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Merlo EM, Tutino R, Myles LAM, Alibrandi A, Lia MC, Minasi D. Type 1 Diabetes Mellitus, Psychopathology, Uncertainty and Alexithymia: A Clinical and Differential Exploratory Study. Healthcare (Basel) 2024; 12:257. [PMID: 38275537 PMCID: PMC10815314 DOI: 10.3390/healthcare12020257] [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: 11/20/2023] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Type 1 diabetes mellitus (T1DM) represents a complex pathology affecting a large number of people. Research suggests that psychological factors influence coping with T1DM. This study aimed to investigate the presence and role of psychopathology, alexithymia and uncertainty in people affected by T1DM. The sample consisted of 137 patients (88 females, 49 males) affected by T1DM aged from 11 to 19 years old (Mean: 13.87; SD: 2.40). The diagnostic protocol consisted of a sociodemographic questionnaire, Self-administration Psychiatric Scales for Children and Adolescents (SAFA), Toronto Alexithymia Scale-20 (TAS-20) and Intolerance to Uncertainty Scale-12 (IUS-12). Descriptive, differential, correlational and regression analyses were performed in order to examine the relationships between these variables. The results suggested the sample had high levels of psychopathological indexes, alexithymia and intolerance of uncertainty. Also, there were significant differences between TAS-20 and IUS-12 distributions with respect to psychopathology. Correlations and multivariate linear regressions indicated age, gender and education significantly predicted alexithymia and intolerance of uncertainty. This data suggest the presence of elevated psychopathology, alexithymia and uncertainty in people with diabetes.
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Affiliation(s)
- Emanuele Maria Merlo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy
| | - Rita Tutino
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy; (R.T.); (M.C.L.); (D.M.)
| | | | - Angela Alibrandi
- Department of Economics, University of Messina, 98122 Messina, Italy;
| | - Maria Carmela Lia
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy; (R.T.); (M.C.L.); (D.M.)
| | - Domenico Minasi
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy; (R.T.); (M.C.L.); (D.M.)
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Antidepressants and Risk of Type 2 Diabetes Mellitus: A Population-Based Nested Case-Control Study. J Clin Psychopharmacol 2021; 40:359-365. [PMID: 32639288 DOI: 10.1097/jcp.0000000000001228] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE/BACKGROUND The increased risk of type 2 diabetes mellitus (T2DM) among users of antidepressants (ADs) might be mediated by depression. We investigated whether ADs are associated with increased risk of T2DM in patients with depression. Moreover, the relationship between binding affinities of serotonin transporter (SERT) of ADs and the risk of T2DM is examined. METHODS/PROCEDURES We conducted a retrospective nested case-control study using data from Taiwan's National Health Insurance Research Database between 2000 and 2013. A total of 3038 patients with depression, 1519 cases of T2DM, and 1519 controls matched for age, sex, and index date, were included. Exposure to ADs was categorized by type and SERT. The association between AD exposure and T2DM development was assessed using conditional logistic regression analysis. FINDINGS/RESULTS No association between T2DM development and selective serotonin reuptake inhibitors (adjusted odds ratio [AOR], 1.01; 95% confidence interval [CI], 0.87-1.19; P = 0.962), serotonin-norepinephrine reuptake inhibitors (AOR, 1.13; 95% CI, 0.94-1.37; P = 1.196), tricyclic antidepressants (AOR, 1.01; 95% CI, 0.85-1.21; P = 0.906), or others (AOR, 0.88; 95% CI, 0.75-1.03; P = 0.104) was found. Alternatively, no association between individual ADs and potency of affinity to SERT and the risk of T2DM was found. IMPLICATIONS/CONCLUSIONS No association between ADs and increase risk of T2DM was found in patients with depression. However, regular metabolic evaluations are recommended for patients with depression regularly taking ADs.
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Akena D, Okello ES, Simoni J, Wagner G. The development and tailoring of a peer support program for patients with diabetes mellitus and depression in a primary health care setting in Central Uganda. BMC Health Serv Res 2020; 20:436. [PMID: 32430046 PMCID: PMC7236139 DOI: 10.1186/s12913-020-05301-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/06/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND About 20-40% of patients with diabetes mellitus (DM) suffer from depressive disorders (DD) during the course of their illness. Despite the high burden of DD among patients with DM, it is rarely identified and adequately treated at the majority of primary health care clinics in sub-Saharan Africa (SSA). The use of peer support to deliver components of mental health care have been suggested in resource constrained SSA, even though its acceptability have not been fully examined. METHODS We conducted qualitative interviews (QI) to assess the perceptions of DM patients with an experience of suffering from a DD about the acceptability of delivering peer support to patients with comorbid DM and DD. We then trained them to deliver peer support to DM patients who were newly diagnosed with DD. We identified challenges and potential barriers to a successful implementation of peer support, and generated solutions to these barriers. RESULTS Participants reported that for one to be a peer, they need to be mature in age, consistently attend the clinics/keep appointments, and not to be suffering from any active physical or co-morbid mental or substance abuse disorder. Participants anticipated that the major barrier to the delivery of peer support would be high attrition rates as a result of the difficulty by DM patients in accessing the health care facility due to financial constraints. A potential solution to this barrier was having peer support sessions coinciding with the return date to hospital. Peers reported that the content of the intervention should mainly be about the fact that DM was a chronic medical condition for which there was need to adhere to lifelong treatment. There was consensus that peer support would be acceptable to the patients. CONCLUSION Our study indicates that a peer support program is an acceptable means of delivering adjunct care to support treatment adherence and management, especially in settings where there are severe staff shortages and psycho-education may not be routinely delivered.
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Affiliation(s)
- Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elialilia S. Okello
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
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Nyoni AM, Chiwaridzo M, Tadyanemhandu C, January J, Dambi JM. Profiling the mental health of diabetic patients: a cross-sectional survey of Zimbabwean patients. BMC Res Notes 2018; 11:772. [PMID: 30373680 PMCID: PMC6206650 DOI: 10.1186/s13104-018-3881-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022] Open
Abstract
Objective The burden of diabetes mellitus has exponentially increased in low resource settings. Patients with diabetes are more likely to exhibit poor mental health which negatively affects treatment outcomes. However, patients with high levels of social support (SS) are likely to report optimal mental health. We sought to determine how SS affects the report of psychiatric morbidity and health-related quality of life (HRQoL) in 108 diabetic patients in Harare, Zimbabwe. Results The average age of participants was 54.1 (SD 18.6) years. Most of the participants were; females (69.4%), married (51.9%), and were of low level of income (43.5%). 37.1% of the participants exhibited signs of psychiatric morbidity [mean Shona Symptoms Questionnaire score—6.7 (SD 3.2)]. Further, patients also reported lower HRQoL [mean EQ-5D-VAS score—64.1 (SD 15.3)] and high levels of SS [mean Multidimensional Scale of Perceived Social Support score—43.7 (SD 11.5)]. Patients who received greater amount of SS had optimal mental health. Being female, unmarried, lower education attainment, having more comorbid conditions, being diagnosed with type 2 diabetes and having been diagnosed of diabetes for a longer duration were associated with poorer mental health. It is important to develop context-specific interventions to improve diabetic patients’ mental health. Electronic supplementary material The online version of this article (10.1186/s13104-018-3881-9) contains supplementary material, which is available to authorized users.
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Black S, Kraemer K, Shah A, Simpson G, Scogin F, Smith A. Diabetes, Depression, and Cognition: a Recursive Cycle of Cognitive Dysfunction and Glycemic Dysregulation. Curr Diab Rep 2018; 18:118. [PMID: 30267224 DOI: 10.1007/s11892-018-1079-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW The study aims to examine the effects of diabetes and depression on executive functioning (EF) and to review the effects of EF deficits on diabetes management. RECENT FINDINGS Both type 2 diabetes and depression influence EF, and in turn, EF has an impact on diabetes management. Individuals with both comorbidities (i.e., diabetes and depression) experience greater deficits in EF than individuals with just one of the morbidities (i.e., depression or diabetes). The disruption in EF results in poor diabetes management and poor emotion regulation which ultimately increases the probability of a recursive cycle of depression and hyperglycemia. This recursive cycle can ultimately lead to diabetes-related complications.
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Affiliation(s)
- Sheila Black
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA.
| | - Kyle Kraemer
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA
| | - Avani Shah
- School of Social Work, University of Alabama, Box 870314, Tuscaloosa, AL, 35401, USA
| | - Gaynell Simpson
- School of Social Work, University of Alabama, Box 870314, Tuscaloosa, AL, 35401, USA
| | - Forrest Scogin
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA
| | - Annie Smith
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA
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Abstract
OBJECTIVE The aims of the study were to examine the current evidence for executive function (EF) performance differences between groups with type 1 diabetes mellitus (T1DM) and nondiabetic control groups during adolescence and early adulthood and to explore the relationships between EF and diabetes-related risk factors. METHODS A systematic review of the literature examining EF performance in groups with T1DM was conducted according to the PRISMA guidelines. Electronic database searches for published and unpublished literature yielded a final set of 26 articles after application of inclusion and exclusion criteria. A meta-analysis was conducted on a subset of these articles (n = 17) comparing EF performance in T1DM and control groups, across a total sample size of 1619. RESULTS Sixteen of 26 studies found significantly lower EF on at least one task in groups with T1DM. Meta-analyses of the performance difference between T1DM groups and control groups without diabetes showed that inhibition (g = -0.28, p < .001), working memory (g = -0.34, p < .001), set-shifting (g = -0.31, p = .012), and overall EF performance across these domains (g = -0.42, p < .001) were all significantly lower in groups with T1DM. Performance on specific EF domains also seemed to be differentially associated with early age of diabetes onset, chronic hyperglycemia and its complications, and severe hypoglycemia. CONCLUSIONS T1DM and its associated risk factors are related to subtle impairments across the inhibition, working memory, and set-shifting domains of EF. Lower EF may be a key factor contributing to behavioral and clinical problems experienced by individuals with T1DM.
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Atlantis E, Ghassem Pour S, Girosi F. Incremental predictive value of screening for anxiety and depression beyond current type 2 diabetes risk models: a prospective cohort study. BMJ Open 2018; 8:e018255. [PMID: 29362254 PMCID: PMC5786131 DOI: 10.1136/bmjopen-2017-018255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We sought to determine whether screening for anxiety and depression, an emerging risk factor for type 2 diabetes (T2D), adds clinically meaningful information beyond current T2D risk assessment tools. DESIGN Prospective cohort. PARTICIPANTS AND SETTING The 45 and Up Study is a large-scale prospective cohort of men and women aged 45 years and over, randomly sampled from the general population of New South Wales, Australia. 51 588 participants without self-reported diabetes at baseline (2006-2009) were followed up for approximately 3 years (2010). METHODS T2D status was determined by self-reported doctor who diagnosed diabetes after the age of 30 years, and/or current use of metformin. Current symptoms of anxiety and/or depression were measured by the 10-item Kessler Psychological Distress Scale (K10). We determined the optimal cut-off point for K10 for predicting T2D using Tjur's R2 and tested risk models with and without the K10 using logistic regression. We assessed performance measures for the incremental value of the K10 using the area under the receiver operating characteristic (AROC), net reclassification improvement (NRI) and net benefit (NB) decision analytics with sensitivity analyses. RESULTS T2D developed in 1076 individuals (52.4% men). A K10 score of ≥19 (prevalence 8.97%), adjusted for age and gender, was optimal for predicting incident T2D (sensitivity 77%, specificity 53% and positive predictive value 3%; OR 1.70 (95% CI 1.41 to 2.03, P<0.001). K10 score predicted incident T2D independent of current risk models, but did not improve corresponding AROC, NRI and NB statistics. Sensitivity analyses showed that this was partially explained by the baseline model and the small effect size of the K10 that was similar compared with other risk factors. CONCLUSIONS Anxiety and depressing screening with the K10 adds no meaningful incremental value in addition to current T2D risk assessments. The clinical importance of anxiety and depression screening in preventing T2D requires ongoing consideration.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Capital Markets CRC, Sydney, New South Wales, Australia
| | - Shima Ghassem Pour
- Capital Markets CRC, Sydney, New South Wales, Australia
- Translation Health Research Institute, Western Sydney University, Kingswood, New South Wales, Australia
| | - Federico Girosi
- Capital Markets CRC, Sydney, New South Wales, Australia
- Translation Health Research Institute, Western Sydney University, Kingswood, New South Wales, Australia
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Akena D, Kadama P, Ashaba S, Akello C, Kwesiga B, Rejani L, Okello J, Mwesiga EK, Obuku EA. The association between depression, quality of life, and the health care expenditure of patients with diabetes mellitus in Uganda. J Affect Disord 2015; 174:7-12. [PMID: 25479048 PMCID: PMC4549461 DOI: 10.1016/j.jad.2014.11.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/10/2014] [Accepted: 11/13/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Depression is one of the commonest neuropsychiatric disorders in patients with diabetes mellitus (DM) and is associated with poor glycaemic control, vascular complications, a low quality of life and increased health care expenditure. Co-morbid DM and depression remains poorly identified and inadequately treated in sub-Saharan Africa. METHODS We conducted a cross-sectional survey of 437 patients with DM at 3 DM clinics in Uganda. Participants were assessed for depression, blood sugar levels, diabetic neuropathy, quality of life, and health care expenditures. RESULTS The prevalence of depression was 34.8%. Depressed participants were more likely to be suicidal [OR=3.81, (CI 2.87-5.04)], younger [OR=3.98 CI (1.20-13.23)], un-employed [OR=1.99(CI 1.04-3.81)], and having lost a spouse [OR=2.36 (CI 1.29-4.31)]. Overall quality of life was poor [OR=0.67 (CI 0.47-0.96)], they scored poorer in the physical [OR=0.97, (CI 0.95-0.99)], psychological [OR=1.05 (CI 1.03-1.07)], and environmental [OR=0.97, (CI 0.95-0.99)] domains. They had an increased likelihood of incurring direct out-of-pocket payments for health care services [OR=1.56 (CI 1.03-2.36)], and were more likely to be impoverished [OR=1.52 (CI 1.01-2.28)]. LIMITATION The cross sectional nature of this study makes it difficult to examine causation. More studies are required in order to better understand the associations and impact of the factors examined above on patient outcomes. CONCLUSIONS Depression is highly prevalent among patients with DM in Uganda, and is associated with a number of adverse outcomes. A holistic approach that focuses on the depression management among patients with diabetes is recommended.
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Affiliation(s)
- Dickens Akena
- Makerere University College of Health Sciences, Kampala, Uganda,Corresponding author at: Department of Psychiatry, Makerere University College of Health Sciences
| | - Philippa Kadama
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Carolyne Akello
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Brendan Kwesiga
- Makerere University College of Health Sciences, Kampala, Uganda,Infectious Diseases Institute, Makerere University, Kampala, Uganda,Department of Psychiatry, Mbarara University of Science & Technology, Mbarara, Uganda,Department of Psychiatry, Gulu University, Gulu, Uganda,Clinical Epidemiology Unit, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK
| | - Lalitha Rejani
- Makerere University College of Health Sciences, Kampala, Uganda
| | - James Okello
- Department of Psychiatry, Gulu University, Gulu, Uganda
| | | | - Ekwaro. A. Obuku
- Clinical Epidemiology Unit, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda
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Mansur RB, Cha DS, Woldeyohannes HO, Soczynska JK, Zugman A, Brietzke E, McIntyre RS. Diabetes mellitus and disturbances in brain connectivity: a bidirectional relationship? Neuromolecular Med 2014; 16:658-68. [PMID: 24974228 DOI: 10.1007/s12017-014-8316-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/19/2014] [Indexed: 12/26/2022]
Abstract
Diabetes mellitus (DM) is associated with deficits across multiple cognitive domains. The observed impairments in cognitive function are hypothesized to be subserved by alterations in brain structure and function. Several lines of evidence indicate that alterations in glial integrity and function, as well as abnormal synchrony within brain circuits and associated networks, are observed in adults with DM. Microangiopathy and alterations in insulin homeostasis appear to be principal effector systems, although a unitary explanation subsuming the complex etiopathology of white matter in DM is unavailable. A contemporary model of disease pathophysiology for several mental disorders, including but not limited to mood disorders, posits abnormalities in the synchronization of cellular systems in circuits. The observation that similar abnormalities occur in diabetic populations provides the basis for hypothesizing the convergence of pathoetiological factors. Herein, we propose that abnormal structure, function and chemical composition as well as synchrony within and between circuits is an accompaniment of DM and is shared in common with several mental disorders.
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Affiliation(s)
- Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada,
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Abstract
OBJECTIVE The collaborative care model is recommended for depression in adults with a chronic physical health problem like diabetes. We sought to systematically assess the effect of collaborative care on depression and glycaemia in adults with comorbid depression and diabetes to inform guidelines and practice. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched PubMed, Scopus, Cochrane Library, CINAHL, Health Source Nursing, MEDLINE, PsychINFO and reference lists of retrieved articles published before August 2013. INCLUSION CRITERIA Randomised controlled trials (RCTs) on collaborative care (ie, coordinated multidisciplinary model of care) for depression that reported the effects on depression and glycaemic outcomes in adults with comorbid clinically relevant depression and diabetes were eligible. DATA EXTRACTION AND ANALYSIS Data on the mean difference in depression and glycaemic outcomes were extracted and pooled using random effects meta-analysis. RESULTS Seven RCTs included for review reported effects on depression outcomes in 1895 participants, and glycated haemoglobin (HbA1c) level in 1556 participants. Collaborative care significantly improved the depression score (standardised mean difference was -0.32 (95% CI -0.53 to -0.11); I(2)=79%) and HbA1c level (weighted mean difference was -0.33% (95% CI -0.66% to -0.00%); I(2)=72.9%) compared with control conditions. Depression remission did not predict better glycaemic control across studies. CONCLUSIONS Limited evidence from short-to-medium term RCTs predominantly conducted in the USA suggests that collaborative care for depression significantly improves both depression and glycaemia outcomes, independently, in people with comorbid depression and diabetes.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, University of Western Sydney, Campbelltown Campus, Campbelltown, New South Wales, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Paul Fahey
- School of Science and Health, University of Western Sydney, Campbelltown Campus, Campbelltown, New South Wales, Australia
| | - Jann Foster
- School of Nursing and Midwifery, University of Western Sydney, Campbelltown Campus, Campbelltown, New South Wales, Australia
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Abstract
RATIONALE Past research on the association of antidepressant medication use with glycemic control abnormalities has produced mixed results. OBJECTIVE To examine the association of antidepressant use with glycemic control abnormalities and screen-positive diabetes in a representative population sample of US adults without a diagnosis of diabetes. METHODS Using data from adult participants of the National Health and Nutrition Examination Survey (NHANES, 2005-2010), the association of antidepressant use with continuous measures of HbA1c, fasting blood sugar, 2-h oral glucose tolerance test, insulin sensitivity and screen-positive diabetes according to HbA1c, fasting blood sugar and 2-h oral glucose tolerance test were assessed. RESULTS Antidepressant use was not associated with increased levels of HbA1c, fasting blood sugar, 2-h oral glucose tolerance test, reduced insulin sensitivity or increased prevalence of screen-positive diabetes. Results were mostly consistent across sociodemographic groups and across different lengths of exposure, different classes of antidepressants and levels of body mass index. CONCLUSIONS In this representative population sample, antidepressant use was not associated with an increased risk of abnormalities in glycemic control or undetected diabetes. Positive findings from past research may be attributable to detection bias, in that individuals prescribed antidepressants may be more likely to be tested and diagnosed with diabetes.
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