Prevalence of depression in patients with type 2 diabetes attended in primary care in Spain

[Diabetes and women, why are we different?]

Diabetes affects men and women differently and the mistaken assumption of equality in its clinical expression can lead to errors and delays in the diagnostic process and the therapeutic strategy adopted. The objective is to show the gender differences that influence the approach to this pathology and what the role of the family doctor is in the monitoring of women with diabetes. It is a review of the impact of diabetes at different stages of a woman's life, how hormonal changes affect glycemic control, gestational diabetes, how diabetes affects the development of chronic complications in women and their consequences, the existing differences in the control of cardiovascular risk factors and the differential aspects by sex of the different families of drugs used in the treatment of diabetes.

Quality of life, stress, anxiety and depression and associated factors among people with type 2 diabetes mellitus in Western region Saudi Arabia

Introduction

The objective of this study is to evaluate the quality of life (QoL), depression, anxiety, and stress, along with associated factors among individuals with diabetes in Saudi Arabia.

Methods

This survey was conducted at King Abdulaziz University (KAU), Jeddah, Kingdom of Saudi Arabia (KSA). The assessment of depression, anxiety, and stress related to Type 2 Diabetes Mellitus (T2DM) was conducted using the DASS-21 questionnaire, while diabetes-related QoL was evaluated using the revised version of the diabetes QoL questionnaire (RV-DQoL13). Data were analyzed using SPSS-26.

Results

A total of 251 subjects were included in the study (165 [65.7%] males and 86 [34.3%] females, mean age 50.1 ± 14.5 years). The individuals with DM had a mean value of QoL of 29.16 ± 9.23, with 46.9% having poor QoL. Furthermore, in dimensions of QoL, almost half of the individuals reported high worry about the disease (49.6%), followed by a high diabetes impact (46.6%) and low life satisfaction (42.9%). The prevalence of depression, anxiety, and stress was 49.4, 71.7, and 49.8%, respectively. A significant correlation was found between depression, anxiety, and stress and DASS-21 scores with QoL (p < 0.001). The regression analysis indicated an association of distinct factors with QoL like age above 41 years (p = 0.004), being married (p < 0.001), being divorced (p = 0.04), higher education (p = 0.007), regular medicine intake (p = 0.01), regular exercise (p = 0.03), lipid profile (p = 0.01), HbA1c (p < 0.001), and DASS-21 scores (p < 0.001). Poor QoL score (TQoL score > 27) was significantly associated with depression, anxiety, and stress (p < 0.001). The participants with higher monthly income, shorter disease duration, regular medicine use, and altered lipid profile, and older subjects had a lower chance of depression, anxiety, and stress.

Conclusion

Approximately half of individuals with T2DM experienced poor QoL, while the prevalence rates for depression, anxiety, and stress were 49.4, 71.7, and 49.8%, respectively. Scores in the domains of impact, worry, and satisfaction were below optimal levels. Several factors were linked to QoL and depression, anxiety, and stress, and an association was observed between DASS-21 scores and QoL.

[Cognition and depression in older people with diabetes]

Cognitive dysfunction, dementia and depression are typical comorbidities of diabetes and are more common in older people with diabetes than in the general population. Both comorbid diseases have a substantial impact on the therapy of diabetes and lead to a reduction of the functional level in everyday life, the quality of life and are associated with increased mortality. This article summarizes the most important results on the etiology of cognitive dysfunction and depression and their consequences for clinical practice.

Path Analysis of Influencing Factors of Depression in Middle-Aged and Elderly Patients with Diabetes

PURPOSE

This study aimed to assess the prevalence of depression in middle-aged and elderly patients with diabetes in China, determine the risk factors of depression in these patients, and explore the internal relationship between influencing factors and depression by constructing a pathway model.

METHODS

Data were collected from the 2018 China Health and Retirement Longitudinal Study (CHRLS). We included 1743 patients with diabetes who were assessed using the CES-D10, which is used to measure depressive symptoms in Chinese older adults. Based on the theory of psychological stress, data were analyzed using SPSS software version 22.0 and MPLUS 8.0. A correlation analysis was used to explore the relationship between the variables and depression scores. A path model was constructed to explore the interrelationships between variables and verify the relationships between variables and depression in patients with diabetes.

RESULTS

The prevalence of depression among patients with diabetes was 42.5%. The path analysis results showed that income, diabetes duration, sleep duration, pain distress, self-rated health, and glycemic control directly affected depression, and self-rated health had the largest effect value. With self-rated health and glycemic control as mediator variables, income, diabetes duration, sleep duration, pain distress, glycemic control, and insulin use had indirect effects on depression by influencing self-rated health. Age, frequency of blood glucose monitoring, and exercise glycemic control awareness indirectly affected depression by affecting glycemic control, self-rated health status, and depression.

CONCLUSION

We found that the path analysis model could construct the interaction between the influencing factors and explore the potential interrelationship between the influencing factors and diabetes-related depression. Patients with diabetes must adhere to regular medication, maintain a healthy lifestyle, and have effective glycemic control. Diabetes depression can be effectively prevented by making psychological knowledge publicly available, providing health education, and establishing corresponding for diabetes.

HCV infection characteristics, treatment uptake and outcomes in patient with diabetes mellitus

BACKGROUND

The interplay between HCV, DM, and DAA therapy is poorly understood. We compared HCV infection characteristics, treatment uptake, and treatment outcomes in patients with and without DM.  METHODS: A retrospective cohort study was conducted using data from The Ottawa Hospital Viral Hepatitis Program. Statistical comparisons between diabetes and non-diabetes were made using χ² and t-tests. Logistic regression analyses were performed to assess predictors of DM and SVR.

RESULTS

One thousand five hundred eighty-eight HCV patients were included in this analysis; 9.6% had DM. Patients with DM were older and more likely to have cirrhosis. HCC and chronic renal disease were more prevalent in the DM group. Treatment uptake and SVR were comparable between groups. Regression analysis revealed that age and employment were associated with achieving SVR. Post-SVR HCC was higher in DM group.

CONCLUSION

The high prevalence of DM in our HCV cohort supports screening. Further assessment is required to determine if targeted, early DAA treatment reduces DM onset, progression to cirrhosis and HCC risk. Further studies are needed to determine if optimization of glycemic control in this population can lead to improved liver outcomes.

Prevalence and Associated Factors of Diabetes Distress, Depression and Anxiety Among Primary Care Patients With Type 2 Diabetes During the COVID-19 Pandemic in Egypt: A Cross-Sectional Study

The prevalence of type 2 diabetes mellitus (T2DM) is growing worldwide. T2DM is often complicated by a range of psychological disorders that interfere with glycemic control and self-care. Previous studies have reported diabetes distress, depression, and anxiety among patients with T2DM; however; little is known about the burden of these comorbid mental disorders in primary care patients with T2DM treated in Egypt during the COVID-19 era. Participants were selected by convenient sampling from eight rural primary healthcare facilities from Ismailia in Egypt. Symptoms of diabetes distress, depression and anxiety were assessed by using the Arabic version of the 20-item Problem Areas in Diabetes (PAID), Patient Health Questionnaire 9, and Generalized Anxiety Disorder Scales, respectively. Multiple hierarchical logistic regression models were used to estimate the significant factors associated with diabetes distress, depression, and anxiety. A total of 403 individuals with T2DM were interviewed. The prevalence of severe diabetes distress was 13.4% (95% CI: 10.1-16.7), while prevalence of depressive and anxiety symptoms was 9.2% (95% CI: 6.4-12.0%), and 4.0% (95% CI: 2.1-5.9), respectively. In a series of hierarchical logistic regression models, significant predictors for diabetes distress were being married, illiterate, not-working, living with insufficient income, and having multi-comorbidities. Likewise, the significant predictors for depression and anxiety were elevated glycated hemoglobin level and the higher PAID total score, while having multi-comorbidities was a significant predictor for anxiety only. Diabetes distress was more prevalent than depressive and anxiety symptoms in this study population. Several sociodemographic and clinical characteristics were identified to be related with psychological problems among patients with T2DM, which necessitate a multidisciplinary team-based approach for optimal screening and management.

The economic burden of anxiety and depression on the working age population with diabetes in Spain

Diabetes mellitus (DM) is a complex, chronic, multifactorial, and costly health problem representing 8% of total public health expenditures in Spain. The objective of this study was to analyse the prevalence and costs of Anxiety (AX) and Depression (DP) in the Spanish working population with DM. Data were obtained from the National Health Survey of Spain 2017. A multivariate analysis was conducted to predict the use of resources and absenteeism/presenteeism. Direct and indirect costs were calculated. The final population analysed contained 15,822 subjects (18-65 years old). DM prevalence was 4.8%, and AX-DP 10.6% (50.5% were men). Self-diagnosed health was rated as regular, poor or very poor in 89% of DM subjects with DP-AX. The average costs estimated were €24,643.41 for DM subjects with AX-DP and €20,059.53 for those with only DM. The total estimated 2017 economic impact of DM was 2.4% of Spanish gross domestic product (13% directly related to DP-AX). Indirect costs represented 72.7% of total DP-AX costs. Spanish society is paying a considerable price for the incidence of DP-AX levels with DM in the working population. This global challenge has important repercussions for individuals' quality of life, health systems, and countries' development and economic growth.

Multimorbidity and achievement of treatment goals among patients with type 2 diabetes: a primary care, real-world study

Background

Type 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. have one or more long-term diseases in addition to T2D. Multimorbidity may play a role in the achievement of T2D treatment targets, but is still not fully understood. The aims of the present cross-sectional, register-based study were to evaluate the prevalence and the most common patterns of multimorbidity among patients with T2D; and to study the potential associations between multimorbidity and treatment goal achievement, including measurements of glycosylated haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and systolic blood pressure (sBP).

Methods

The study population consisted of 4545 primary care patients who received a T2D diagnosis between January 2011 and July 2019 in Rovaniemi Health Centre, Finland. Data on seven long-term concordant (T2D-related) diseases, eight long-term discordant (non-T2D-related) diseases, potential confounders (age, sex, body mass index, prescribed medication), and the outcomes studied were collected from patients’ records. Logistic regression models with odds ratios (ORs) and 95 % confidence intervals (CIs) were assessed to determine the associations between multimorbidity and the achievement of treatment targets.

Results

Altogether, 93 % of the patients had one or more diseases in addition to T2D, i.e. were considered multimorbid. Furthermore, 21 % had only concordant disease(s) (Concordant subgroup), 8 % had only discordant disease(s) (Discordant subgroup) and 64 % had both (Concordant and discordant subgroup). As either single diseases or in combination with others, hypertension, musculoskeletal (MS) disease and hyperlipidaemia were the most prevalent multimorbidity patterns. Being multimorbid in general (OR 1.32, CI 1.01–1.70) and belonging to the Concordant (OR 1.45, CI 1.08–1.95) and Concordant and discordant (OR 1.31, CI 1.00–1.72) subgroups was associated with achievement of the HbA1c treatment target. Belonging to the Concordant and discordant subgroup was related to meeting the LDL treatment target (OR 1.31, CI 1.00–1.72).

Conclusions

Multimorbidity, including cardiovascular risk and the musculoskeletal disease burden, was extremely prevalent among the T2D patients who consulted primary health care. Primary care clinicians should survey the possible co-existence of long-term diseases among T2D patients to help maintain adequate treatment of T2D.

Assessing prevalence and predictors of depression in Type 2 Diabetes Mellitus (DM) patients - The DEPDIAB study

OBJECTIVES

Depression is common in diabetes and has significant impact on health outcomes. Suicidal ideation also forms a part of the spectrum of diabetes and coexistent depression. To assess the predictors of depression as well as its prevalence in Type 2 Diabetes Mellitus (T2DM) patients, we conducted a cross sectional study entitled "DEPression in DIABetes" (DEPDIAB).

MATERIAL AND METHODS

A cohort of consecutive 1371 T2DM patients from Eastern India suffering from diabetes greater than 1 year was assessed in a cross- sectional survey in 9 different hospitals and medical polyclinics in Kolkata, India for depression by administering the 9-item PHQ - 9 and Beck depression scales. Socioeconomic status was assessed by the "Revised Kuppuswamy and B G Prasad socio-economic scales for 2016", a validated scoring system for assessing the socioeconomic status of Indian patients.

RESULTS

In our study 836 patients (60.9%) were male and 535 (39.02%) were female. 56 patients (4.1%) met the criteria for major depression and 494 patients (36.16%) for minor depression. No sign of depression was found in 816 patients (59.74%). Depression was strongly associated with younger age (18-40 years vs. >60 years) [OR-2.09; 95% CI 1.11-3.96], female sex [OR-1.31; 95% CI 1.11-2.01], low socioeconomic status [OR-2.69; 95% CI 1.34-3.79], poor compliance [OR- 5.05; 95% CI 2.79-8.13], hypoglycemia [OR 1.466; 95% CI 1.076-1.999] and difficulty in managing day-to-day activities [OR- 4.648; 95% CI 3.450-6.262] Suicidal ideation was detected in 201 patients (14.8%). Among patients who had repeated attacks of hypoglycemia (>1 episode per month), 22% experienced suicidal ideation. This was significantly higher than in patients who had not suffered from hypoglycemia (12%) (p < 0.0001). Patients with HbA1C of 7% or lower experienced statistically significantly lesser suicidal ideation than patients with a higher HbA1C (12% vs. 16.8% {p = 0.016}). Suicidal ideation did not correlate withbody mass index (BMI), fasting plasma glucose (FPG) or insulin usage.

CONCLUSIONS

We found a high prevalence of depression in T2DM patients in Eastern India. Younger age, female sex, lower socio-economic status, poor compliance, hypoglycemia, and difficulty in managing day to day activities emerged as significant predictors of depression in this study. Recurrent episodes of hypoglycemia were an independent risk factor for suicidal ideation in patients with depression. Depression was not significantly associated with co morbidities associated with T2D and surprisingly insulin usage was not associated with increased depression.

Association between mental health comorbidity and health outcomes in type 2 diabetes mellitus patients

Type 2 diabetes mellitus (T2D) is often accompanied by chronic diseases, including mental health problems. We aimed at studying mental health comorbidity prevalence in T2D patients and its association with T2D outcomes through a retrospective, observational study of individuals of the EpiChron Cohort (Aragón, Spain) with prevalent T2D in 2011 (n = 63,365). Participants were categorized as having or not mental health comorbidity (i.e., depression, anxiety, schizophrenia, and/or substance use disorder). We performed logistic regression models, controlled for age, sex and comorbidities, to analyse the likelihood of 4-year mortality, 1-year all-cause hospitalization, T2D-hospitalization, and emergency room visit. Mental health comorbidity was observed in 19% of patients. Depression was the most frequent condition, especially in women (20.7% vs. 7.57%). Mortality risk was higher in patients with mental health comorbidity (odds ratio 1.24; 95% confidence interval 1.16-1.31), especially in those with substance use disorder (2.18; 1.84-2.57) and schizophrenia (1.82; 1.50-2.21). Mental health comorbidity also increased the likelihood of all-cause hospitalization (1.16; 1.10-1.23), T2D-hospitalization (1.51; 1.18-1.93) and emergency room visit (1.26; 1.21-1.32). These results suggest that T2D healthcare management should include specific strategies for the early detection and treatment of mental health problems to reduce its impact on health outcomes.

Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses

Objectives: To estimate the clinical and economic burden of type 2 diabetes (T2D) in established (EST) and emerging markets (EMG).Methods: Three systematic literature reviews were conducted in MEDLINE and Embase to capture all relevant publications reporting 1) the epidemiology of T2D and complications in T2D and 2) the economic burden of T2D and associated complications.Results: In total, 294 studies were included in this analysis. Evidence indicates a high and increasing overall prevalence of T2D globally, ranging up to 23% in EMG markets and 14% in EST markets. Undiagnosed cases were higher in EMG versus EST markets (up to 67% vs 38%), potentially due to a lack of education and disease awareness in certain regions, that could lead to important clinical and economic consequences. Poor glycemic control was associated with the development of several complications (e.g. retinopathy, cardiovascular diseases and nephropathy) that increase the risk of morbidity and mortality. Direct costs were up to 9-fold higher in patients with vs without T2D-related complications.Conclusions: The burden of T2D, related complications and inherent costs are higher in emerging versus established market countries. This review explores potential strategies to reduce costs and enhance outcomes of T2D treatment in developing countries.

Higher risk of depression in individuals with type 2 diabetes and obesity: Results of a meta-analysis

The aim of this study was to determine the risk of having significant depressive symptoms in subjects with obesity and type 2 diabetes mellitus through a meta-analysis. Our results showed that individuals with obesity and diabetes have an increased risk of having significant symptoms of depression. In subgroup analyses, we observed that Caucasian populations have an increased risk of having these symptoms. Our meta-analysis suggests that obesity is associated with an increased risk of having significant depressive symptoms in patients with type 2 diabetes, and they could be even higher in Caucasian populations.

Prevalence and predictors of depression, anxiety, and stress symptoms among patients with type II diabetes attending primary healthcare centers in the western region of Saudi Arabia: a cross-sectional study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a prevalent health problem, not only globally, but also in Saudi Arabia. A growing body of literature suggests a bi-directional association between T2DM and various mental health disorders. This study aimed to investigate the prevalence and predictors of depression, anxiety, and stress among T2DM patients in the western region of Saudi Arabia.

METHODS

Between May and August 2018, a cross-sectional study was conducted among adult patients with T2DM in five public primary care centers in the western region of Saudi Arabia. Sociodemographic characteristics and symptoms of depression, anxiety, and stress were measured using the self-administered, previously validated Depression, Anxiety, and Stress Scale (DASS-21) questionnaire. Simple descriptive statistics were used. Forward binary logistic regression was used to identify predictors of depression, anxiety, and stress.

RESULTS

A total of 450 adults with T2DM were included (56.9% men; 43.1% women). The prevalence of depression, anxiety, and stress was 33.8%, 38.3%, and 25.5%, respectively. Major predictors of psychological distress were age, sex, the presence of comorbidities, duration since T2DM diagnosis, and serum level of hemoglobin A1c. Compliance with diabetes management measures and older age were the only protective factors.

CONCLUSION

Patients with T2DM had significantly high rates of depression, anxiety, and stress. We recommend periodic screening of patients with T2DM for psychological distress using easy and inexpensive validated screening tools like the DASS-21 questionnaire. Further larger-scale studies are needed to investigate the causes and outcomes of these higher rates of psychological distress among Saudi patients with diabetes.

The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies

AIMS

Depression is a common co-morbidity in patients with type 2 diabetes mellitus (T2DM). Untreated depression in these patients adversely affects self-care activities and other diabetes complications. The aim of this study is to estimate the prevalence of depression among patients with T2DM by conducting a meta-analysis of observational studies.

METHODS

MEDLINE, Web of Science, Science Direct, and Google Scholar databases were searched for all observational studies that assessed depression in T2DM. Relevant articles were searched using the combination of Medical Subject Heading (MeSH) terms of "depression", "depressive disorder", and "diabetes mellitus" published between January 2007 and July 2018. Random effects model was used to estimate the weighted prevalence rates and 95% CI using "metaprop program in STATA 11".

RESULTS

In total, the 248 included studies (with 273 reported prevalence) identified 83,020,812 participants; of them, 23,245,827 (28%; 95% CI 27, 29) suffered from different severity levels of depressive disorders. The prevalence of depression was separately reported in 137,372 males and 134,332 females. Of them, 31,396 males (23%, 95% CI: 20, 26) and 45,673 females (34%, 95% CI: 31, 38) were depressed. Compared with global estimate, depression prevalence was lower in Europe (24%) and Africa (27%), but higher in Australia (29%) and Asia (32%). The prevalence in America was equal to the estimated prevalence in the world (28%). Depression was more common in subjects younger than 65 compared with elderlies (31% vs. 21%).

CONCLUSION

Our findings demonstrated that almost one in four adults with T2DM experienced depression. Given the high prevalence of depressive disorders in diabetic patients, screening these patients for co-morbid depression and its relevant risk factors is highly recommended.

The association between insulin therapy and depression in patients with type 2 diabetes mellitus: a meta-analysis

OBJECTIVES

Several patients with type 2 diabetes mellitus (T2DM) have depressive disorders. Whether insulin treatment was associated with increased risk of depression remains controversial. We performed a meta-analysis to evaluate the association of insulin therapy and depression.

DESIGN

A meta-analysis.

METHODS

We conducted a systematic search of PubMed, PsycINFO, Embase and the Cochrane Library from their inception to April 2016. Epidemiological studies comparing the prevalence of depression between insulin users and non-insulin users were included. A random-effects model was used for meta-analysis. The adjusted and crude data were analysed.

RESULTS

Twenty-eight studies were included. Of these, 12 studies presented with adjusted ORs. Insulin therapy was significantly associated with increased risk of depression (OR=1.41, 95% CI 1.13 to 1.76, p=0.003). Twenty-four studies provided crude data. Insulin therapy was also associated with an odds for developing depression (OR=1.59, 95% CI 1.41 to 1.80, p<0.001). When comparing insulin therapy with oral antidiabetic drugs, significant association was observed for adjusted (OR=1.42, 95% CI 1.08 to 1.86, p=0.008) and crude (OR=1.61, 95% CI 1.35 to 1.93, p<0.001) data.

CONCLUSIONS

Our meta-analysis confirmed that patients on insulin therapy were significantly associated with the risk of depressive symptoms.

The validation of the visual screening tool for anxiety disorders and depression in hypertension and/or diabetes

Background

Depression and anxiety disorders remain poorly detected at primary health care, particularly in patients with hypertension and/or diabetes. A visual screening tool for anxiety disorders and depression (VISTAD) has been developed, but not validated.

Aim

To validate the VISTAD in primary health care participants diagnosed with hypertension and/or diabetes.

Setting

Participants were recruited from five primary health care centres in the Eastern Cape, South Africa (urban, peri-urban and rural).

Methods

The study used a cross-sectional study design to validate the VISTAD. The VISTAD was validated against the International Neuropsychiatric Interview (M.I.N.I) using field testing. A demographic questionnaire was used to collect data on socio-economic variables.

Results

Sixty-nine (87%) females and 10 (13%) males with a mean age of 49 (SD 8.6844) participated in the study. Fifty black people (63%), 16 mixed race people (20%) and 13 white people (16%) participated in the study. The majority of the participants (77%) did not complete high school. The area under curve score (AUC) for the VISTAD in screening for depression was 0.91, and for anxiety disorders, 0.87 post-traumatic stress disorder, 0.87 panic disorder, 0.85 social phobia, 0.88 agoraphobia, and 0.83 generalised anxiety disorder revealing acceptable psychometric properties.

Conclusion

The use of the VISTAD as a screening tool at primary health care in people living with hypertension and/or diabetes is recommended. The VISTAD could, therefore, play a key role in the prevention and early treatment of individuals diagnosed with hypertension and/or diabetes across cultures and levels of education. The VISTAD needs to be validated in a large population representative of primary care patients diagnosed with hypertension and/or diabetes.

Prevalence of depression in patients with type 2 diabetes mellitus in Spain (the DIADEMA Study) : results from the MADIABETES cohort

OBJECTIVE

To estimate the prevalence of depression in patients diagnosed with type 2 diabetes mellitus (T2DM), and to identify sociodemographic, clinical and psychological factors associated with depression in this population. Additionally, we examine the annual incidence rate of depression among patients with T2DM.

METHODS

We performed a large prospective cohort study of patients with T2DM from the Madrid Diabetes Study. The first recruitment drive included 3443 patients. The second recruitment drive included 727 new patients. Data have been collected since 2007 (baseline visit) and annually during the follow-up period (since 2008).

RESULTS

Depression was prevalent in 20.03% of patients (n=592; 95% CI 18.6% to 21.5%) and was associated with previous personal history of depression (OR 6.482; 95% CI 5.138 to 8.178), mental health status below mean (OR 1.423; 95% CI 1.452 to 2.577), neuropathy (OR 1.951; 95% CI 1.423 to 2.674), fair or poor self-reported health status (OR 1.509; 95% CI 1.209 to 1.882), treatment with oral antidiabetic agents plus insulin (OR 1.802; 95% CI 1.364 to 2.380), female gender (OR 1.333; 95% CI 1.009 to 1.761) and blood cholesterol level (OR 1.005; 95% CI 1.002 to 1.009). The variables inversely associated with depression were: being in employment (OR 0.595; 95% CI 0.397 to 0.894), low physical activity (OR 0.552; 95% CI 0.408 to 0.746), systolic blood pressure (OR 0.982; 95% CI 0.971 to 0.992) and social support (OR 0.978; 95% CI 0.963 to 0.993). In patients without depression at baseline, the incidence of depression after 1 year of follow-up was 1.20% (95% CI 1.11% to 2.81%).

CONCLUSIONS

Depression is very prevalent among patients with T2DM and is associated with several key diabetes-related outcomes. Our results suggest that previous mental status, self-reported health status, gender and several diabetes-related complications are associated with differences in the degree of depression. These findings should alert practitioners to the importance of detecting depression in patients with T2DM.

Weight loss increases all-cause mortality in overweight or obese patients with diabetes: A meta-analysis

BACKGROUND

Overweight and obese patients with diabetes are advised to lose weight to improve their health; however, recent studies have demonstrated that weight loss may be associated with worse long-term survival in patients with diabetes. This meta-analysis aimed to examine the relationships between weight loss and all-cause mortality in overweight or obese individuals with diabetes.

METHODS

We searched the PubMed and EMBASE databases from inception to February 2017. We included prospective studies that reported sufficient information to extract mortality-specific relative risks (RRs) with corresponding 95% confidence intervals (CIs). RRs with 95% CIs were pooled using a random-effects model. A subgroup analysis was also performed to explore sources of heterogeneity.

RESULTS

Of the 1652 studies identified, 8 met the inclusion criteria. A total of 18,887 patients were included in this analysis. We found that compared with a stable weight, weight loss was associated with an increased risk of all-cause mortality (RR, 1.15; 95% CI, 1.04 to 1.28) and cardiovascular disease (CVD) mortality (RR, 1.15; 95% CI, 1.02 to 1.29) in overweight or obese adults with diabetes, whereas intentional weight loss was not associated with changes in all-cause mortality (RR, 0.90; 95% CI, 0.67 to 1.22). Weight gain was not associated with changes in all-cause mortality (RR, 1.17; 95% CI, 0.87 to 1.58) or CVD mortality (RR, 0.97; 95% CI, 0.93 to 1.01). Compared with an initial body mass index (BMI) of 25 to 30 kg/m, an initial BMI of >35 kg/m was associated with increased all-cause mortality (RR, 1.23; 95% CI, 1.01 to 1.50), which was further increased with an initial BMI of >40 kg/m (RR, 1.50; 95% CI, 1.16 to 1.94).

CONCLUSION

Our results indicate that weight loss but not weight gain increased all-cause mortality and CVD mortality in overweight or obese adults with diabetes.

Reductions in food cravings are similar with low-fat weight loss diets differing in protein and carbohydrate in overweight and obese adults with type 2 diabetes: A randomized clinical trial

Food cravings are common in type 2 diabetes (T2D). Higher-protein diets are effective in improving satiety but their effect on cravings is unclear. It was hypothesized that a high protein (HP) diet would provide greater reductions in cravings than an isocaloric higher-carbohydrate diet (HC). In a randomized controlled trial, 61 adults (54% males) with T2D (means ± SD: BMI 34.3 ± 5.1 kg/m²; aged 55 ± 8 years) consumed either a HP diet (mean across study: 29% protein, 34% carbohydrate, 31% fat) or an isocaloric HC diet (21%:48%:24%) for 12-weeks each of weight loss (WL) and weight maintenance (WM). The Food Craving Inventory (FCI), measuring types of foods craved and the General Food Craving Questionnaires measuring traits (G-FCQ-T) and states (G-FCQ-S) were assessed at Weeks 0, 12 and 24. Weight changes were similar between groups (means ± SEM: WL: -7.8 ± 0.6 kg, WM: -0.6 ± 0.4 kg). No group effects or group x time interactions were found for any outcome (P ≥ .07). Independent of group, all food cravings (except carbohydrates) and G-FCQ-T subscales decreased over the 24-week study (P ≤ .04) with sweets and fast food cravings, loss of control and emotional cravings reducing following WL (P ≤ .03). Obsessive preoccupation with food decreased following both phases (WL: P = .03; WM: P = .001). Weight was associated with several FCI subscales (r ≥ 0.24, P ≤ .04). In conclusion, both the HP and HC diets provided significant reductions in food cravings after similar weight losses which were maintained when weight was stabilized.

Association between depression and persistence with oral antihyperglycemic drugs in type 2 diabetes mellitus patients in Germany

The goal of the present work was to study the impact of depression on persistence with oral antihyperglycemic drugs in type 2 diabetes mellitus (T2DM) patients followed in general practices in Germany. We included T2DM patients who were treated with oral antihyperglycemic drugs and had an initial diagnosis of depression from 1262 general practices in Germany between January 2013 and December 2015. T2DM controls without depression were included and matched (1:1) to T2DM cases with depression based on age, sex, physician, and initial antihyperglycemic therapy, using a propensity score method. Persistence was estimated as therapy duration without treatment disruption, which was defined as at least 3 months without oral antihyperglycemic drugs. This study included 6449 T2DM patients with depression and 6449 T2DM patients without depression. After 12 months of follow-up, 67.5% of cases with depression and 69.7% of controls without depression were found to be persistent with oral antihyperglycemic drugs (p = 0.627). Depression had no significant impact on persistence with antihyperglycemic drugs in the entire population (HR = 1.03) or in the different subgroups (HRs ranging from 1.00 to 1.06). Depression was not significantly associated with persistence with antihyperglycemic drugs in Germany.