Should we screen for emotional distress in type 2 diabetes mellitus?

Diabetes distress profiles and health outcomes of individuals with type 2 diabetes and overweight/obesity: A cluster analysis

AIMS

To determine the prevalence and patterns of diabetes distress, and evaluate the differences in health outcomes between profiles.

METHODS

This cross-sectional study included 330 adults with T2DM and overweight/obesity. The participants completed questionnaires on diabetes distress, sleep quality, self-efficacy, depression, anxiety and positive and negative affect. A cluster analysis was performed to identify different patterns of diabetes distress and one-way ANOVA was used to investigate the differences in physical and psychological outcomes between profiles.

RESULTS

30.6% of patients were identified as moderately to highly distressed, with the regimen-related distress found to be the most prominent. The Cluster analysis revealed four distinct clusters: 1) "comprehensively exhausted profile"; 2) "strained profile"; 3) "high internal anguish profile"; 4) "unperturbed profile". The measures of fasting blood glucose (FBG), glycated hemoglobin (HbA1c), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, sleep quality, depression, anxiety, positive and negative affect and self-efficacy differ between clusters.

CONCLUSIONS

This study identified important differences that existed in patterns of diabetes distress among people with T2DM and overweight/obesity, and this variation can be utilized to tailor intervention strategies to the particular needs of different subgroups within individuals with T2DM.

Impact of diabetes distress on glycemic control and diabetic complications in type 2 diabetes mellitus

The effect of diabetes distress on glycemic control and its association with diabetes complications is still poorly understood. We aimed to study the clinical features of patients with high diabetes distress, focusing on changes in glycemic control and risk of diabetic complications. From the Korean National Diabetes Program data, we investigated 1862 individuals with type 2 diabetes mellitus (T2DM) who completed diabetic complication studies and the Korean version of the Problem Areas in Diabetes Survey (PAID-K). A total score of PAID-K ≥ 40 was considered indicative of high distress. Individuals with high distress (n = 589) had significantly higher levels of glycated hemoglobin than those without distress (7.4% vs. 7.1%, p < 0.001). This trend persisted throughout the 3-year follow-up period. Higher PAID-K scores were associated with younger age, female gender, longer duration of diabetes, and higher carbohydrate intake (all p < 0.05). There was a significant association between high distress and diabetic neuropathy (adjusted odds ratio, 1.63; p = 0.002), but no significant association was found with other complications, including retinopathy, albuminuria, and carotid artery plaque. In conclusion, high diabetes distress was associated with uncontrolled hyperglycemia and higher odds of having diabetic neuropathy.

The role of social support and the built environment on diabetes management among structurally exposed populations in three regions in Ghana

Sub-Saharan Africa is undergoing an epidemiological transition driven by rapid, unprecedented demographic, socio-cultural, and economic transitions. These transitions are driving increases in the risk and prevalence of diabetes and other non-communicable diseases (NCDs). As NCDs rise, several attempts have been made to understand the individual level factors that increase NCDs risks, knowledge, and attitudes around specific NCDs as well as how people live and manage NCDs. While these studies are important, and enhance knowledge on chronic diseases, little attention has been given to the role of social and cultural environment in managing chronic NCDs in underserved settings. Using purposive sampling among persons living with Diabetes Mellitus (PLWD) and participating in diabetes programs from regional and municipal hospitals in the three underserved regions in Ghana (n = 522), we assessed diabetes management and supportive care needs of PLWDs using linear latent and mixed models (gllamm) with binomial and a logit(log) link function. The result indicates that PLWDs with strong perceived social support (OR = 2.27, p ≤ 0.05) were more likely to report good diabetes management compared to PLWDs with weak perceived social support. The built environment, living with other health conditions, household wealth, ethnicity and age were associated with diabetes management. Overall, the study contributes to wider discussions on the role changing built and socio-cultural environments in the rise of diet-related diseases and their management as many Low- and Middle-Income Countries (LMICs) experience rapid epidemiological and nutrition transitions.

The prevalence of diabetes distress in Chinese patients with type 2 diabetes: A systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the prevalence of Diabetes Distress (DD) in type 2 diabetes mellitus (T2DM) patients in China.

METHODS

The PubMed, PsycInfo, Web of Science, The Cochrane Library, EMBASE, China Knowledge Resource in Integrated Database (CNKI), WanFang Database, Weipu Database (VIP), and Chinese Biomedical Database (CBM) electronic databases were searched from inception to August 2022, for cross-sectional studies, that reported prevalence of DD.

RESULTS

This study included 55 articles involving 13,160 patients with T2DM. The pooled prevalence of DD was 53.2%. The results of the subgroup analysis showed that among the five regions in China, the highest prevalence of DD was observed in Central China (66%), while the lowest prevalence was recorded in North China (23%). The highest prevalence of DD was 82% in unmarried people. while the lowest prevalence of DD among outpatients was as low as 42%. The results of meta-regression showed that there was no correlation between the prevalence of DD and the year of publication, the average age of the patients, or the duration of the disease.

CONCLUSION

More than half of T2DM patients in China may suffer from DD, which is not conducive to the self-management of diabetes patients. The burden on the healthcare system and the burden of disease on individual patients may increase as a result. Medical staff should pay attention to the monitoring and management of the mental health status of patients with T2DM.

Exploring the Interrelationships between Diabetes, Nutrition, Anxiety, and Depression: Implications for Treatment and Prevention Strategies

Across the world, diabetes, depression, and anxiety symptoms have gained widespread recognition as significant public health issues. Recent research has unveiled a mutually influential relationship between diabetes and these two mental health conditions, where each disorder impacts the course and outcomes of the others. The role of nutrition emerges as pivotal in preventing and treating depression, anxiety, and diabetes. A thorough literature review was undertaken to investigate the reciprocal effects between anxiety, depression, and diabetes, including their impact on the development and severity of each condition. Additionally, the effects of nutrition on the prevention and management of depression, anxiety, diabetes, and related complications in at-risk individuals were assessed. Our findings show that mental disorders, such as depression and anxiety, increase the risk of developing type 2 diabetes and are associated with poorer glycemic control, increased diabetes-related complications, and higher mortality rates. Conversely, diabetes is also linked with an increased risk of developing depression and anxiety. The biological, psychological, and social factors that contribute to the comorbidity between these two conditions are complex and multifaceted. Therefore, an integrated approach to the management of both conditions is critical for improving patient outcomes and reducing the overall burden of disease. Nutritional interventions should be utilized to reduce the risk of diabetes in patients with anxiety and depression as well as enhance mental health in patients with diabetes.

Association of Insomnia with Anxiety and Depression in Type 2 Diabetic Patients: A Cross-Sectional Study

Background

Type 2 diabetes mellitus (T2DM) is associated with sleep disorders, which in turn may lead to anxiety and depression. Sleep deprivation impairs glucose metabolism causing a decrease in insulin sensitivity and glucose tolerance. The present study aimed to determine the association of insomnia with anxiety and depression in patients with T2DM.

Methods

A cross-sectional study was conducted in 2020 at the Endocrinological Department of City Clinical Hospital №1, affiliated with Astana Medical University (Astana, Kazakhstan). A total of 376 patients with decompensated T2DM were included in the study. Insomnia was assessed using the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Multivariable logistic regression was used to assess the association of insomnia with anxiety and depression.

Results

All patients showed signs of sleep disturbances. Based on the HADS cutoff score >8, anxiety and depression were observed in 48 (12.80%) and 46 (12.20%) patients, respectively. PSQI, ISI, and HADS indicators were associated with an increased risk of anxiety and depression symptoms. In terms of anxiety, the adjusted odds ratio for PSQI and ISI scores were 1.09 (P=0.08) and 1.07 (P=0.01), respectively. These for depression were 1.10 (P=0.06) and 1.07 (P=0.01), respectively.

Conclusion

Sleep quality is an important indicator of psychological health in patients with T2DM, especially those who exhibit signs of anxiety and depression.

Simplifying carb counting: A randomized controlled study - Feasibility and efficacy of an individualized, simple, patient-centred carb counting tool

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.

Exploring the Needs of Adults Living With Type 1 or Type 2 Diabetes Distress Using the Problem Areas in Diabetes 5 Tool

OBJECTIVES

This study investigated the feasibility and acceptability of implementing a screening tool as a part of routine care and the subsequent screening experiences of patients and clinicians. Additionally, potential sources of diabetes distress (DD) were identified in this clinical population.

METHODS

Our investigation was a cross-sectional, mixed-methods, convenience sample of 203 patients living with type 1 or type 2 diabetes from 2 Canadian tertiary hospital-based clinics. The Problem Areas in Diabetes 5 (PAID5) scale was used to assess DD. Structured telephone interviews of patients with high DD scores and care provider focus group transcriptions were analyzed using a deductive thematic content analysis.

RESULTS

The prevalence of DD was 45%. Lack of medication coverage (p=0.02) and presence of neuropathy (p=0.04) were approximately 5- and 2-fold more likely to be predictors of high DD, respectively. Patient interviews identified DD screening as an opportunity to share and feel supported but demonstrated their fear of discussing mental health concerns. Patients found discussion about mental health helpful and often did not require a referral to a mental health specialist. Staff focus groups discussed screening as a feasible tool, but also acknowledged barriers and knowledge gaps that preclude DD screening integration in routine clinical practice. Specialized training for clinicians may help increase confidence and improve uptake of DD screening into routine clinical practice.

CONCLUSIONS

The prevalence of DD in outpatient care settings is high. Findings suggest that integrating the PAID5 screening tool into regular clinical practice is feasible by patients and care providers.

Sweet as Sugar-How Shared Social Identities Help Patients in Coping with Diabetes Mellitus

Social identification is health-beneficial as social groups provide social support (i.e., the social cure effect). We study this social cure effect in diabetes patients by focusing on two relevant sources of social support, namely medical practitioners (MP) and fellow patients. As both groups have diabetes-specific knowledge, we predict that sharing an identity with them provides access to specific support, which, in turn, optimizes individuals' diabetes management and reduces diabetes-related stress. We further predict that identifying with their MP or fellow patients will be more strongly related to perceived social support among individuals with lower diabetes-specific resilience because they pay more attention to supportive cues. We tested this moderated mediation model in a two-wave study with n = 200 diabetes patients. Identification with the MP related to more support, which, in turn, was related to better diabetes management and less diabetes-specific stress. Identification with fellow patients related to more support; however, social support was unrelated to diabetes management and stress. Resilience only moderated the relationship between MP identification and support, as people with lower resilience levels reported more support from their MP. This study shows the importance of social identification with the MP and other diabetes patients, especially for people with lower resilience levels.

Diabetes Treatment and Mental Illness: A Call for an Integrated Health Care System in Underserved Semi-Rural Malaysia

Diabetes mellitus (DM) management imposes a tremendous psychological burden on patients. The study investigates the association between DM treatment with blood glucose (BG) control and common mental health conditions. A cross-sectional study was conducted among 1821 individuals with DM in a community-based survey conducted in 2013. Information on respondents’ sociodemographic, mental health, DM treatment, and BG levels was collected. Multinomial logistic regression was employed to examine the association of diabetes treatment with controlled BG levels (<11.1 mmol/L) (42.5%, n = 774) or uncontrolled BG levels (34.3%, n = 625) compared with those not undergoing treatment (23.2%, n = 422) on depression anxiety, and stress. Having DM treatment and controlled BG was associated with high depressive symptoms (Relative Risk Ratio, RRR: 2.42; 95% CI 1.33−4.41) and high anxiety symptoms (1.66; 1.08−2.56) but not with perceived stress. However, treated DM with uncontrolled BG was associated with anxiety (high: 1.64; 1.05−2.56; low: 2.59; 1.10−6.09) but not depression or perceived stress. Our results suggest that being treated for DM, regardless of glucose control status, was associated with anxiety symptoms, whereas being treated with controlled BG was associated with high depressive symptoms. This situation highlights the need for integrative, multidisciplinary care for DM patients with mental health comorbidities.

Association of depression and parasympathetic activation with glycemic control in type 2 diabetes mellitus

AIM

Patients with type 2 diabetes mellitus exhibited autonomic nervous system (ANS) dysfunction and comorbidities with depressive or anxiety symptoms were related to poor glycemic control. Heart rate variability (HRV) converted from electrocardiogram (ECG) has been used as the ANS index. The study aimed to explore the associations between depression, anxiety, HRV, and glycemic control in patients with type 2 diabetes mellitus.

METHODS

The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires were used to assess depressive and anxiety symptoms in 647 patients with type 2 diabetes mellitus (mean age was 63 ± 10 years, 56 % males). The ECG raw signals were collected from a 5-min sitting and resting baseline and then transformed to HRV indices referring ANS activation. Blood glucose and lipid profiles including glycated hemoglobin (HbA1c), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglyceride were obtained from the electronic medical records.

RESULTS

Ninety-nine (15 %) participants had depressive symptoms and 59 (9 %) had anxiety symptoms. Depression and HbA1c were negatively correlated with parasympathetic activation. Depression and anxiety were positively correlated with sympathetic activation. After controlling for demographic data and lipid profiles, depression was a significant positive predictor for HbA1c levels; and HRV indices (lnLF and lnHF) were the significant negative predictors for HbA1c levels. Mediation effect analysis showed that depression was a mediator between parasympathetic activation and glycemic control.

CONCLUSIONS

Lower parasympathetic activation and higher depressive symptoms may affect glycemic control in patients with type 2 diabetes mellitus. Intervention programs targeting to increase parasympathetic activities and reducing depression could be further tested for their effects on glycemic outcomes for potential clinical use.

Diabetes-related distress and its association with the complications of diabetes in Iran

Purpose

Diabetes-related distress (DRD) has negative emotional effects on the patients’ quality of life. This is while the condition often goes undiagnosed despite it being common among diabetic patients. This study investigated the prevalence of DRD and its association with diabetes complications among a group of Iranian type 2 diabetic patients (T₂DM).

Methods

This descriptive-analytical cross-sectional study was conducted on 186 T₂DM patients referred to a diabetes clinic in a teaching hospital from the beginning of May 2019 to the end of April 2020. Two questionnaires on disease-related information and diabetes distress screening scale (DDS) were filled out for each patient. The latter was divided into four domains, emotional burden (EB), diabetes-related interpersonal distress (ID), physician-related distress (PD), and regimen-related distress (RD). In addition to the frequency of DRD and its association with age, sex, body mass index (BMI), hypertension, hemoglobin A₁C, duration of disease, and type of medication regimen (oral, insulin, or mix) along with the history of cardiovascular disease (CVDs), retinopathy, nephropathy, and diabetic foot were assessed.

Results

DRD was reported in 47% of the patients. Being female, old age, hypertension, high hemoglobin A₁C levels, nephropathy, and retinopathy were significantly associated with DRD (P-value =  < 0.001, 0.013, 0.014, 0.007, 0.001, and 0.004, respectively). The history of the diabetic foot had a significant relationship with PD and ID (P-value = 0.007 and < 0.001, respectively). Multivariate regression showed gender and the existence of complications to have a direct effect on the development of DRD.

Conclusion

DRD prevalence is relatively high and requires screening to identify and treat high-risk patients. Further studies are needed to study diabetes, its complications and their relation with DRD to help reduce such conditions and improve the patient’s quality of life.

Effect of treadmill walking for anxiety, depression and social well-being in women with diabetes type 2: A randomized controlled trial

Anxiety and depression are higher in persons with diabetes leading to poor glycaemic control and diabetes-related emotional distress. Some diabetic women do not engage in exercises perceiving it to make their diabetes worse. The researchers' objective of this treadmill walking program was to determine its effect on anxiety, depression and social well-being in women with diabetes type 2 (DT2). We randomized 49 sedentary women with DT2 into treadmill walking at moderate intensity of 40-60% of their age-adjusted maximal heart rate, three times per week on alternate days for 12 weeks. The control attended electronic lectures on diet, diabetes and mental health. The treadmill group had no adverse effects and their anxiety, depression and social well-being scores improved with no significant changes for the control. We offer women with DT2 an easy, safe indoors exercise preventing them from abuse from men, erratic drivers and extreme weather conditions with positive physiological responses.

Type 2 diabetes mellitus and anxiety symptoms: a cross-sectional study in Peru

BACKGROUND

Information about the effect of type 2 diabetes mellitus (T2DM) awareness in the prevalence of anxiety disorders is scarce. Moreover, reports from resource-constrained and semiurban settings are usually focused on hospital-based data, instead of population-based surveys. We aimed to evaluate the association between T2DM and anxiety symptoms, with emphasis on T2DM awareness.

METHODS

A secondary data analysis was conducted using information from a population-based study. The outcome of interest was the presence of anxiety symptoms assessed by the Goldberg anxiety test, while the exposure variable was T2DM, defined using the oral glucose tolerance test. In addition, another definition was used based on self-reported T2DM awareness of previous diagnosis. Prevalence ratios (PR) and 95% confidence intervals (CI) were reported using Poisson regression models.

RESULTS

Data from 1,607 participants, of mean age 48.2 (SD: 10.6) years, and 809 (50.3%) females, were analyzed. Of all participants, 176 (11.0%; 95% CI: 9.5%-12.6%) had T2DM, 105 (59.7%) were aware of previous diagnosis, and 674 (41.9%; 95% CI: 39.5%-44.4%) had anxiety symptoms. In multivariable model, T2DM was not associated with anxiety symptoms (PR = 1.16; 95% CI: 0.99-1.36); however, individuals aware of T2DM diagnosis had a 36% (95% CI: 14%-64%) greater prevalence of anxiety symptoms compared to those without T2DM. Additionally, those aware of T2DM diagnosis had a 56% (95% CI: 13%-116%) higher probability to have anxiety symptoms compared to those not aware of T2DM diagnosis.   Conclusions: The association between T2DM and anxiety symptoms was present among those participants who self-reported T2DM diagnosis, as opposed to those with T2DM but not aware and to those without T2DM. Evaluation of anxiety symptoms may be relevant among those with previous T2DM diagnosis.

Psychometric validation of diabetes distress scale in Bangladeshi population

Diabetes Distress (DD)-an emotional or affective state arise from challenge of living with diabetes and the burden of self-care-negatively impact diabetes management and quality of life of T2DM patients. Early detection and management of DD is key to efficient T2DM management. The study aimed at developing a valid and reliable instrument for Bangladeshi patients as unavailability such a tool posing challenge in diabetes care. Linguistically adapted, widely used, 17-item Diabetes Distress Scale (DDS), developed through forward-backward translation from English to Bengali, was administered on 1184 T2DM patients, from four diabetes hospitals in Bangladesh. Psychometric assessment of the instrument included, construct validity using principal component factor analysis, internal consistency using Cronbach's α and discriminative validity through independent t-test and test-retest reliability using intraclass-correlation coefficient (ICC) and Kappa statistics. Factor analysis extracted 4 components similar to original DDS domains, confirms the construct validity. The scale demonstrated satisfactory internal consistency (α = 0.838), stability (test-retest ICC = 0.941) and good agreement across repeated measurements (Kappa = 0.584). Discriminative validity revealed that patients with complication (p < 0.001) and those are on insulin (p < 0.001) had significantly higher distress scores in all domains. Bengali version of DDS is a valid and reliable tool for assessing distress among Bangladeshi T2DM patients.

The cross talk between chronotype, depression symptomatology, and glycaemic control among sudanese patients with diabetes mellitus: A case-control study

Aim of the Study:

There is an increasing awareness about chronotype and depression among patients with diabetes mellitus as commonly ignored serious association. We aimed to investigate the same among patients with type 2 diabetes mellitus and their relation to glycaemic control.

Subjects' and Methods:

This case-control study conducted at two diabetes centers in Omdurman, Sudan during the period from April 2019 to September 2019. Ninety-two patient with type 2 diabetes and 94 controls signed a written informed consent then interviewed using a structured questionnaire based on the morningness–eveningness scale and the 12-item general health questionnaire; A blood sample was taken for the glycated haemoglobin to assess glycaemic control. The Statistical Package for Social Silences was used for Data analysis.

Results:

They were 92 patients with diabetes (58.7% women) and 94 healthy control subjects (52.1% women); matched for ages (57.03 ± 8.59 for diabetic patients and 58.46 ± 10.58 years for control subjects) and sex. Morning chronotype was reported in 95.3% vs. 47.5% and intermediate chronotype was evident in 52.4% vs. 4.3% in controls and patients respectively, P < 0.05. Depression symptomatology was found in 76.1% of patients with diabetes vs. 40.4% of control subjects, P < 0.05. No association was shown between depression symptomatology, chronotype, age, sex, and HbA1c, P > 0.05.

Conclusion:

Sudanese patients with diabetes were more likely intermediate, less morning chronotype, and more depressed compared to their counterparts. No association was found between depression symptomatology and other patient's characters. Larger studies investigating the risk behind depression, chrono-nutrition, and social jetlag among patients with diabetes are needed.

Prevalence and Determinant Factors of Diabetes Distress in Community-Dwelling Elderly in Qom, Iran

Background:

Diabetes distress (DD) is common among the patients with type 2 diabetes (T2D), but few studies investigated this problem and its related factors in the elderly population. This study has focused on the prevalence rate of DD and its determinants in community-dwelling elderly in Qom, Iran.

Methods:

This study was cross-sectional. A total of 519 subjects community-dwelling with T2D participated in the study. Collected data contained sociodemographic information, some clinical variables (body mass index and duration of diabetes) knowledge, attitude, and self-efficacy. Participants' distress was measured via diabetes distress scale (DDS). The cut of 3 (≥3) was considered as the presence of distress. Also, the attitude, self-efficacy, and knowledge about diabetes were measured by questioner. Multiple logistic regression analysis was applied to detect predictors of DD.

Results:

The mean age of the participants was 68.38 ± 6.78 and 53.6% were female. Among the participants, 48.6% were identified with positive DD. According to the results of logistic regression analysis, being female (odds ration [OR] = 1.688, P = 0.009), being widowed or divorced (OR = 1.629, P = 0.027), being over-weight or obese (OR = 1.627, P = 0.027), and having less than 10 years in disease duration (OR = 1.721, P = 0.029), attitude (OR = 0.590, P < 0.001), and self-efficacy (OR = 0.658, P = 0.009) were identified as the independent predictors of DD. No significant association was found between DD and age, occupational status, education level, and knowledge (P > 0.05).

Conclusions:

The prevalence of DD is considerable among the elderly in Qom. It seems that more attention should be paid to the mental aspects of the patients with T2D specially in high risk groups.

Type 2 diabetes mellitus and anxiety symptoms: a cross-sectional study in Peru

BACKGROUND

Information about the effect of type 2 diabetes mellitus (T2DM) awareness in the prevalence of anxiety disorders is scarce. Moreover, reports from resource-constrained and semiurban settings are usually focused on hospital-based data, instead of population-based surveys. We aimed to evaluate the association between T2DM and anxiety symptoms, with emphasis on T2DM awareness.

METHODS

A secondary data analysis was conducted using information from a population-based study. The outcome of interest was the presence of anxiety symptoms assessed by the Goldberg anxiety test, while the exposure variable was T2DM, defined using the oral glucose tolerance test. In addition, another definition was used based on self-reported T2DM awareness of previous diagnosis. Prevalence ratios (PR) and 95% confidence intervals (CI) were reported using Poisson regression models.

RESULTS

Data from 1,607 participants, of mean age 48.2 (SD: 10.6) years, and 809 (50.3%) females, were analyzed. Of all participants, 176 (11.0%; 95% CI: 9.5%-12.6%) had T2DM, 105 (59.7%) were aware of previous diagnosis, and 674 (41.9%; 95% CI: 39.5%-44.4%) had anxiety symptoms. In multivariable model, T2DM was not associated with anxiety symptoms (PR = 1.16; 95% CI: 0.99-1.36); however, individuals aware of T2DM diagnosis had a 36% (95% CI: 14%-64%) greater prevalence of anxiety symptoms compared to those without T2DM. Additionally, those aware of T2DM diagnosis had a 56% (95% CI: 13%-116%) higher probability to have anxiety symptoms compared to those not aware of T2DM diagnosis.   Conclusions: The association between T2DM and anxiety symptoms was present among those participants who self-reported T2DM diagnosis, as opposed to those with T2DM but not aware and to those without T2DM. Evaluation of anxiety symptoms may be relevant among those with previous T2DM diagnosis.

Meta-analysis of studies on depression prevalence among diabetes mellitus patients in Africa

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion or insulin action. It can be caused by the consumption of carbohydrate meals or medication side effects. Depression as a comorbid condition in an individual with diabetes is accountable for increased disability, mortality, and significant health problem in patients. As a continent, Africa does not have an overall estimation of depression prevalence among diabetes mellitus patients at a regional level. Consequently, this study's purpose was to use the meta-analysis method to summarize estimates of extant studies that have reported depression prevalence among patients with diabetes mellitus in Africa. The literature search method was executed to classify studies with reported depression prevalence with evidently designed inclusion and exclusion criteria. In total, 20 studies from sundry screened articles were appropriate for ultimate inclusion in the meta-analysis. Since substantial heterogeneity was expected, a random-effects meta-analysis was carried out using the number of cases with a total sample size to estimate the prevalence of diabetes mellitus at a regional level. The residual amount of heterogeneity was found to be high according to the statistics of τ² = 0.06; I² = 99.10%, chi-square = 2184.85, degree of freedom = 19 and P =< 0.001. The pooled depression prevalence was 40% within a 95% confidence interval of 29%–51%. The meta-regression analysis result showed that none of the included moderators contributed to the heterogeneity of studies. The result of effect size estimates against its standard error showed publication bias with a P-value of 0.001. The meta-analysis findings of this study have indicated that depression prevalence in Africa is still high. Reporting on numerous risk factors like socio-demographic characteristics were not possible in this study because of a lack of completeness in the included articles. Consequently, screening diabetes patients for comorbid depression with its associated risk factors is highly recommended.

Altered White Matter Microstructures in Type 2 Diabetes Mellitus: A Coordinate-Based Meta-Analysis of Diffusion Tensor Imaging Studies

Objective

Type 2 diabetes mellitus (T2DM) is often accompanied by cognitive decline and depressive symptoms. Numerous diffusion tensor imaging (DTI) studies revealed microstructural white matter (WM) abnormalities in T2DM but the findings were inconsistent. The present study aimed to conduct a coordinate-based meta-analysis (CBMA) to identify statistical consensus of DTI studies in T2DM.

Methods

We performed a systematic search on relevant studies that reported fractional anisotropy (FA) differences between T2DM patients and healthy controls (HC). The anisotropic effect size seed-based d mapping (AES-SDM) approach was used to explore WM alterations in T2DM. A meta-regression was then used to analyze potential influences of sample characteristics on regional FA changes.

Results

A total of eight studies that comprised 245 patients and 200 HC, along with 52 coordinates were extracted. The meta-analysis identified FA reductions in three clusters including the left inferior network, the corpus callosum (CC), and the left olfactory cortex. Besides, FA in the CC was negatively correlated with body mass index (BMI) in the patients group.

Conclusions

T2DM could lead to subtle WM microstructural alterations, which might be associated with cognitive deficits or emotional distress symptoms. This provides a better understanding of the pathophysiology of neurodegeneration and complications in T2DM.

Systematic Review Registration

Registered at PROSPERO (http://www.crd.york.ac.uk/PROSPERO), registration number: CRD42020218737.

Specific Dimensions of Depression Have Different Associations With Cognitive Decline in Older Adults With Type 2 Diabetes

OBJECTIVE

Depression is highly frequent in older adults with type 2 diabetes and is associated with cognitive impairment, yet little is known about how various depression dimensions differentially affect cognition. We investigated longitudinal associations of specific depression dimensions with cognitive decline.

RESEARCH DESIGN AND METHODS

Participants (N = 1,002) were from the Israel Diabetes and Cognitive Decline study, were ≥65 years of age, had type 2 diabetes, and were not experiencing dementia at baseline. Participants underwent a comprehensive neuropsychological battery at baseline and every 18 months thereafter, including domains of episodic memory, attention/working memory, semantic categorization/language, and executive function, and Z-scores of each domain were averaged and further normalized to calculate global cognition. Depression items from the 15-item Geriatric Depression Scale were measured at each visit and subcategorized into five dimensions: dysphoric mood, withdrawal-apathy-vigor (entitled apathy), anxiety, hopelessness, and memory complaint. Random coefficients models examined the association of depression dimensions with baseline and longitudinal cognitive functioning, adjusting for sociodemographics and baseline characteristics, including cardiovascular risk factors, physical activity, and use of diabetes medications.

RESULTS

In the fully adjusted model at baseline, all dimensions of depression, except for anxiety, were associated with some aspect of cognition (P values from 0.01 to <0.001). Longitudinally, greater apathy scores were associated with faster decline in executive function (P = 0.004), a result that withstood adjustment for multiple comparisons. Associations of other depression dimensions with cognitive decline were not significant (P > 0.01).

CONCLUSIONS

Apathy was associated with a faster cognitive decline in executive function. These findings highlight the heterogeneity of depression as a clinical construct rather than as a single entity and point to apathy as a specific risk factor for cognitive decline among older adults with type 2 diabetes.

Why Are Individuals With Diabetes Less Active? The Mediating Role of Physical, Emotional, and Cognitive Factors

BACKGROUND

Despite the key role of physical activity in the management of diabetes, many individuals with diabetes do not engage in the recommended levels of physical activity. However, our knowledge of the mechanisms underlying the relationship between diabetes and physical inactivity is limited.

PURPOSE

To investigate the associations between diabetes and the levels and evolution of physical activity across aging, and to determine whether physical, emotional, and cognitive factors mediate these associations.

METHODS

Data from 105,622 adults aged 50-96 years from the Survey of Health, Ageing and Retirement in Europe (SHARE) were used in adjusted linear mixed models to examine whether diabetes was associated with physical activity levels and variations across aging. The potential mediators were subjective energy, muscle strength, physical and cognitive disability, sleep problems, depressive symptoms, and cognitive functions. The variables were measured up to seven times over a 13-year period.

RESULTS

Individuals with diabetes demonstrated a lower level and a steeper decrease in physical activity across aging than individual without diabetes. Mediators explained ~53% and 94% of the association of diabetes with the level of physical activity and with the linear evolution of physical activity across aging, respectively. All mediators were significantly associated with physical activity. Physical and cognitive disability as well as depressive symptoms were the strongest mediators, while sleep was the lowest one.

CONCLUSIONS

These findings suggest that the etiology of physical inactivity in individuals with diabetes can result from several physical, emotional, and cognitive changes associated with the emergence of this disease.

Facilitating participation in cardiovascular preventive initiatives among people with diabetes: a qualitative study

Background

Type 2 diabetes (T2D) is associated with a significantly increased risk of cardiovascular disease (CVD). The DIAbetic CArdioVAscular Screening and intervention trial (DIACAVAS) was designed to clarify whether advanced imaging for subclinical atherosclerosis combined with medical treatment is an effective strategy to develop individualised treatment algorithms for Danish men and women with T2D aged 40–60. But in the DIACAVAS pilot study, the uptake was only 41%. Consequently, we explored how people experienced living with T2D to understand how to improve the uptake in initiatives targeting the prevention of CVD.

Methods

We used semi-structured interviews to obtain information on how the respondents experienced having T2D. For supplementary information, we used structured interviews on e.g. socioeconomic factors. From April to October 2019, 17 participants aged 40–60 years were recruited from general practices and diabetes outpatient clinics in Denmark. Several levels of analysis were involved consistent with inductive content analysis.

Results

The participants’ experiences of living with T2D fell along two continuums, from an emotional to a cognitive expression and from reactive to proactive disease management. This led to identification of four archetypal characteristics: (I) powerlessness, (II) empowerment, (III) health literacy, and (IV) self-efficacy. These characteristics indicated the importance of using different approaches to facilitate participation in cardiovascular preventive initiatives. Additionally, findings inspired us to develop a model for facilitating participation in future preventive initiatives.

Conclusion

Encouraging people with T2D to participate in cardiovascular preventive initiatives may necessitate a tailored invitation strategy. We propose a model for an invitational process that takes into consideration invitees’ characteristics, including powerlessness, empowerment, health literacy and self-efficacy. This model may enhance participation in such initiatives. However, participation is a general concern, not only in relation to cardiovascular prevention. Our proposed model may be applicable in preventive services for people with T2D in general.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10172-6.

Modulation of depression-related behaviors by adiponectin AdipoR1 receptors in 5-HT neurons

The adipocyte-derived hormone adiponectin has a broad spectrum of functions beyond metabolic control. We previously reported that adiponectin acts in the brain to regulate depression-related behaviors. However, its underlying neural substrates have not been identified. Here we show that adiponectin receptor 1 (AdipoR1) is expressed in the dorsal raphe nucleus (DRN) and colocalized with tryptophan hydroxylase 2 (TPH2), a marker of serotonin (5-HT) neurons. Selective deletion of AdipoR1 in 5-HT neurons induced anhedonia in male mice, as indicated by reduced female urine sniffing time and saccharin preference, and behavioral despair in female mice and enhanced stress-induced decrease in sucrose preference in both sexes. The expression levels of TPH2 were downregulated with a concurrent reduction of 5-HT-immunoreactivity in the DRN and its two major projection regions, the hippocampus and medial prefrontal cortex (mPFC), in male but not female mice lacking AdipoR1 in 5-HT neurons. In addition, serotonin transporter (SERT) expression was upregulated in both DRN projection fields of male mice but only in the mPFC of female mice. These changes presumably lead to decreased 5-HT synthesis and/or increased 5-HT reuptake, thereby reducing 5-HT transmission. The augmented behavioral responses to the selective serotonin reuptake inhibitor fluoxetine but not desipramine, a selective norepinephrine reuptake inhibitor, observed in conditional knockout male mice supports deficient 5-HT transmission underlying depression-related phenotypes. Our results indicate that adiponectin acts on 5-HT neurons through AdipoR1 receptors to regulate depression-related behaviors in a sex-dependent manner.

People with diabetes need a lower cut-off than others for depression screening with PHQ-9

Aims

This study evaluated the psychometric characteristics of the Polish version of the PHQ-9 in detecting major depression (MDD) and ‘MDD and/or dysthymia’ in people with and without type 2 diabetes.

Methods

Participants were randomly selected from a diabetes outpatient facility (N = 216) and from among patients admitted to a medical center and psychiatric hospital (N = 99). The participants completed the PHQ-9. The Hamilton Depression Rating Scale and the Mini International Neuropsychiatric Interview were used to identify the presence of psychiatric symptoms. The optimal cut-offs for PHQ-9 in people with and without type 2 diabetes were investigated based on two methods: 1) Youden’s index which identifies cut-off points useful in scientific research; 2) a second method of two-stage screening for depressive disorders to provide guidance for clinical practice.

Results

The Polish version of the PHQ-9 is a reliable and valid screening tool for depression in people with and without type 2 diabetes. An optimal cut-off of ≥ 7 was indicated by Youden’s index and ≥ 5 by the two-stage method for screening for MDD and ‘MDD and/or dysthymia’ in the group with type 2 diabetes. A cut-off of ≥ 11 was optimal for screening for both MDD and ‘MDD and/or dysthymia’ among people without diabetes (Youden’s index). The two-stage approach suggested a ≥ 10 score for screening for MDD and ≥ 9 for screening for ‘MDD and/or dysthymia’ in people without diabetes.

Conclusions

A lower cut-off score of the PHQ-9 is recommended for people with type 2 diabetes as compared to the general population.

Depressive Symptoms are Associated with High Levels of Serum Low-Density Lipoprotein Cholesterol in Older Adults with Type 2 Diabetes Mellitus

Fundamento

O Diabetes Mellitus Tipo 2 (DMT2) é comum nos idosos, que também apresentam um nível elevado de fatores de risco para doenças cardiovasculares (DCVs), tais como dislipidemia. Entretanto, o papel da depressão nos pacientes com DMT2 e sua relação com fatores de risco para DCV são pouco estudados.

Objetivo

O objetivo do presente estudo foi investigar a relação entre sintomas depressivos (SDs) e fatores de risco cardiovascular conhecidos em idosos comunitários portadores de DMT2.

Métodos

Trata-se de um estudo transversal, no qual foram incluídos 85 idosos comunitários com DMT2. Os SDs foram avaliados através da Escala de Depressão Geriátrica de Yesavage, em versão reduzida (GDS-15). Os seguintes fatores de risco cardiovascular foram avaliados: pressão arterial sistólica (PAS) e diastólica (PAD), glicose plasmática em jejum (GPJ), perfil lipídico (triglicerídeos séricos (TG), colesterol total sérico (CT), colesterol sérico de lipoproteína de baixa densidade (LDL-C) e colesterol sérico de lipoproteína de baixa densidade (HDL-C)) e índice de massa corporal (IMC). A análise de regressão múltipla de Poisson foi utilizada para avaliar a associação entre os SDs e cada fator de risco cardiovascular ajustado por sexo, idade, tempo em atividades físicas moderadas e status funcional. O nível de significância adotado para a análise foi de 5%.

Resultados

Dentre todos os fatores de risco analisados, apenas o aumento de LDL-C apresentou uma correlação com níveis elevados de SD (RP=1,005; IC95% 1,002-1,008). Foi observada uma associação significativa entre os níveis de HDL-C (RP=0,99; IC95% 0,98-0,99) e a PAS (RP=1,009; IC95% 1,004-1,014).

Conclusão

Nos idosos com DMT2, a presença de SD foi associada a níveis de LDL-C, HDL-C e PAS, mesmo após o ajuste por sexo, idade, nível de atividade física e capacidade funcional. (Arq Bras Cardiol. 2020; 115(3):462-467)

Interaction of sleep quality and anxiety on quality of life in individuals with type 2 diabetes mellitus

Purpose

Sleep disturbances and anxious symptoms are very common in people with type 2 diabetes mellitus(T2DM). This study aimed to assess the interactive effects of poor sleep quality and anxious symptoms on the quality of life of people with T2DM.

Methods

Nine hundred and forty-four participants with T2DM were enrolled in a cross-sectional study. Demographic and physiological characteristics were recorded. Each participant completed a Chinese version of the Pittsburgh Sleep Quality Index, the Patient Health Questionnaire-9 and General Anxiety Disorder questionnaire, and the Diabetes Specificity Quality of Life scale. The products of poor sleep quality and anxiety were added to a logistic regression model to evaluate the multiplicative interactions, expressed as the relative excess risk of interaction, the attributable proportion of interaction, and the synergy index.

Results

Poor sleep quality and anxiety symptoms were associated with reduced quality of life. There was a significant interaction between poor sleep quality and anxiety symptoms; this combined effect significantly reduced quality of life scores by 6.09-fold. The relative excess risk of interactions was 1.36.

Conclusions

The combined effect of poor sleep quality and anxiety symptoms reduces quality of life in people with T2DM.

Trial registration

ChiCTR-IOP-16008045. Registered 3 March 2016.

A clinical study to investigate gum infection in patients undergoing kidney dialysis.

The prevalence and predictors of diabetes distress in elderly with type 2 diabetes mellitus

AIMS

Diabetes distress (DD) leads to damaging consequences in patients with type 2 diabetes mellitus (T2DM). Few studies have been carried out on the DD among elderly in Iran. The aim of the current study was to investigate the prevalence of DD and some of its related factors on the elderly living in Qom, Iran.

METHODS

This study was cross-sectional, in design. It lasted for three months (December to February 2018). 519 community dwelling(aged 60 and over) participated in the study. Participants' distress measured by diabetes distress scale (DDS). The cut of 3(≥3) was considered as the presence of distress. In addition, socio-demographic information was assessed. In order to determine predictors factors of DD, the logistic regression analysis was applied.

RESULTS

The mean age (±SD) of the participants was 68.38 (SD:6.78) with the majority being female (53.6%). Among them, 48.6% were identified with DD. A multi-variable logistic regression analysis showed that being female (OR = 1.94, [ 1.30-2.31]), sedentary lifestyle (OR = 3.59, [1.43-9.03]), complications (OR = 3.10, [2.06-4.67]), body mass index (BMI) of 25 or more (OR = 2.46, [1.54-3.94]), duration of disease below 10 years (OR = 2.60, [ 1.56-4.31]), two comorbidity (OR = 2.07, [ 1.19-3.61]) and three or more comorbidity (OR = 3.51, [ 1.20-10.27]) are the predictors of DD.

CONCLUSIONS

DD is notably prevalent among the elderly with T2DM. Attention to psychological aspects of diabetes is a health priority, especially among women and other high-risk groups.

Frequência de sofrimento emocional é elevada em pessoas com diabetes assistidas na atenção primária

Introdução: Pessoas com diabetes podem sofrer com o estresse da doença e apresentar sentimentos como culpa, raiva, medo e depressão, que caracterizam o Sofrimento Emocional Específico da Diabetes. Objetivo: estimar a frequência desse sofrimento e seus fatores associados em pessoas assistidas na atenção primária em Blumenau, Santa Catarina. Métodos: Trata-se de estudo transversal. Pessoas com diabetes assistidas por 4 equipes de saúde da família (n=196) responderam ao questionário “Problems Areas in Diabetes”, que apresenta 20 questões em 4 subdimensões, além de questões sobre suas características sociodemográficas (sexo, idade, escolaridade) e clínicas (tempo de doença, uso de insulina e medicação antidepressiva). Estimou-se os escores de sofrimento geral e subdimensões com base na soma das respostas em escala de 0 (melhor) a 100 (pior). Mediu-se a frequência do sofrimento emocional grave (escore >40) e sua associação com as variáveis de estudo por regressão logística não condicional. Resultados: Participaram 196 pessoas, 58,2% eram mulheres, 26,2% faziam uso de insulina e 20,6% de antidepressivos. A idade média foi de 61,6 anos, o tempo médio de tratamento de diabetes foi 9,5 anos. O escore médio de sofrimento emocional foi de 33,6 (dp=27,6) e mediana de 23,8. 36,2% dos participantes apresentaram sofrimento emocional grave. O sofrimento emocional grave se mostrou principalmente entre pessoas com 19 a 64 anos (OR=2,1, IC95%1,1 - 4,1), com tempo de doença de 2 a 5 anos (OR=6,4; IC95% 1,1 - 36,1) e 5 anos e mais (OR=5,4; IC95% 1,1 - 28,8) e em uso de medicação antidepressiva (OR=2,8 IC95% 1,3 - 6,0). Conclusão: Mais de um terço das pessoas com diabetes tem sofrimento emocional grave, marcadamente os adultos com mais tempo de doença e com tratamento para depressão. Sugere-se que essas pessoas tenham seu cuidado priorizado pelas equipes de saúde na atenção primária.

Validation of the Polish version of WHO-5 as a screening instrument for depression in adults with diabetes

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.

Effectiveness of psychoeducational interventions for the treatment of diabetes-specific emotional distress and glycaemic control in people with type 2 diabetes: A systematic review and meta-analysis

AIMS

Psychological comorbidity, such as depression and/or diabetes-specific emotional distress (DSD), is highly prevalent in people with type 2 diabetes (T2DM) and associated with poorer treatment outcomes. While treatments for depression are well established, interventions specifically designed for DSD are sparse. The aim of this study was to determine interventions that successfully address DSD and HbA1c in people with T2DM.

METHODS

Seven databases were searched to identify potentially relevant studies. Eligible studies were selected and appraised independently by two reviewers. Multiple meta-analyses and meta-regression analyses were performed to synthesise the data; the primary analyses determined the effect of interventions on DSD, with secondary analyses assessing the effect on HbA1c.

RESULTS

Thirty-two studies (n = 5206) provided sufficient DSD data, of which 23 (n = 3818) reported data for HbA1c. Meta-analyses demonstrated that interventions significantly reduced DSD (p = 0.034) and HbA1c (p = 0.006) compared to controls, although subgroup meta-analyses and meta-regression to explore specific intervention characteristics that might mediate this effect yielded non-significant findings.

CONCLUSIONS

The findings demonstrate that existing interventions successfully reduce DSD and HbA1c in people with T2DM. While promising, deductions should be interpreted tentatively, highlighting a stark need for further focused exploration of how best to treat psychological comorbidity in people with T2DM.

Physical activity and muscle-brain crosstalk

Neurological and mental illnesses account for a considerable proportion of the global burden of disease. Exercise has many beneficial effects on brain health, contributing to decreased risks of dementia, depression and stress, and it has a role in restoring and maintaining cognitive function and metabolic control. The fact that exercise is sensed by the brain suggests that muscle-induced peripheral factors enable direct crosstalk between muscle and brain function. Muscle secretes myokines that contribute to the regulation of hippocampal function. Evidence is accumulating that the myokine cathepsin B passes through the blood-brain barrier to enhance brain-derived neurotrophic factor production and hence neurogenesis, memory and learning. Exercise increases neuronal gene expression of FNDC5 (which encodes the PGC1α-dependent myokine FNDC5), which can likewise contribute to increased brain-derived neurotrophic factor levels. Serum levels of the prototype myokine, IL-6, increase with exercise and might contribute to the suppression of central mechanisms of feeding. Exercise also increases the PGC1α-dependent muscular expression of kynurenine aminotransferase enzymes, which induces a beneficial shift in the balance between the neurotoxic kynurenine and the neuroprotective kynurenic acid, thereby reducing depression-like symptoms. Myokine signalling, other muscular factors and exercise-induced hepatokines and adipokines are implicated in mediating the exercise-induced beneficial impact on neurogenesis, cognitive function, appetite and metabolism, thus supporting the existence of a muscle-brain endocrine loop.

Structural and functional damage to the hippocampal neurovascular unit in diabetes-related depression

Previous studies have shown that models of depression exhibit structural and functional changes to the neurovascular unit. Thus, we hypothesized that diabetes-related depression might be associated with damage to the hippocampal neurovascular unit. To test this hypothesis, neurons, astrocytes and endothelial cells were isolated from the brain tissues of rat embryos and newborn rats. Hippocampal neurovascular unit co-cultures were produced using the Transwell chamber co-culture system. A model of diabetes-related depression was generated by adding 150 mM glucose and 200 μM corticosterone to the culture system and compared with the neuron + astrocyte and astrocyte + endothelial cell co-culture systems. Western blot assay was used to measure levels of structural proteins in the hippocampal neurovascular unit co-culture system. Levels of basic fibroblast growth factor, angiogenic factor 1, glial cell line–derived neurotrophic factor, transforming growth factor β1, leukemia inhibitory factor and 5-hydroxytryptamine in the hippocampal neurovascular unit co-culture system were measured by enzyme-linked immunosorbent assay. Flow cytometry and terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling staining was used to assess neuronal apoptosis in the hippocampal neurovascular unit. The neurovascular unit triple cell co-culture system had better barrier function and higher levels of structural and secretory proteins than the double cell co-culture systems. In comparison, in the model of diabetes-related depression, the neurovascular unit was damaged with decreased barrier function, poor structural integrity and impaired secretory function. Moreover, neuronal apoptosis was markedly increased, and 5-hydroxytryptamine levels were reduced. These results suggest that diabetes-related depression is associated with structural and functional damage to the neurovascular unit. Our findings provide a foundation for further studies on the pathogenesis of diabetes-related depression.

Understanding Diabetes-Related Distress Characteristics and Psychosocial Support Preferences of Urban African American Adults Living With Type 2 Diabetes: A Mixed-Methods Study

Purpose The purpose of this study is to understand diabetes-related distress (DRD) characteristics and identify psychosocial support preferences of urban African American adults living with type 2 diabetes (T2DM). Methods A 2-phase, mixed-methods sequential explanatory study design was used to gather data. In phase 1, a purposive sample of participants (N = 155) was recruited and asked to complete a written survey. The Diabetes Distress Scale (DDS17) was used to assess DRD, including subscales-emotional burden (EB), regimen distress (RD), interpersonal distress (ID), and physician distress (PD). In phase 2, a subset of phase 1 participants (N = 23) volunteered to attend 1 of 4 gender-stratified follow-up focus groups to contextualize the quantitative survey results. Results Survey findings indicate that on average, participants had moderate levels of DRD (aggregate), RD, and EB but had low ID and PD. During follow-up focus groups, participants described RD and EB as their primary distress types and emphasized that clinicians should prioritize the mental health aspects of T2DM similarly to its physical aspects. Participants expressed a desire for culturally appropriate peer support groups as a psychosocial support resource for distress coping and specifically requested the development of gender-stratified groups and groups for young adults. Conclusions Results support the need to screen for and address diabetes-related distress among African American patients with T2DM. Findings also inform the development of culturally appropriate psychosocial support resources to facilitate diabetes-related distress coping.

The prevalence of diabetes-specific emotional distress in people with Type 2 diabetes: a systematic review and meta-analysis

AIMS

Psychological comorbidity, such as depression and/or diabetes-specific emotional distress (diabetes distress), is widespread in people with Type 2 diabetes and is associated with poorer treatment outcomes. Although extensive research into the prevalence of depression has been conducted, the same attention has not been given to diabetes distress. The aim of this systematic review was to determine the overall prevalence of diabetes distress in people with Type 2 diabetes.

METHODS

Seven databases were searched to identify potentially relevant studies; eligible studies (adult population aged > 18 years with Type 2 diabetes and an outcome measure of diabetes distress) were selected and appraised independently by two reviewers. Multiple fixed- and random-effects meta-analyses were performed to synthesize the data; with primary analyses to determine the overall prevalence of diabetes distress in people with Type 2 diabetes, and secondary meta-analyses and meta-regression to explore the prevalence across different variables.

RESULTS

Fifty-five studies (n = 36 998) were included in the meta-analysis and demonstrated an overall prevalence of 36% for diabetes distress in people with Type 2 diabetes. Prevalence of diabetes distress was significantly higher in samples with a higher prevalence of comorbid depressive symptoms and a female sample majority.

CONCLUSIONS

Diabetes distress is a prominent issue in people with Type 2 diabetes that is associated with female gender and comorbid depressive symptoms. It is important to consider the relationship between diabetes distress and depression, and the significant overlap between conditions. Further work is needed to explore psychological comorbidity in Type 2 diabetes to better understand how best to identify and appropriately treat individuals.

Prevalence and factors associated with anxiety and depression among type 2 diabetes in Qassim: A descriptive cross-sectional study

OBJECTIVES

To assess the prevalence of anxiety and depression and to identify their associated risk factors among people with type 2 diabetes mellitus.

METHODS

A cross-sectional, single-centre study that included 300 adults with type 2 diabetes mellitus was conducted at The Diabetic Center of King Saud Hospital in the Qassim region. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariable analysis using multiple logistic regression was conducted to evaluate the combined effect of various factors associated with anxiety and depression, adjusting for confounding variables.

RESULTS

Overall, 43.6% (95% CI: 37.9-49.3%) and 34.8% (95% CI: 29-40%) of the participants experienced anxiety and depression, respectively. Anxiety was more common among patients who had poor social support (OR 5.35, P 0.001). Anxiety was less common among retired people (OR 0.36, P 0.048) and those having diabetes for more than ten years (OR 0.39, P 0.006). In contrast, depression was more common among patients who had received moderate (OR 2.47, P 0.031) or low social support (OR 6.62, P 0.000) but less common among those having diabetes for more than ten years (OR 0.44, P 0.022).

CONCLUSION

This study showed that the prevalence of anxiety and depression is high among adults with type 2 diabetes mellitus. These results should alert clinicians to identify and treat anxiety and depression as part of multidisciplinary diabetes care. Larger community-based studies are needed to identify the magnitude of these problems and their related factors.

Validation of the WHO-5 as a first-step screening instrument for depression in adults with diabetes: Results from Diabetes MILES - Australia

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.

Challenges faced by physicians when discussing the Type 2 diabetes diagnosis with patients: insights from a cross-national study (IntroDia® )

AIMS

To investigate physicians' recalled experiences of their conversations with patients at diagnosis of Type 2 diabetes, because physician-patient communication at that time may influence the patient's subsequent self-care and outcomes.

METHODS

As part of a large cross-national study of physician-patient communication during early treatment of Type 2 diabetes (IntroDia^® ), we conducted a cross-sectional survey of physicians treating people with Type 2 diabetes in 26 countries across Africa, Asia, Europe, Latin America, the Middle East, North America and Oceania. The survey battery was designed to evaluate physician experiences during diagnosis conversations as well as physician empathy (measured using the Jefferson Scale of Physician Empathy).

RESULTS

A total of 6753 of 9247 eligible physicians completed the IntroDia^® survey (response rate 73.0%). Most respondents (87.5%) agreed that the conversation at diagnosis of Type 2 diabetes impacts the patient's acceptance of the condition and self-care. However, almost all physicians (98.9%) reported challenges during this conversation. Exploratory factor analysis revealed two related yet distinct types of challenges (r = 0.64, P < 0.0001) associated with either patients (eight challenges, α = 0.87) or the situation itself at diagnosis (four challenges, α = 0.72). There was a significant inverse association between physician empathy and overall challenge burden, as well as between empathy and each of the two types of challenges (all P < 0.0001). Study limitations include reliance on accurate physician recall and inability to assign causality to observed associations.

CONCLUSIONS

Globally, most physicians indicated that conversations with patients at diagnosis of Type 2 diabetes strongly influence patient self-care. Higher physician empathy was associated with fewer challenges during the diagnosis conversation.

Screening for and subsequent participation in a trial for depression and anxiety in people with type 2 diabetes treated in primary care: Who do we reach?

AIMS

This study investigated (factors related to) (a) the response to a screening procedure for depression and anxiety in people with type 2 diabetes in primary care, and (b) participation in a subsequent randomised controlled trial targeting depressive or anxiety symptoms.

METHODS

People with type 2 diabetes (n=1837) received a screening questionnaire assessing depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7). Eligible persons who scored above the cut-off score (PHQ-9≥7 or GAD-7≥8) were offered to participate in the trial.

RESULTS

In total, 798 people (43%) returned the screening questionnaire. Non-responders were more often female (53% vs 44%, p<0.001), had higher LDL cholesterol levels (Cohen's d=0.17, p=0.001) and a higher albumin/creatinine ratio (Cohen's d=0.08, p=0.01). In total, 130 people (18%) reported elevated depressive or anxiety symptoms. Twenty-seven persons agreed to participate in the trial. Factors related to participation were a high education level, a higher level of diabetes distress and a history of psychological problems.

CONCLUSIONS

Using screening as recruitment resulted in a small number of participants in a treatment trial for anxiety and depression. Research is needed to investigate whether screening is also followed by a low uptake of treatment in primary care outside a RCT setting.

Diabetes Distress, Depression and Glycemic Control in a Canadian-Based Specialty Care Setting

OBJECTIVES

The objectives of this study were to determine rates of diabetes distress and depression in patients with type 2 diabetes in a tertiary care setting, to examine the relationship among glycemic control, diabetes distress and depression, and to identify predictors of diabetes distress and depression on the basis of demographic and clinical characteristics.

METHODS

We recruited 148 adults with type 2 diabetes who were presenting to a specialty diabetes clinic in Vancouver, British Columbia, Canada. Participants completed a questionnaire measuring diabetes distress, depressive symptoms and demographic backgrounds. The Diabetes Distress Scale was used to assess overall distress as well as 4 distinct distress dimensions, including emotional burden, physician-related, regimen-related and interpersonal distress. The Personal Health Questionnaire-9 was used to assess depressive symptoms. Glycated hemoglobin (A1C) data were also collected.

RESULTS

The prevalence of diabetes distress and depression was 39% and 12% in our population, respectively. A1C levels emerged as a significant predictor of emotional burden (p=0.03) and regimen-related distress (p=0.01); higher A1C levels were associated with increased distress regarding emotional functioning and regimen adherence. A1C levels (p=0.02) and education levels (p=0.03) emerged as predictors of physician-related distress, with higher A1C levels associated with decreased distress regarding confidence in physicians.

CONCLUSIONS

Our findings reveal that the rate of diabetes distress for patients in a tertiary care setting is high. Furthermore, diabetes distress, particularly emotion- and self-care-related distress, plays a significant role in glycemic control, whereas depression does not. Routine screening for diabetes distress as part of an initial specialty clinic evaluation should be explored.

The effectiveness of a value-based EMOtion-cognition-Focused educatIonal programme to reduce diabetes-related distress in Malay adults with Type 2 diabetes (VEMOFIT): study protocol for a cluster randomised controlled trial

BACKGROUND

Type 2 diabetes mellitus (T2DM) patients experience many psychosocial problems related to their diabetes. These often lead to emotional disorders such as distress, stress, anxiety and depression, resulting in decreased self-care, quality of life and disease control. The purpose of the current study is to evaluate the effectiveness of a brief value-based emotion-focused educational programme in adults with T2DM on diabetes-related distress (DRD), depressive symptoms, illness perceptions, quality of life, diabetes self-efficacy, self-care and clinical outcomes.

METHODS

A cluster randomised controlled trial will be conducted in 10 public health clinics in Malaysia, all providing diabetes care according to national clinical practice guidelines. Patients' inclusion criteria: Malay, ≥ 18 years with T2DM for at least 2 years, on regular follow-up with one of three biomarkers HbA1c, systolic blood pressure and LDL-cholesterol sub-optimally controlled, and with a mean 17-item Diabetes Distress Scale (DDS-17) score ≥ 3. The intervention consists of four sessions and one booster over a period of 4 months that provide information and skills to assist patients in having proper perceptions of their T2DM including an understanding of the treatment targets, understanding and managing their emotions and goal-setting. The comparator is an attention-control group with three meetings over a similar period. With an estimated intra-cluster correlation coefficient ρ of 0.015, a cluster size of 20 and 20% non-completion, the trial will need to enroll 198 patients.

PRIMARY OUTCOME

the between groups difference in proportion of patients achieving a mean DDS-17 score < 3 (non-significant distress) at 6 months post-intervention. Secondary outcomes will be the differences in the above mentioned variables between groups.

DISCUSSION

We hypothesize that primary and secondary outcomes will improve significantly after the intervention compared to the comparator group. The results of this study can contribute to better care for T2DM patients with DRD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02730078 . Registered on 29 March 2016, last updated on 4 January 2017.