severity, indicators of suicidality, comorbidity, mortality, health care utilization, and polygenic risk scores for MDD. Results We found consistent patterns of increasing morbidity and/or adverse outcomes across the five groups, providing evidence for convergent validity. Limitations The study population is from a single rural integrated health system which is predominantly white, possibly limiting its generalizability. Conclusion Our study provides initial evidence that a simple algorithm, generalizable to most EHR data sets, provides categories with meaningful face and convergent validity that can be used for stratification of an entire patient population.
Collapse
|
32
|
van Puffelen A, Kasteleyn M, de Vries L, Rijken M, Heijmans M, Nijpels G, Schellevis F. Self-care of patients with type 2 diabetes mellitus over the course of illness: implications for tailoring support. J Diabetes Metab Disord 2020; 19:81-89. [PMID: 32550159 DOI: 10.1007/s40200-019-00479-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 12/17/2019] [Indexed: 11/28/2022]
Abstract
Purpose Type 2 diabetes requires patients to make lifestyle changes and perform daily self-care. To determine at what stages patients may need particular self-management support, we examined (1) whether patients' performance of self-care related to their diabetes duration, and (2) whether illness characteristics (treatment and complications) and diabetes-related distress influenced this relationship. Methods Cross-sectional data from 590 type 2 diabetes patients were analysed through linear and logistic regression analysis. Self-care behaviours were assessed by the revised Summary of Diabetes Self-Care Activities (SDSCA) measure. Diabetes duration (model 1), treatment and complications (model 2), and distress, as assessed by the Problem Areas In Diabetes (PAID) scale (model 3), were stepwise included. Sociodemographic characteristics were added to all models to account for confounding. Results Patients with a longer history of diabetes were less physically active, but monitored their blood glucose levels more frequently than more recently diagnosed patients. These relationships were mediated by the presence of complications and the use of insulin, with lower levels of physical activity being found among patients with macrovascular complications and higher frequencies of glucose monitoring among patients on insulin. All predictors together explained maximally 5% of the variance in self-care, except for glucose monitoring (37%) and smoking (11%). Conclusion Type 2 diabetes patients' self-care activity changes over the course of illness. To provide tailored self-management support, diabetes care providers should take into account patients' phase of illness, including their treatment and complications, as well as their personal characteristics and distress level.
Collapse
Affiliation(s)
- Anne van Puffelen
- NIVEL (the Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Marise Kasteleyn
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands
| | - Lianne de Vries
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Mieke Rijken
- NIVEL (the Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands
- Department of Health and Social Management, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Monique Heijmans
- NIVEL (the Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Giel Nijpels
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - François Schellevis
- NIVEL (the Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| |
Collapse
|
33
|
Cichoń E, Kiejna A, Kokoszka A, Gondek T, Rajba B, Lloyd CE, Sartorius N. Validation of the Polish version of WHO-5 as a screening instrument for depression in adults with diabetes. Diabetes Res Clin Pract 2020; 159:107970. [PMID: 31805355 DOI: 10.1016/j.diabres.2019.107970] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/14/2019] [Accepted: 11/29/2019] [Indexed: 01/18/2023]
Abstract
AIMS The aim of this study was to validate and report the factorial analysis of the World Health Organization's 5-item Well-being Index (WHO-5) among outpatients with type 2 diabetes. We investigated the psychometric properties of the WHO-5 and its suitability for identifying potential depressive symptoms in Polish adults with diabetes. METHODS Participants were randomly chosen among Polish diabetes outpatients and invited to participate in the cross-sectional study (N = 216). Participants completed the Polish version of the WHO-5, Problem Areas in Diabetes Scale and Patient Health Questionnaire. RESULTS Factor analyses identified the one-factor structure of the Polish version of the WHO-5. The internal consistency of the Polish version of the WHO-5 is satisfying. With regard to convergent validity, there were significant negative associations between the WHO-5 and PAID, the PHQ-9, HbA1c and the amount of medical complications. The AUC indicates that the WHO-5 is an effective measure for identifying depressive symptoms. The optimal cut off values of ≤12 yielded the best sensitivity/specificity trade-off for identifying depression among people with diabetes. CONCLUSIONS The Polish version of the WHO-5 is a reliable, valid outcome measure for outpatients with type 2 diabetes and can be a useful instrument for screening for depression in people with diabetes.
Collapse
Affiliation(s)
- Ewelina Cichoń
- Department of Psychology, WSB University in Toruń, Toruń, Poland; Department of Psychology, Faculty of Education, Psychology Research Unit for Public Health, University of Lower Silesia, Wroclaw, Poland.
| | - Andrzej Kiejna
- Department of Psychology, WSB University in Toruń, Toruń, Poland; Department of Psychology, Faculty of Education, Psychology Research Unit for Public Health, University of Lower Silesia, Wroclaw, Poland
| | - Andrzej Kokoszka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Gondek
- Specialty Training Section, Polish Psychiatric Association, Poland; Section on Education, World Psychiatric Association, Switzerland
| | - Beata Rajba
- Department of Psychology, WSB University in Toruń, Toruń, Poland; Department of Psychology, Faculty of Education, Psychology Research Unit for Public Health, University of Lower Silesia, Wroclaw, Poland
| | - Cathy E Lloyd
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| |
Collapse
|
34
|
Andrade CJDN, Alves CDAD. Relationship between bullying and type 1 diabetes mellitus in children and adolescents: a systematic review. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
35
|
Andrade CJDN, Alves CDAD. Relationship between bullying and type 1 diabetes mellitus in children and adolescents: a systematic review. J Pediatr (Rio J) 2019; 95:509-518. [PMID: 30391140 DOI: 10.1016/j.jped.2018.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/20/2018] [Accepted: 09/24/2018] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To carry out a systematic review on the relationship of bullying with type 1 diabetes in children and adolescents. METHODS Systematic review, according to the PRISMA methodology, in which the databases PubMed, Web of Science, Scopus, Thomson Reuters, Eighteenth Century Collections Online, Begell House Digital Library, LILACS, and SciELO were searched using the terms "bullied", "aggression", "peer victimization", "victimization", "school violence", "diabetes mellitus", "type 1 diabetes mellitus", "autoimmune diabetes", "children" and "adolescents." The authors included original studies, involving bullying associated with type 1 diabetes, with children and adolescents, without language restriction and publication period, with texts available in full. RESULTS Of the 32 articles found, four studies met the selection criteria. Of these studies 85.7% identified occurrence of victimization in diabetics or found a higher frequency in diabetic children and adolescents when compared with young people with other chronic conditions or with healthy peers. Association between bullying and worse glycemic control was observed in two studies, and all the studies mention the fact that type 1 diabetes is a limiting factor for socialization related to diabetes, with less social support and difficulties for the management of the disease in public environments, such as school. The type of bullying suffered varied, including physical, verbal, social, psychological, and sexual. CONCLUSION Most of the studies showed an association between bullying and type 1 diabetes when compared to individuals with no such condition. Knowledge of this association has become essential for the follow-up of these patients and the implementation of preventive programs.
Collapse
Affiliation(s)
| | - Crésio de Aragão Dantas Alves
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Hospital Universitário Prof. Edgard Santos, Unidade de Endocrinologia Pediátrica, Salvador, BA, Brazil
| |
Collapse
|
36
|
|
37
|
Nefs G, Hendrieckx C, Reddy P, Browne JL, Bot M, Dixon J, Kyrios M, Speight J, Pouwer F. Comorbid elevated symptoms of anxiety and depression in adults with type 1 or type 2 diabetes: Results from the International Diabetes MILES Study. J Diabetes Complications 2019; 33:523-529. [PMID: 31129003 DOI: 10.1016/j.jdiacomp.2019.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/05/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
AIMS We examined: (a) the prevalence of comorbid elevated symptoms of anxiety/depression; (b) its demographic/clinical correlates; (c) associations with self-care behaviors, by diabetes type. METHODS Cross-sectional self-report data of 6590 adults with diabetes (42% type 1; 58% type 2) from the Australian and Dutch Diabetes MILES studies were used. Elevated symptoms of anxiety/depression were defined as GAD-7 ≥ 10/PHQ-9 ≥ 10. RESULTS In both diabetes types, comorbid elevated symptoms of anxiety/depression were present in 9% and symptoms of anxiety alone in 2%; symptoms of depression alone were present in 8% of adults with type 1 diabetes and 11% with type 2 diabetes. Shorter diabetes duration (type 1 only) was the only characteristic that distinguished those with comorbid elevated symptoms of anxiety/depression but not those with symptoms of anxiety/depression alone from the reference group (no/minimal symptoms of anxiety/depression). Those with comorbid elevated symptoms of anxiety/depression had increased odds of sub-optimal diabetes self-care behaviors compared with the reference group, with higher odds than those with symptoms of anxiety or depression alone. CONCLUSIONS Comorbid elevated symptoms of anxiety/depression affected one in ten respondents, who also had increased odds of suboptimal diabetes self-care. Those with shorter type 1 diabetes duration may be at increased risk.
Collapse
Affiliation(s)
- Giesje Nefs
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, the Netherlands; Tilburg University, Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg, the Netherlands; Diabeter, National treatment and research center for children, adolescents and young adults with type 1 diabetes, Rotterdam, the Netherlands.
| | - Christel Hendrieckx
- Deakin University, School of Psychology, Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Prasuna Reddy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; University of Technology Sydney, Australia; Swinburne University of Technology, Hawthorn, Australia
| | | | - Mariska Bot
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands
| | - John Dixon
- Human Neurotransmitters, Baker Heart and Diabetes Institute, Melbourne, Australia; Primary Care Research, Monash University, Melbourne, Australia
| | - Michael Kyrios
- College of Education, Psychology and Social Work, Flinders University, Australia
| | - Jane Speight
- Deakin University, School of Psychology, Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia; AHP Research, Hornchurch, United Kingdom; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - François Pouwer
- Deakin University, School of Psychology, Geelong, Australia; Department of Psychology, University of Southern Denmark, Odense, Denmark; STENO Diabetes Center Odense
| |
Collapse
|
38
|
Liu X, Boogaard L, Erasmus V, Sybrands E, Buijks H, Mackenbach JP, Polinder S. Assessing screening instruments and thresholds to detect risk of depression in diabetes patients, a brief report. Prim Care Diabetes 2019; 13:380-383. [PMID: 30581071 DOI: 10.1016/j.pcd.2018.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/29/2022]
Abstract
Over the last decades several self-report instruments have been developed to identify diabetes at risk for depression. In a sample of diabetes outpatients, we assessed the accuracy of three widely-used instruments, and recommend the instruments with the best sensitivity and specificity for identifying diabetes in need of early treatment for depression.
Collapse
Affiliation(s)
- Xiaona Liu
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Laura Boogaard
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vicki Erasmus
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric Sybrands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hanneke Buijks
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Suzanne Polinder
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
39
|
de Joode JW, van Dijk SE, Walburg FS, Bosmans JE, van Marwijk HW, de Boer MR, van Tulder MW, Adriaanse MC. Diagnostic accuracy of depression questionnaires in adult patients with diabetes: A systematic review and meta-analysis. PLoS One 2019; 14:e0218512. [PMID: 31220131 PMCID: PMC6586329 DOI: 10.1371/journal.pone.0218512] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/04/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Comorbid depression is common among patients with diabetes and has severe health consequences, but often remains unrecognized. Several questionnaires are used to screen for depression. A systematic review and meta-analysis regarding the diagnostic accuracy of depression questionnaires in adults with diabetes is unavailable. Our aim was to conduct a systematic review and meta-analysis to evaluate the diagnostic accuracy of depression questionnaires in adults with type 1 or type 2 diabetes. METHODS PubMed, Embase and PsycINFO were searched from inception to 28 February 2018. Studies were included when the diagnostic accuracy of depression questionnaires was assessed in a diabetes population and the reference standard was a clinical interview. Data extraction was performed by one reviewer and checked by another. Two reviewers independently conducted the quality assessment (QUADAS-2). Diagnostic accuracy was pooled in bivariate random effects models. The main outcome was diagnostic accuracy, expressed as sensitivity and specificity, of depression questionnaires in an adult diabetes population. This study is reported according to PRISMA-DTA and is registered with PROSPERO (CRD42018092950). RESULTS A total 6,097 peer-reviewed articles were screened. Twenty-one studies (N = 5,703 patients) met the inclusion criteria for the systematic review. Twelve different depression questionnaires were identified, of which the CES-D (n = 6 studies) and PHQ-9 (n = 7 studies) were the most frequently evaluated. Risk of bias was unclear for multiple domains in the majority of studies. In the meta-analyses, five (N = 1,228) studies of the CES-D (≥16), five (N = 1,642) of the PHQ-9 (≥10) and four (N = 822) of the algorithm of the PHQ-9 were included in the pooled analysis. The CES-D (≥16) had a pooled sensitivity of 85.0% (95%CI, 71.3-92.8%) and a specificity of 71.6% (95%CI, 62.5-79.2%); the PHQ-9 (≥10) had a sensitivity of 81.5% (95%CI, 57.1-93.5%) and a specificity of 79.7% (95%CI, 62.1-90.4%). The algorithm for the PHQ-9 had a sensitivity of 60.9% (95%CI, 52.3-90.8%) and a specificity of 64.0% (95%CI, 53.0-93.9%). CONCLUSIONS This review indicates that the CES-D had the highest sensitivity, whereas the PHQ-9 had the highest specificity, although confidence intervals were wide and overlapping. The algorithm for the PHQ-9 had the lowest sensitivity and specificity. Given the variance in results and suboptimal reporting of studies, further high quality studies are needed to confirm the diagnostic accuracy of these depression questionnaires in patients with diabetes.
Collapse
Affiliation(s)
- Johanna W. de Joode
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Susan E.M. van Dijk
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Knowledge Institute of Medical Specialists, Utrecht, The Netherlands
| | - Florine S. Walburg
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Harm W.J. van Marwijk
- Department of Primary Care and Public Health, University of Brighton, Brighton, United Kingdom
- Brighton and Sussex Medical School, Watson Building House, University of Brighton, Brighton, United Kingdom
| | - Michiel R. de Boer
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maurits W. van Tulder
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marcel C. Adriaanse
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
40
|
Hernar I, Graue M, Richards D, Strandberg RB, Nilsen RM, Tell GS, Haugstvedt A. Electronic capturing of patient-reported outcome measures on a touchscreen computer in clinical diabetes practice (the DiaPROM trial): a feasibility study. Pilot Feasibility Stud 2019; 5:29. [PMID: 30820340 PMCID: PMC6381687 DOI: 10.1186/s40814-019-0419-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/13/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Living with type 1 diabetes (T1D) is demanding, and emotional problems may impair ability for diabetes self-management. Thus, diabetes guidelines recommend regular assessment of such problems. Using patient-reported outcome measures (PROMs) to assess diabetes-related distress and psychological well-being is considered useful. It has been proposed that future work should examine the use of PROMs to support the care of individual patients and improve the quality of health services. To our knowledge, the use of PROMs has not been systematically evaluated in diabetes care services in Norway. Electronically captured PROMs can be directly incorporated into electronic patient records. Thus, the study's overall aim was to examine the feasibility and acceptability of capturing PROMs electronically on a touchscreen computer in clinical diabetes practice. METHODS Adults with T1D age ≥ 40 years completed PROMs on a touchscreen computer at Haukeland University Hospital's diabetes outpatient clinic. We included 46 items related to diabetes-related distress, self-perceived diabetes competence, awareness of hypoglycaemia, occurrence of hyperglycaemia, hypoglycaemia and fluctuating glucose levels, routines for glucose monitoring, general well-being and health-related quality of life. Participants subsequently completed a paper-based questionnaire regarding comprehension and relevance of the PROMs, acceptance of the number of items and willingness to complete electronic PROMs annually. We wrote field notes in the outpatient clinic based on observations and comments from the invited participants. RESULTS During spring 2017, 69 participants (50.7% men), age 40 to 74 years, were recruited. Generally, the touchscreen computer functioned well technically. Median time spent completing the PROMs was 8 min 19 s. Twenty-nine (42.0%) participants completed the PROMs without missing items, with an 81.4% average instrument completion rate. Participants reported that the PROMs were comprehensible (n = 62) and relevant (n = 46) to a large or very large degree, with an acceptable number of items (n = 51). Moreover, 54 were willing to complete PROMs annually. Participants commented that the focus on living with diabetes was valued. CONCLUSIONS Capturing PROMs on a touchscreen computer in an outpatient clinic was technically and practically feasible. The participants found the PROMs to be relevant and acceptable with a manageable number of items, and reported willingness to complete PROMs annually.
Collapse
Affiliation(s)
- Ingvild Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020 Bergen, Norway
| | - David Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020 Bergen, Norway
- Institute for Health Research, University of Exeter Medical School, Exeter, UK
| | - Ragnhild B. Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020 Bergen, Norway
| | - Roy M. Nilsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020 Bergen, Norway
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Grethe S. Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020 Bergen, Norway
| |
Collapse
|
41
|
Haugstvedt A, Hernar I, Strandberg RB, Richards DA, Nilsen RM, Tell GS, Graue M. Use of patient-reported outcome measures (PROMs) in clinical diabetes consultations: study protocol for the DiaPROM randomised controlled trial pilot study. BMJ Open 2019; 9:e024008. [PMID: 30782722 PMCID: PMC6340474 DOI: 10.1136/bmjopen-2018-024008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/28/2018] [Accepted: 12/05/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Although diabetes distress is found to be associated with decreased glycaemic control among adults with type 1 diabetes, the psychological and emotional impact of living with the condition is often not recognised and often under-reported in diabetes care. Therefore, regular assessment of diabetes distress is recommended. Assessment of diabetes distress using patient-reported outcome measures (PROMs) in clinical practice has the potential to enhance care for people with diabetes by identifying problems and improving patient-clinician communication. In this study protocol, we describe a pilot randomised controlled trial (RCT) aiming to test the feasibility of all components of an empowerment-based intervention using PROMs as dialogue support in clinical diabetes consultations, and to address the uncertainties associated with running a fully powered evaluation study. METHODS AND ANALYSIS We will undertake a two-arm pilot RCT of an intervention using the Problem Areas In Diabetes (PAID) scale in clinical diabetes consultations in order to conclude whether a fully powered trial is appropriate and/or feasible. The study will also include qualitative indepth interviews with participants and healthcare providers. Our objectives are to (1) evaluate the recruitment procedures and attrition rates; (2) evaluate the performance of the randomisation procedure; (3) evaluate the participants' mean scores on the outcome measures before and after the intervention; (4) evaluate if the intervention consultations are acceptable and feasible; and (5) explore patients' and healthcare providers' experiences with the use of PAID as dialogue support and empowerment-based communication skills in clinical diabetes consultations. The quantitative data analysis includes descriptive statistics (frequencies, percentages, means, SD and CI). For the qualitative data, we will perform thematic analysis. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Western Norway Regional Committee for Medical and Health Research Ethics (2017/1506/REC west). We will present the findings from the study phases at national and international conferences and submit manuscripts to peer-reviewed journals and popular science journals. TRIAL REGISTRATION NUMBER NCT03471104; Pre-results.
Collapse
Affiliation(s)
- Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ingvild Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - David A Richards
- Institute for Health Research, University of Exeter Medical School, Exeter, UK
| | - Roy Miodini Nilsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| |
Collapse
|
42
|
Janssen J, Koekkoek PS, Biessels GJ, Kappelle JL, Rutten GEHM. Depressive symptoms and quality of life after screening for cognitive impairment in patients with type 2 diabetes: observations from the Cog-ID cohort study. BMJ Open 2019; 9:e024696. [PMID: 30782740 PMCID: PMC6340460 DOI: 10.1136/bmjopen-2018-024696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To assess changes in depressive symptoms and health-related quality of life (HRQOL) after screening for cognitive impairment in people with type 2 diabetes. DESIGN A prospective cohort study, part of the Cognitive Impairment in Diabetes (Cog-ID) study. SETTING Participants were screened for cognitive impairment in primary care. People suspected of cognitive impairment (screen positives) received a standardised evaluation at a memory clinic. PARTICIPANTS Participants ≥70 years with type 2 diabetes were included in Cog-ID between August 2012 and September 2014, the current study includes 179 patients; 39 screen positives with cognitive impairment, 56 screen positives without cognitive impairment and 84 participants not suspected of cognitive impairment during screening (screen negatives). OUTCOME MEASURES Depressive symptoms and HRQOL assessed with the Center for Epidemiologic Studies Depression Scale (CES-D), 36-Item Short-Form Health Survey, European Quality of Life-5 Dimensions questionnaire and the EuroQol Visual Analogue Scale. Outcomes were assessed before the screening, and 6 and 24 months after screening. An analysis of covariance model was fitted to assess differences in score changes among people diagnosed with cognitive impairment, screen negatives and screen positives without cognitive impairment using a factor group and baseline score as a covariate. RESULTS Of all participants, 60.3% was male, mean age was 76.3±5.0 years, mean diabetes duration 13.0±8.5 years. At screening, participants diagnosed with cognitive impairment had significantly more depressive symptoms and a worse HRQOL than screen negatives. Scores of both groups remained stable over time. Screen positives without cognitive impairment scored between the other two groups at screening, but their depressive symptoms decreased significantly during follow-up (mean CES-D: -3.1 after 6 and -2.1 after 24 months); their HRQOL also tended to improve. CONCLUSIONS Depressive symptoms are common in older people with type 2 diabetes. Screening for and a subsequent diagnosis of cognitive impairment will not increase depressive symptoms.
Collapse
Affiliation(s)
- Jolien Janssen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paula S Koekkoek
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert-Jan Biessels
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jaap L Kappelle
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Guy E H M Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
43
|
Azami G, Soh K, Sazlina SG, Salmiah M, Khosravi A, Aazami S, Valizadeh R. The Effect of Depression on Poor Glycemic Control in Adults with Type 2 Diabetes: The Mediating Roles of Self-Efficacy and Self-Management Behaviors. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2019. [DOI: 10.1159/000502126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> High levels of depression and poor self-efficacy and self-management are associated with worse glycemic control, but the linkage and pathway between these variables are poorly understood. We conducted this study to investigate the hypothesis that self-efficacy and self-management mediate the influence of depression on poor glycemic control. <b><i>Methods:</i></b> We studied a purposive sample of 142 adults with type 2 diabetes attending a public clinic in Ilam, Iran. Hierarchical linear regression analysis and structural equation modeling were used to explore the relationships among the variables of interest. <b><i>Result:</i></b> Depression directly and negatively affects self-efficacy and indirectly affects self-management behaviors, which in turn have direct effects on hemoglobin A1c (HbA1c). Self-efficacy mediates the relationship between depression and self-management behaviors. Self-efficacy and self-management behaviors partially mediate the effect of depression on HbA1c. These results confirmed that the data fit the hypothesized model very well. <b><i>Conclusion:</i></b> Careful monitoring of glycemic control might be important in those individuals who exhibit clinical signs of depression. Effective treatment programs should probably pay close attention to not only screening and treatment of depression but also skills training to enhance patient self-efficacy and self-management of diabetes to improve HbA1c.
Collapse
|
44
|
Amsberg S, Wijk I, Livheim F, Toft E, Johansson UB, Anderbro T. Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: study protocol for a randomised controlled trial. BMJ Open 2018; 8:e022234. [PMID: 30498037 PMCID: PMC6278833 DOI: 10.1136/bmjopen-2018-022234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Integrating diabetes self-management into daily life involves a range of complex challenges for affected individuals. Environmental, social, behavioural and emotional psychological factors influence the lives of those with diabetes. The aim of this study is to evaluate the impact of a stress management group intervention based on acceptance and commitment therapy (ACT) among adults living with poorly controlled type 1 diabetes. METHODS AND ANALYSIS This study will use a randomised controlled trial design evaluating treatment as usual (TAU) and ACT versus TAU. The stress management group intervention will be based on ACT and comprises a programme divided into seven 2-hour sessions conducted over 14 weeks. A total of 70 patients who meet inclusion criteria will be recruited over a 2-year period with follow-up after 1, 2 and 5 years.The primary outcome measure will be HbA1c. The secondary outcome measures will be the Depression Anxiety Stress Scales, the Swedish version of the Hypoglycemia Fear Survey, the Swedish version of the Problem Areas in Diabetes Scale, The Summary of Self-Care Activities, Acceptance Action Diabetes Questionnaire, Swedish Acceptance and Action Questionnaire and the Manchester Short Assessment of Quality of Life. The questionnaires will be administered via the internet at baseline, after sessions 4 (study week 7) and 7 (study week 14), and 6, 12 and 24 months later, then finally after 5 years. HbA1c will be measured at the same time points.Assessment of intervention effect will be performed through the analysis of covariance. An intention-to-treat approach will be used. Mixed-model repeated measures will be applied to explore effect of intervention across all time points. ETHICS AND DISSEMINATION The study has received ethical approval (Dnr: 2016/14-31/1). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders. TRIAL REGISTRATION NUMBER NCT02914496; Pre-results.
Collapse
Affiliation(s)
- Susanne Amsberg
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Ingrid Wijk
- Department of Nursing Science, Sophiahemmet University College, Stockholm, Sweden
| | - Fredrik Livheim
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eva Toft
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Ersta Hospital, Stockholm, Sweden
| | - Unn-Britt Johansson
- Department of Nursing Science, Sophiahemmet University College, Stockholm, Sweden
- Department of Clinical Sciences and Education, Södersjukhuset, Stockholm, Sweden
| | - Therese Anderbro
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
- Department of psychology, Stockholm University, Stockholm, Sweden
| |
Collapse
|
45
|
Jeong M, Reifsnider E. Associations of Diabetes-Related Distress and Depressive Symptoms With Glycemic Control in Korean Americans With Type 2 Diabetes. DIABETES EDUCATOR 2018; 44:531-540. [DOI: 10.1177/0145721718807443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Mihyun Jeong
- Department of Nursing, Gyeongju University, Gyeongju, Republic of Korea
| | - Elizabeth Reifsnider
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| |
Collapse
|
46
|
Santos DC, Pizarro MH, Barros BSV, de Melo LGN, Porto LC, Silva DA, Gomes MB. Does ancestry influence health-related quality of life in type 1 diabetes patients? A nationwide study in Brazil. Acta Diabetol 2018; 55:377-385. [PMID: 29397447 DOI: 10.1007/s00592-017-1096-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/28/2017] [Indexed: 02/07/2023]
Abstract
AIMS The aim of the present study was to evaluate the relationship between self-reported color/race and genomic ancestry with HRQoL of patients with type 1 diabetes in a highly admixed population. METHODS This was a nationwide, cross-sectional study conducted with 1760 patients with type 1 diabetes from 2011 to 2014 at public clinics in all five Brazilian geographical regions. Information on HRQoL was obtained from two self-completed questionnaires: Short Form-6 Dimensions (SF-6D) and EuroQol-5 Dimensions (EQ-5D) with a visual analogue scale (EQ-VAS). Genomic ancestry was assessed using a Multiplex PCR methodology. Utility scores generated from the questionnaires were analyzed with multivariate logistic regression models. RESULTS We included 1698 patients. Those patients who self-reported as black had lower EQ-VAS scores compared to the patients who self-reported as white (67.46 ± 18.45; 72.37 ± 16.44, respectively, p = 0.02). In a linear regression model, each 1% increase in African ancestry resulted in a 9.5 point decrease in EQ-VAS score (p < 0.001). In a multivariate logistic regression, after adjusting for demographic, socioeconomic status and diabetes-related variables, African ancestry remained associated with lower EQ-VAS scores. CONCLUSION A higher level of African ancestry implicates on lower quality of life even after adjustments for sociodemographic and diabetes-related data. Gender, physical activity and diabetes-related microvascular complications were strongly associated with low HRQoL in all three questionnaires used. This fact highlights the importance of social aspects when assessing quality of life, as well as the need for regular practice of physical activity and prevention of chronic complications to improve patients' quality of life.
Collapse
Affiliation(s)
- Deborah Conte Santos
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77- 3º andar - Vila Isabel, Rio de Janeiro, RJ, CEP 20551-030, Brazil.
| | - Marcela Haas Pizarro
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77- 3º andar - Vila Isabel, Rio de Janeiro, RJ, CEP 20551-030, Brazil
| | - Bianca S V Barros
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77- 3º andar - Vila Isabel, Rio de Janeiro, RJ, CEP 20551-030, Brazil
| | - Laura G Nunes de Melo
- Department of Ophthalmology, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luis Cristovão Porto
- Histocompatibility and Cryopreservation Laboratory (HLA), State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dayse A Silva
- DNA Diagnostic Laboratory (LDD), State University of Rio Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marilia Brito Gomes
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77- 3º andar - Vila Isabel, Rio de Janeiro, RJ, CEP 20551-030, Brazil
| |
Collapse
|
47
|
Association between pro- and anti-inflammatory cytokines and depressive symptoms in patients with diabetes-potential differences by diabetes type and depression scores. Transl Psychiatry 2018; 7:1. [PMID: 29520075 PMCID: PMC5843637 DOI: 10.1038/s41398-017-0009-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Subclinical inflammation has been implicated in the development of depression, a common comorbidity of type 1 diabetes (T1D) and type 2 diabetes (T2D). This study aimed to characterise the relationships between biomarkers of inflammation and depressive symptoms in T1D and T2D. Biomarkers of inflammation were measured in serum of participants with elevated depressive symptoms and T1D (n = 389, mean age 38 years, diabetes duration 15 ± 11 years) or T2D (n = 204, mean age 56 years, diabetes duration 13 ± 8 years). Subclinical depression was examined using three questionnaires (Center for Epidemiologic Studies Depression [CES-D], Patient Health Questionnaire-9 [PHQ-9], 5-item World Health Organization Well-Being Index [WHO-5]). In T1D, levels of interleukin-1 receptor antagonist (IL-1RA) were positively associated with two depression scores (CES-D, PHQ-9), and high-sensitivity C-reactive protein (hsCRP) was positively associated with depression for one score (WHO-5) after adjustment for age, sex, body mass index, diabetes duration, metabolic variables, medication and comorbidities (P = 0.008-0.042). In T2D, IL-18 and IL-1RA were positively associated with depression for two scores (IL-18: PHQ-9, WHO-5; IL-1RA: CES-D, WHO-5), hsCRP was associated with one depression score (PHQ-9), and adiponectin showed an inverse association with one depression score (PHQ-9) after adjustment (P = 0.006-0.048). No associations were found for IL-6 and CC-chemokine ligand 2 (CCL2). In conclusion, we observed associations between hsCRP, IL-1RA and depressive symptoms in patients with diabetes. In T2D, there was additional evidence for associations of IL-18 and (inversely) adiponectin with depressive symptoms. The strength of the associations appeared to depend on diabetes type and the method used to asssess depressive symptoms.
Collapse
|
48
|
Hapunda G, Abubakar A, Pouwer F, van de Vijver F. Depressive Symptoms Are Negatively Associated with Glucose Testing and Eating Meals on Time among Individuals with Diabetes in Zambia. Diabetes Metab J 2017; 41:440-448. [PMID: 29199409 PMCID: PMC5741553 DOI: 10.4093/dmj.2017.41.6.440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/27/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Depression is an established risk factor for cardiovascular diseases and mortality among individuals living with diabetes, and impaired self-care behaviors may play a mediating role. In Africa, this association is not very well known. In this study, we examined the associations between depressive symptoms and different aspects of diabetes self-care in Zambian individuals with diabetes mellitus. METHODS A total of 157 individuals with diabetes mellitus participated. The sample was drawn from four city hospitals in Zambia. Diabetes self-care was assessed using the diabetes self-care inventory, and depression was assessed using the major depression inventory. RESULTS Fifty-nine percent of the sample had type 1 diabetes mellitus. Variations in self-care activities and behaviors were reported as least adhered to by individuals with type 1 and type 2 diabetes mellitus, in adolescent and adult patients. Regression analysis indicated that there was no association between total diabetes self-care and the depression total score. However, depression was associated with poor glucose testing and not eating meals on time by patients with diabetes. CONCLUSION Some variance on poor self-care was explained by demographic characteristics, specifically age, body mass index, and to some extent, socioeconomic status. Recognition and successful treatment of depression in patients with diabetes might help to optimize self-care behaviors, especially glucose testing and eating meals on time. However, this hypothesis needs further testing.
Collapse
Affiliation(s)
- Given Hapunda
- Department of Psychology, University of Zambia, Lusaka, Zambia.
| | - Amina Abubakar
- Department of Culture Studies, Tilburg University, Tilburg, The Netherlands
- Department of Public Health, Pwani University, Kilifi, Kenya
- Neuroassessment, Center for Geographic Medicine Research, Neurosciences Research Group, Kilifi, Kenya
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Fons van de Vijver
- Department of Culture Studies, Tilburg University, Tilburg, The Netherlands
- Work Well Unit, North-West University, Potchefstroom, South Africa
- School of Psychology, University of Queensland, Brisbane, Australia
| |
Collapse
|
49
|
Depression and anxiety disorders in people with diabetes. CURRENT PROBLEMS OF PSYCHIATRY 2017. [DOI: 10.1515/cpp-2017-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction: As the global number of diabetes and the burden of depression together with other mental disorders increases, there is a need for better understanding of the connection between these diseases. In patients with diabetes, mental disorders are more common than in the general population, especially anxiety disorders and depression, which are often difficult to detect by health professionals.
Material and methods: Using the keywords searched in the international bibliographic databases: Embase, Medline, Science Direct, Web of Science. We analyzed clinical trials published in English and international journals
Results: Patients with diabetes are exposed to serious physical and mental complications. The occurence of depression and psychiatric disorders among people with diabetes was twice as frequent as in the general population. There are also studies showing a higher risk of suicide among people with diabetes. In addition, patients with both diseases, diabetes and depression, had an increased risk of cardiovascular complications and increased mortality and higher costs of health care. Diabetic patients have increased incidence of anxiety disorders in relation to non-diabetic patients by 20%.
Conclusion: Further researches and integration of medical and psychological treatment are needed. Cooperation between psychiatrists and diabetologists can reduce mental and physical harm in patients with diabetes.
Collapse
|
50
|
Halliday JA, Hendrieckx C, Busija L, Browne JL, Nefs G, Pouwer F, Speight J. Validation of the WHO-5 as a first-step screening instrument for depression in adults with diabetes: Results from Diabetes MILES - Australia. Diabetes Res Clin Pract 2017; 132:27-35. [PMID: 28783530 DOI: 10.1016/j.diabres.2017.07.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/29/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
AIMS Screening for depression is recommended internationally. The World Health Organization's 5-item Well-being Index (WHO-5) is used clinically to screen for depression but its empirical suitability for this purpose is not well documented. We investigated the psychometric properties of the WHO-5 and its suitability for identifying likely depression in Australian adults with diabetes. METHODS The Diabetes MILES - Australia study dataset provided a sample of N=3249 who completed the WHO-5 (positively-worded 5-item measure of emotional well-being) and the PHQ-9 (9-item measure of depressive symptoms). Analyses were conducted for the full sample, and separately by diabetes type and treatment (type 1, non-insulin-treated type 2, and insulin-treated type 2 diabetes). Construct (convergent and factorial) validity and reliability of the WHO-5 were examined. ROC analyses were used to examine the sensitivity and specificity of the WHO-5 as a depression screening instrument, comparing two commonly used WHO-5 cut-off values (≤7 and <13) with the PHQ-9. RESULTS For the whole sample, the WHO-5 demonstrated satisfactory internal consistency reliability (α=0.90) and convergent validity with the PHQ-9 (r=-0.73, p<0.001). Confirmatory factor analysis partially supported factorial validity: Χ2(5)=834.94, p<0.001; RMSEA=0.23, 90% CI 0.21-0.24; CFI=0.98, TLI=0.96; factor loadings=0.78-0.92. The AUC was 0.87 (95% CI: 0.86-0.89, p<0.001). The sensitivity/specificity of the WHO-5 for detecting likely depression was 0.44/0.96 for the ≤7 cut-off, and 0.79/0.79 for the <13 cut-off, with similar findings by diabetes type and treatment. CONCLUSIONS These findings support use of a WHO-5 cut-point of <13 to identify likely depression in Australian adults with diabetes, regardless of type/treatment.
Collapse
Affiliation(s)
- Jennifer A Halliday
- School of Psychology, Deakin University, 1 Geringhap Street, Geelong 3220, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia.
| | - Christel Hendrieckx
- School of Psychology, Deakin University, 1 Geringhap Street, Geelong 3220, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia
| | - Lucy Busija
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne 3000, VIC, Australia
| | - Jessica L Browne
- School of Psychology, Deakin University, 1 Geringhap Street, Geelong 3220, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia
| | - Giesje Nefs
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands; Diabeter, Center for pediatric and adolescent diabetes care and research, Blaak 6, 3011 TA Rotterdam, The Netherlands
| | - François Pouwer
- Department of Psychology, University of Southern Denmark, Campusvej 55, Odense M 5230, Denmark
| | - Jane Speight
- School of Psychology, Deakin University, 1 Geringhap Street, Geelong 3220, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; AHP Research, Hornchurch, Essex, UK
| |
Collapse
|