Physical and psychosocial factors associated with depression among adults with type 2 diabetes mellitus at a Federally Qualified Healthcare Center

Depression among Bangladeshi diabetic patients: a cross-sectional, systematic review, and meta-analysis study

AIM

This study aims to assess the prevalence and associated factors of depression among diabetic patients in a cross-sectional sample and perform a systematic review and meta-analysis of the extant studies to date.

METHODS

A face-to-face semi-structured interview of established diabetic patients was conducted in four districts of Bangladesh between May 24 to June 24, 2022, and the Patient Health Questionnaire (PHQ-2) was used to detect depression. PRISMA guidelines were followed to conduct a systematic review and meta-analysis, with Bangladeshi articles published until 3rd February 2023.

RESULTS

The prevalence of depression among 390 diabetic patients was 25.9%. Having secondary education and using both insulin and medication increased the likelihood of depression, whereas being a business professional and being physically active reduced the likelihood of depression. The systematic review and meta-analysis indicated that the pooled estimated prevalence of depression was 42% (95% CI 32-52%). Females had a 1.12-times higher risk of depression than males (OR = 1.12, 95% CI: 0.99 to 1.25, p < 0.001).

CONCLUSIONS

Two-fifths of diabetic patients were depressed, with females at higher risk. Since depression among diabetic patients increases adverse outcomes, improved awareness and screening methods should be implemented to detect and treat depression in diabetic patients.

Quantifying burden of intravitreal injections: questionnaire assessment of life impact of treatment by intravitreal injections (QUALITII)

AIM

To quantify the areas of burden experienced by patients requiring repeated intravitreal injections (IVI) in the management of exudative retinal diseases.

METHODS

The validated Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections survey was administered to patients at four retina clinical practices across four US states. The primary outcome measure was Treatment Burden Score (TBS), a single score assessing overall burden.

RESULTS

Of 1416 (n=657 age-related macular degeneration; n=360 diabetic macular oedema/diabetic retinopathy; n=221 retinal vein occlusion; n=178 other/uncertain) patients, 55% were women with an average age of 70 years. Patients most frequently reported receiving IVI every 4-5 weeks (40%). The mean TBS was 16.1±9.2 (range 1-48; scale of 1-54), and the TBS was higher in patients with diabetic macular oedema and/or diabetic retinopathy (DMO/DR) (17.1) compared with those with age-related macular degeneration (15.5) or retinal venous occlusive (15.3) (p=0.028). Though the mean level of discomfort was quite low (1.86) (scale 0-6), 50% of patients reported experiencing side effects more than half of the visits. Patients having received fewer than 5 IVI reported higher mean anxiety levels before (p=0.026), during (p=0.050) and after (p=0.016) treatment compared with patients having received more than 50 IVI. After the procedure, 42% of patients reported restrictions from usual activities due to discomfort. Patients reported a high mean satisfaction rating of 5.46 (scale 0-6) with the care of their diseases.

CONCLUSIONS

The mean TBS was moderate and highest among patients with DMO/DR. Patients with more total injections reported lower levels of discomfort and anxiety but higher disruption to daily life. Despite the challenges related to IVI, the overall satisfaction with treatment remained high.

Integration of Diabetes and Depression Care Is Associated with Glucose Control in Midwestern Federally Qualified Health Centers

BACKGROUND

The 2016 American Diabetes Association position statement emphasized that psychosocial and medical care should be integrated and provided to all people with diabetes.

OBJECTIVE

To determine whether better integration of diabetes and depression care is associated with better glycemic control.

DESIGN

Cross-sectional surveys of Midwestern federally qualified health center (FQHC) leaders and primary care providers (PCPs) in 2016. Responses were linked to FQHC-level data on the percentage of patients with uncontrolled diabetes (glycated hemoglobin ≥ 9%; 75 mmol/mol).

PARTICIPANTS

Midwest Clinicians' Network-affiliated FQHC leaders, and PCPs at the FQHCs.

MAIN MEASURES

Multilevel models were used to determine associations between the percentage of patients with uncontrolled diabetes and FQHC and PCP characteristics; presence of diabetes and behavioral health care services; and PCPs' perception of the stage of integration between diabetes and depression care services based on the transtheoretical model (i.e., pre-contemplation, contemplation, preparation, action, or maintenance).

KEY RESULTS

Response rates were 60% for the FQHC survey (N = 77) and 55% for the PCP survey (N = 538). In adjusted models, FQHCs in which PCPs perceived a higher stage of integration between diabetes and depression care had 3% fewer patients with uncontrolled diabetes per 1-level increase in integration stage (p = 0.01); on-site diabetes self-management education was associated with 7% fewer patients with uncontrolled diabetes (p < 0.01).

CONCLUSIONS

At Midwestern FQHCs, a higher stage of perceived integration of diabetes and depression care was associated with better FQHC-level glycemic control. Future studies are needed to elucidate what defines integration of diabetes and depression care services.

Depression Among Patients with Type 2 Diabetes Mellitus: Prevalence and Associated Factors in Hue City, Vietnam

BACKGROUND AND AIMS

Depression is common in people with type 2 diabetes mellitus. The association of depression and diabetes has negative effects on patients. This study investigated the prevalence of depression in individuals with type 2 diabetes mellitus and examined the social, psychological and clinical factors associated with depression.

PATIENTS AND METHODS

The study included 216 inpatients with type 2 diabetes mellitus at the Department of Endocrinology and Neurology, Hue Central Hospital and the Department of General Internal Medicine, Hue University Hospital. This descriptive cross-sectional study evaluated depression using the Patient Health Questionnaire-9 (PHQ-9). Data were collected on patients' socio-demographic factors such as sex, age, marital and economic status, level of education and clinical factors including duration of type 2 diabetes mellitus, fasting blood glucose, HbA1C, comorbidities or complications as well as health behavior including alcohol consumption, smoking and physical activities. Logistic regression was used to analyze the factors associated with depression in patients with type 2 diabetes mellitus.

RESULTS

23.2% of the patients had depression. The rates of severe, moderate and mild depression were 0.5, 0.9 and 21.8%, respectively. Multivariate logistic regression analysis indicated several factors associated with depression in participants, including age under 60 years, poor economic status, unstable or part-time work, having stress during the past year, without/poor treatment adherence to type 2 diabetes mellitus, and engaging in heavy physical activity or physical activity less than three days per week.

CONCLUSION

The prevalence of depression among patients with type 2 diabetes mellitus is high. Endocrinologists should be made aware of the increased risk of depression in this patient population and screening individuals for relevant risk factors is highly recommended.