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Majidi S, Cohen L, Holt RIG, Clements M, O’Neill S, Renard E, Tynan D, Naranjo D, Messer LH, Klonoff DC, Barnard-Kelly K. Healthcare Professional Experiences and Opinions on Depression and Suicide in People With Diabetes. J Diabetes Sci Technol 2024; 18:667-675. [PMID: 37162023 PMCID: PMC11089883 DOI: 10.1177/19322968231171616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE People with diabetes have an increased risk of depression, intentional self-injury and self-harm (ISI), and suicide compared with the general population. This study aimed to explore experiences and awareness of healthcare professionals (HCPs) regarding depression, ISI, and suicide, and understand resource use and needs among HCPs who care for persons with diabetes (PWD). METHODS Healthcare professionals who see children and/or adults with type 1 diabetes or type 2 diabetes anonymously completed an online survey about their experiences, opinions, barriers, and needs surrounding identification and care of PWD with depression, ISI, and suicide. RESULTS One hundred twenty-nine HCPs participated. The majority were medical doctors (MDs) or advanced practice providers (APPs). Only a quarter of MDs and APPs felt very comfortable asking about ISI or suicidal ideation (SI), whereas 20% felt they had received appropriate training to support those with ISI or SI. The primary needs reported include more training on how to ask, respond, and support those expressing ISI and SI. Healthcare professionals reported wanting better access to resources for PWD. DISCUSSION The HCPs tend to underestimate SI in the diabetes population and rates of training were low. Areas to address include providing education and training to HCPs to improve identification and management of ISI and suicide risk. These data can inform the development of mechanisms to improve discussions of depression and suicide and of resources to help HCPs support PWD.
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Affiliation(s)
- Shideh Majidi
- Division of Endocrinology, Children’s National Hospital, Washington, DC, USA
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren Cohen
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Richard I. G. Holt
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Clements
- Pediatrics, Endocrinology, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Simon O’Neill
- Health Intelligence and Professional Liaison, Diabetes UK, London, UK
| | - Eric Renard
- Department of Endocrinology and Diabetes, Montpellier University Hospital, and Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Doug Tynan
- Jefferson Medical College, Philadelphia, PA, USA
| | - Diana Naranjo
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Laurel H. Messer
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
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Daneshmand M, Kashefizadeh M, Soleimani M, Mirzaei S, Tayim N. Network analysis of depression, cognitive functions, and suicidal ideation in patients with diabetes: an epidemiological study in Iran. Acta Diabetol 2024; 61:609-622. [PMID: 38366164 DOI: 10.1007/s00592-024-02234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/02/2024] [Indexed: 02/18/2024]
Abstract
AIMS The main aim of this study was to assess the prevalence of suicidal ideation and previous suicide attempts among Iranian patients diagnosed with Type-1 diabetes (T1D) and Type-2 diabetes (T2D). Additionally, the study sought to estimate the network structure of depressive symptoms and cognitive functions. METHODS 1073 patients participated in the current study. We used Patient Health Questionnaire-9 (PHQ-9), Ask Suicide-Screening Questionnaire, diabetes-related factors, and a battery of cognitive functions tasks to estimate network structures. Also, suicidal ideations and suicide attempts prevalence have been estimated. Statistical analyses were performed using R-studio software, including mixed-graphical models (MGMs) for undirected effects and Directed Acyclic Graphs (DAGs) for directed effects. RESULTS The prevalence of suicidal ideation was 29.97% in T1D and 26.81% in T2D (p < 0.05). The history of suicide attempts was higher in T1D (10.78%) compared to T2D (8.36%) (p < 0.01). In the MRF networks for T1D, suicidal ideation was directly linked to 'feeling guilt (PHQ.6)', 'Suicide (PHQ.9)', HbA1c, and FBS, while the Inhibition node was directly related to suicidal ideation. The DAGs suggested connections between 'depression', HbA1c, and 'inhibition' with suicidal ideation, along with a link between the current family history of suicide attempts and the patient's history of suicide attempts. For T2D, the MRF networks indicated direct links between suicidal ideation and 'anhedonia (PHQ.1)', 'suicide (PHQ.9)', age, being female, and BMI, with inhibition also being directly related to suicidal ideation. The DAGs revealed connections between 'depression', age, and 'inhibition' with suicidal ideation, as well as links between being female or single/divorced and the patient's history of suicide attempts. CONCLUSION The findings suggest that suicide ideation is highly prevalent in patients with diabetes, and these symptoms should be carefully monitored in these patients.
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Affiliation(s)
- Mojgan Daneshmand
- Department of Psychology, Islamic Azad University, Rodhen Branch, Rudehen, Iran
| | | | - Masoumeh Soleimani
- Department of Psychology, Adiban Institute of Higher Education, Garmsar, Iran
| | | | - Natalie Tayim
- Department of Psychology, School of Social Sciences and Humanities, Doha Institute for Graduate Studies, Doha, Qatar
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Chen SW, Wu YQ, Li S, Li J, Lang XE, Zhang XY. Prevalence, risk factors and clinical correlates of glucose disturbances in a large sample of Han Chinese patients with first-episode drug-naïve major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:549-557. [PMID: 36884047 DOI: 10.1007/s00406-023-01581-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/26/2023] [Indexed: 03/09/2023]
Abstract
Glucose disturbances are a common comorbidity of major depressive disorder (MDD) patients and have been extensively studied in the past. However, few studies have explored glucose disturbances in first-episode drug-naïve (FEDN) MDD patients. The purpose of this study was to examine the prevalence and risk factors of glucose disturbances in FEDN MDD patients to understand the relationship between MDD and glucose disturbances in the acute early phase and provide important implications for therapeutic interventions. Using a cross-sectional design, we recruited a total of 1718 MDD patients. We collected their socio-demographic information, clinical data, and blood glucose indicators.17-item Hamilton Depression Rating Scale (HAMD), 14-item Hamilton Anxiety Rating Scale (HAMA), and the positive symptom subscale of the Positive and Negative Syndrome Scale (PANSS) were used to assess their depression, anxiety, psychotic symptoms, respectively. The prevalence of glucose disturbances in FEDN MDD patients was 13.6%. Depression, anxiety and psychotic symptoms, body mass index (BMI) levels and suicide attempts rates were higher in the group with glucose disorders than in the group without glucose disorders among patients with first-episode drug-naive MDD. Correlation analysis showed that glucose disturbances were associated with HAMD score, HAMA score, BMI, psychotic symptoms and suicide attempts. Furthermore, binary logistic regression showed that HAMD score and suicide attempts were independently associated with glucose disturbances in MDD patients. Our findings suggest that the prevalence of comorbid glucose disturbances is very high in FEDN MDD patients. Moreover, more severe depressive symptoms and higher suicide attempts are correlated with glucose disturbances in MDD FEDN patients in the early stage.
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Affiliation(s)
- Shi Wang Chen
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
| | - Yan Qing Wu
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
| | - Shen Li
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
| | - Jie Li
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
| | - Xiao E Lang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiang-Yang Zhang
- Institute of Psychology, Chinese Academy of Sciences, Department of Psychology, University of Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, China.
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Fan ZH, Xu J, Ge MW, Huang JW, Ni HT, Shen WQ, Chen HL. Suicide death, suicidal ideation and suicide attempt in patients with diabetes: A systematic review and meta-analysis. J Adv Nurs 2024. [PMID: 38294134 DOI: 10.1111/jan.16074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/12/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
AIMS Diabetes has been indicated to be a risk factor for suicide. We aim to estimate the prevalence of suicide in patients with diabetes. DESIGN A meta-analysis using PRISMA methodology was adopted to examine the incidence of suicide in diabetic patients. DATA SOURCES From inception to October 2022, three online databases (PubMed, China National Knowledge Infrastructure and Web of Science) were used to search studies. REVIEW METHODS We used random-effects model to analysis. And our primary outcome was the incidence of suicide death per 100 person-years, and other outcomes were prevalence of suicidal ideation and suicide attempt. To explore the sources of heterogeneity in our study, we performed subgroup and meta-regression analyses. RESULTS The suicide death rate in diabetic patients was 0.027 per 100 person-years, with a higher rate for Type 1 Diabetes Mellitus compared to Type 2 Diabetes Mellitus. The prevalence of suicidal ideation in diabetes patients was 0.175, with a higher prevalence in Type 1 Diabetes Mellitus compared to Type 2 Diabetes Mellitus. The prevalence of suicide attempts in diabetes patients was 0.033, indicating a higher rate for Type 2 Diabetes Mellitus compared to Type 1 Diabetes Mellitus. CONCLUSIONS The results indicate a high rate of suicide among people with diabetes, and this study identifies populations and regions at high risk for suicide. Our review emphasizes interventions in mental health and the improvement of suicide prevention programmes. IMPACT The study investigated suicide death, suicidal ideation and suicide attempt in diabetic individuals. Suicide rates are elevated among diabetic patients, and various patient groups face distinct suicide risks. It is important to prioritize the mental well-being of diabetic individuals and enhance interventions, including personalized approaches, to inform public health efforts aimed at preventing and addressing suicide among diabetic patients. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement.
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Affiliation(s)
- Zhan-Hong Fan
- Medicine school of Nantong University, Nantong, Jiangsu, PR China
| | - Jie Xu
- Medicine school of Nantong University, Nantong, Jiangsu, PR China
| | - Meng-Wei Ge
- Medicine school of Nantong University, Nantong, Jiangsu, PR China
| | - Jie-Wei Huang
- Medicine school of Nantong University, Nantong, Jiangsu, PR China
| | - Hai-Tao Ni
- Medicine school of Nantong University, Nantong, Jiangsu, PR China
| | - Wang-Qin Shen
- Medicine school of Nantong University, Nantong, Jiangsu, PR China
| | - Hong-Lin Chen
- Public Health school of Nantong University, Nantong, Jiangsu, PR China
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Gupta R, Edupuganti S, Zamir I, Singh A, Thawani HT. Latent Autoimmune Diabetes in Adults and a Continuous Glucose Monitoring Device: An Unfortunate Outcome. Cureus 2023; 15:e49141. [PMID: 38130540 PMCID: PMC10733160 DOI: 10.7759/cureus.49141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Latent autoimmune diabetes in adults (LADA) is a slow-progressing form of autoimmune diabetes. A 44-year-old man with a four-year history of diabetes mellitus (DM), obsessive-compulsive disorder (OCD), and panic disorder was admitted to the hospital for diabetic ketoacidosis. LADA was confirmed with positive GAD-65 antibody. His occupation involved random working days with several weeks off in between projects. During workdays, his insulin dosage required frequent adjustments due to lower blood glucose (BG) readings. Owing to the variable work schedule and constantly changing insulin needs, he was recommended a continuous glucose monitoring (CGM) device. Few days after starting on the CGM device, he was seen in the emergency department because of elevated BG. His home BG readings ranged from 80 to 408 mg/dL. He was getting frustrated with the fluctuating BG readings. At home, he remained agitated and endlessly checked his CGM device. After discharge, he would repeatedly call the endocrinology office with his BG readings with the insulin dose being adjusted accordingly. Few weeks later, the office received a call from his wife informing us that the patient had shot himself in the head. According to his wife, lately he had trouble sleeping, was very anxious, and often had panic attacks. He seemed to struggle with ever-fluctuating BG readings and was obsessed with incessantly changing numbers on his CGM device. Patients with Type 1 DM are at increased risk of mental health disorders and suicide forms a sizeable proportion of deaths in these patients. This case highlights the importance of mental health, especially underlying OCD as a prognostic factor in the management of diabetes with CGM devices.
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Affiliation(s)
- Rohit Gupta
- Internal Medicine and Pediatrics, Hurley Medical Center, Michigan State University, Flint, USA
| | - Srujan Edupuganti
- Internal Medicine and Pediatrics, Hurley Medical Center, Michigan State University, Flint, USA
| | - Irma Zamir
- Internal Medicine and Pediatrics, Hurley Medical Center, Michigan State University, Flint, USA
| | - Adiraj Singh
- Internal Medicine and Pediatrics, Hurley Medical Center, Michigan State University, Flint, USA
| | - Hemant T Thawani
- Endocrinology, Diabetes and Metabolism, Hurley Medical Center, Michigan State University, Flint, USA
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Chen SW, Li X, Lang X, Li J, Zhang XY. Metabolic parameters and thyroid hormones in relation to suicide attempts in patients with first-episode and drug-naive major depressive disorder with comorbid glucose disturbances: a large cross-sectional study. Eur Arch Psychiatry Clin Neurosci 2023; 273:199-207. [PMID: 36127506 DOI: 10.1007/s00406-022-01490-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/29/2022] [Indexed: 12/01/2022]
Abstract
The factors associated with suicide attempts in major depressive disorder (MDD) patients with comorbid glucose disturbances remain unclear. To the best of our knowledge, this is the first study with a large sample size to examine risk factors of suicide attempts in first-episode drug-naïve (FEDN) MDD patients with comorbid glucose disturbances, including clinically relevant factors, metabolic parameters, and thyroid hormone levels. A total of 1718 FEDN MDD patients were enrolled. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) were used to assess the clinical symptoms of patients. Fasting blood glucose, metabolic parameters, and thyroid hormone levels were measured. After controlling for HAMA and HAMD scores, the suicide attempt rate was 1.88 times higher in MDD patients with glucose disturbances than in MDD patients without glucose disturbances. Compared to non-suicide attempters, suicide attempters among the MDD patients with glucose disturbances had higher scores on HAMD and HAMA, PANSS positive symptoms, as well as higher levels of systolic and diastolic blood pressure, TC, LDL-C, thyroid stimulating hormone (TSH), TgAb, and thyroid peroxidases antibody (TPOAb). The combination of positive symptom score, HDL-C, systolic blood pressure, and marital status distinguished suicide attempters from non-suicide attempters. In addition, HAMA score, HAMD score, and TPOAb were associated with the number of suicide attempts in MDD patients with comorbid glucose disturbances. Our results suggest a high incidence of suicide attempts in MDD patients with comorbid glucose disturbances. Several clinically relevant factors, metabolic parameters, and thyroid hormone function have an impact on suicide attempts in MDD patients with comorbid glucose disturbances.
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Affiliation(s)
- Shi Wang Chen
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
| | - Xue Li
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
| | - XiaoE Lang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jie Li
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
| | - Xiang-Yang Zhang
- Institute of Psychology, Chinese Academy of Science, Department of Psychology, University of Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China.
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Interaction effects of diabetes and brain-derived neurotrophic factor on suicidal ideation in patients with acute coronary syndrome. Sci Rep 2022; 12:6602. [PMID: 35459929 PMCID: PMC9033782 DOI: 10.1038/s41598-022-10557-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
Acute coronary syndrome (ACS) is related to an increased risk of suicide. Although both diabetes and the brain-derived neurotrophic factor (BDNF) pathway are closely associated with ACS and suicide, the effects of these factors on suicidal behavior in ACS patients have not been assessed. We investigated the individual and interaction effects of diabetes and BDNF-related markers, namely the serum BDNF (sBDNF) level and the BDNF Val66Met polymorphism, on suicidal ideation (SI) in ACS patients. The presence of diabetes was ascertained, and sBDNF levels and the presence of the BDNF Val66Met polymorphism were measured in 969 patients within 2 weeks after an ACS episode. 711 patients were followed up at 1 year after the ACS episode. SI was assessed using the relevant items of the Montgomery–Åsberg Depression Rating Scale at baseline (acute SI) and the 1-year follow-up (chronic SI). Significant individual effects of low sBDNF levels were found on acute SI. The presence of both diabetes and a low sBDNF level or the BDNF Met/Met genotype was associated with acute SI, with multivariate logistic regression analyses revealing significant interaction effects. The highest frequency of chronic SI was seen in diabetic patients with an sBDNF level in the lowest tertile or with the BDNF Met/Met genotype, although the interaction terms were not statistically significant. Our study suggests that the combination of diabetes and BDNF-related markers, such as the sBDNF level and the BDNF Val66Met polymorphism, might provide a useful predictor of acute SI in ACS patients.
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Hare MJL, Deitch JM, Kang MJY, Bach LA. Clinical, psychological and demographic factors in a contemporary adult cohort with diabetic ketoacidosis and type 1 diabetes. Intern Med J 2021; 51:1292-1297. [PMID: 32358796 DOI: 10.1111/imj.14877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/12/2020] [Accepted: 04/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a potentially life-threatening but often preventable acute complication of type 1 diabetes (T1D). Understanding clinical and psychosocial characteristics of people with DKA, particularly those with multiple presentations, may aid the development of prevention strategies. AIMS To describe clinical, psychological and demographic factors in adults with DKA and particularly those factors associated with recurrent admissions. METHODS A retrospective analysis was performed of all admissions with DKA in people with T1D over a 4-year period from 1 November 2013 to 31 October 2017 at a metropolitan tertiary hospital in Australia. Potential cases were identified by International Classification of Diseases-10th Revision coding data. Data were then manually extracted by clinicians from the electronic medical record. RESULTS There were 154 clinician-adjudicated admissions for DKA among 128 people with T1D. Of these, 16 (13%) had multiple DKA admissions. Forty-one (32%) had a history of depression. The most common factors contributing to presentation included insulin omission (54%), infection (31%), alcohol excess (26%) and new diabetes diagnosis (16%). Compared to people with single admissions, those with recurrent DKA were more likely to smoke (69% vs 27%, P = 0.003), be unemployed (31% vs 11%, P = 0.04) and use illicit substances (44% vs 17%, P = 0.02). CONCLUSIONS There is a high prevalence of psychiatric illness, illicit substance use and social disadvantage among people admitted with DKA, particularly those with recurrent presentations. Insulin omission, often due to inappropriate sick day management, was the most common reason for DKA occurrence. Innovative multidisciplinary models of care are required to address these challenges.
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Affiliation(s)
- Matthew J L Hare
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia.,Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Endocrinology Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Jessica M Deitch
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
| | - Matthew J Y Kang
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia.,Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
| | - Leon A Bach
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine (Alfred), Monash University, Melbourne, Victoria, Australia
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Petit JM, Goueslard K, Chauvet-Gelinier JC, Bouillet B, Vergès B, Jollant F, Quantin C. Association between hospital admission for ketoacidosis and subsequent suicide attempt in young adults with type 1 diabetes. Diabetologia 2020; 63:1745-1752. [PMID: 32642808 DOI: 10.1007/s00125-020-05206-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/14/2020] [Indexed: 01/22/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine the associations between hospitalisation for diabetic ketoacidosis and subsequent hospitalisation for suicide attempt in young adults with type 1 diabetes. METHODS This nationwide historical cohort study included hospital data on all young people hospitalised in France for type 1 diabetes in 2008. Epidemiological follow-up focused on hospitalisations (medical and psychiatric hospital data) from the index hospitalisation to 2017. Survival analyses were done using a Cox proportional hazards regression model to explore the association between hospitalisation for ketoacidosis and subsequent hospitalisation for a suicide attempt. RESULTS In 2008, 16,431 people aged 18-35 years had a hospitalisation mentioning type 1 diabetes. Among them, 1539 (9.4%) had at least one hospitalisation for ketoacidosis between 2008 and 2010. At 9 years, 7.2% of the group hospitalised for ketoacidosis had been hospitalised for a suicide attempt vs only 2.5% in the group not hospitalised for ketoacidosis. The association between hospitalisation for ketoacidosis and suicide attempt decreased over time and was no longer significant after 5 years. CONCLUSIONS/INTERPRETATION We found that young adults admitted to hospital for diabetic ketoacidosis have an increased risk of being admitted to hospital for a subsequent suicide attempt. The risk of a suicide attempt was the highest in the 12 months following the ketoacidosis episode. Our findings support the recommendation that screening for depression and suicide risk should be part of the routine clinical assessment of individuals with type 1 diabetes and ketoacidosis.
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Affiliation(s)
- Jean-Michel Petit
- Inserm Unit, LNC-UMR 1231, University of Burgundy, Dijon, France.
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France.
| | - Karine Goueslard
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, Dijon, France
- University of Burgundy and Franche-Comte, Dijon, France, Inserm, CIC 1432, Dijon, France
- Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
| | | | - Benjamin Bouillet
- Inserm Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France
| | - Bruno Vergès
- Inserm Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France
| | - Fabrice Jollant
- Paris-Descartes University and Sainte-Anne Hospital, Paris, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, Dijon, France
- University of Burgundy and Franche-Comte, Dijon, France, Inserm, CIC 1432, Dijon, France
- Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
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Risk of Depression and Suicidality among Diabetic Patients: A Systematic Review and Meta-Analysis. J Clin Med 2018; 7:jcm7110445. [PMID: 30453557 PMCID: PMC6262418 DOI: 10.3390/jcm7110445] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/19/2022] Open
Abstract
The purpose of this study is to conduct a systematic review and meta-analysis to evaluate the risk of depression and suicidality among diabetic patients. METHODS Medline, PubMed, EMBASE, Cochrane library, and Psych INFO were searched for studies published from 2008 onwards. Meta-analysis was conducted to estimate the pooled effect size. Sources of heterogeneity were investigated by subgroup analysis and meta-regression. RESULTS In total, 5750 articles were identified and of those, 17 studies on suicidality and 36 on depression were included in this study. Our analysis suggests a positive relationship between diabetes and depression (cohort studies odds ratio (OR) 1.49, 95% confidence interval (CI): 1.36⁻1.64 and cross-sectional studies OR 2.04, 95% CI, 1.73⁻2.42). Pooled OR values for suicidal ideation, attempted suicide, and completed suicide were 1.89 (95% CI: 1.36⁻2.63), 1.45 (95% CI: 1.07⁻1.96), and 1.85 (95% CI: 0.97⁻3.52), respectively. All findings were statistically significant except for completed suicide. CONCLUSIONS The increased risk of depression and suicidality in diabetic patients highlights the importance of integrating the evaluation and treatment of depression with diabetes management in primary healthcare settings. Further research in this area is needed.
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Gómez-Peralta TG, González-Castro TB, Fresan A, Tovilla-Zárate CA, Juárez-Rojop IE, Villar-Soto M, Hernández-Díaz Y, López-Narváez ML, Ble-Castillo JL, Pérez-Hernández N, Rodríguez-Pérez JM. Risk Factors and Prevalence of Suicide Attempt in Patients with Type 2 Diabetes in the Mexican Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1198. [PMID: 29880751 PMCID: PMC6025580 DOI: 10.3390/ijerph15061198] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND It has been proposed that the risk of death by suicide is higher in patients with diabetes than in the general population. Therefore, it is necessary to investigate the risk factors of suicidal behavior in patients with type 2 diabetes. The aim of the present study was to analyze the prevalence of suicide attempt and determine the risk factors of suicide attempt, in patients with type 2 diabetes in a Mexican population. METHODS Clinic characteristics, anthropometric measurements, biochemical levels, depression, and suicidal behavior were evaluated in 185 Mexican patients with type 2 diabetes. A multivariate logistic regression analysis was performed to find predictive factors of suicide attempt. RESULTS 11.4% of patients reported previous suicide attempts n = 21). Younger patients (OR: 3.63, 95% CI: 1.29⁻10.19), having depression (OR: 3.33, 95% CI: 1.13⁻9.76) and normal BMI (OR: 3.14, 95% CI: 1.11⁻8.83), were predictive factors of suicide attempt. No other variables in the study showed statistical significance. CONCLUSIONS Our results showed a high prevalence of suicidal behavior in patients with type 2 diabetes. We found that younger age, depression and normal BMI could be risk factors of suicide attempt in these patients. Therefore, psychiatric interventions to prevent depression and suicidal behavior in this population are necessary. New studies using larger samples are necessary to replicate and confirm these results.
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Affiliation(s)
- Tania Guadalupe Gómez-Peralta
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86025, Tabasco, Mexico.
| | - Thelma Beatriz González-Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez 86200, Tabasco, Mexico.
| | - Ana Fresan
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de Mexico 14370, Mexico.
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86025, Tabasco, Mexico.
| | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86140, Tabasco, Mexico.
| | - Mario Villar-Soto
- Hospital de Alta Especialidad "Gustavo A. Rovirosa Pérez", Secretaría de Salud, Villahermosa 86140, Tabasco, Mexico.
| | - Yazmín Hernández-Díaz
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez 86200, Tabasco, Mexico.
| | - María Lilia López-Narváez
- Hospital General de Yajalón "Dr. Manuel Velasco Suarez", Secretaría de Salud, Yajalón 29930, Chiapas, Mexico.
| | - Jorge L Ble-Castillo
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86140, Tabasco, Mexico.
| | - Nonanzit Pérez-Hernández
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de Mexico 14080, Mexico.
| | - José Manuel Rodríguez-Pérez
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de Mexico 14080, Mexico.
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12
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Hagger V, Hendrieckx C, Cameron F, Pouwer F, Skinner TC, Speight J. Diabetes distress is more strongly associated with HbA1c than depressive symptoms in adolescents with type 1 diabetes: Results from Diabetes MILES Youth-Australia. Pediatr Diabetes 2018; 19:840-847. [PMID: 29383803 DOI: 10.1111/pedi.12641] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/11/2017] [Accepted: 12/22/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Glycated hemoglobin (HbA1c) is higher during adolescence than at any other life stage. Some research among adolescents indicates that depressive symptoms are associated with suboptimal HbA1c. However, research among adults suggests diabetes distress is a stronger predictor of HbA1c than depressive symptoms. OBJECTIVE To determine the relative contributions of depressive symptoms and diabetes distress to explain the variance in HbA1c among adolescents with type 1 diabetes. PARTICIPANTS AND METHODS Diabetes MILES Youth Study respondents aged 13 to 19 years completed questionnaires assessing depressive symptoms (Patient Health Questionnaire for Adolescents: PHQA-8), diabetes distress (Problem Areas in Diabetes-Teen version: PAID-T), and self-reported socio-demographic and clinical variables, including their most recent HbA1c. Stepwise hierarchical multiple regression was conducted to examine the contributions of depressive symptoms and diabetes distress to HbA1c. RESULTS Participants (N = 450) had a (mean ± SD) age of 15.7 ± 1.9 years; diabetes duration of 6.9 ± 4.3 years; and 38% (n = 169) were male. Twenty-one percent (n = 96) experienced moderate-to-severe depressive symptoms (PHQA-8 ≥ 11) and 36% (n = 162) experienced high diabetes distress (PAID-T > 90). In the final regression model, HbA1c was explained by: diabetes duration (β = .14, P = .001), self-monitoring of blood glucose (β = -.20, P < .001), and diabetes distress (β = .30, P < .001). Following the addition of diabetes distress, depressive symptoms were no longer significantly associated with HbA1c (P = .551). The final model explained 18% of the variance in HbA1c. CONCLUSIONS Consistent with evidence from studies among adults, diabetes distress mediated the relationship between depressive symptoms and HbA1c among adolescents with type 1 diabetes. These findings suggest that clinicians need to be aware of diabetes distress.
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Affiliation(s)
- Virginia Hagger
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Christel Hendrieckx
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Fergus Cameron
- Royal Children's Hospital and Murdoch Children's Research Institute, Melbourne, Australia
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Timothy C Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Jane Speight
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia.,AHP Research, Hornchurch, UK
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13
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Mansur RB, Lee Y, Subramaniapillai M, Brietzke E, McIntyre RS. Cognitive dysfunction and metabolic comorbidities in mood disorders: A repurposing opportunity for glucagon-like peptide 1 receptor agonists? Neuropharmacology 2018; 136:335-342. [PMID: 29481915 DOI: 10.1016/j.neuropharm.2018.01.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 12/14/2022]
Abstract
Major depressive disorder and bipolar disorder are highly prevalent and disabling conditions. Cognition is considered a core domain of their psychopathology and a principle mediator of psychosocial impairment, disproportionately accounting for overall illness-associated costs. There are few interventions with replicated evidence of efficacy in treating cognitive deficits in mood disorders. Evidence also indicates that cognitive deficits are associated with obesity and involve significant impairment across multiple domains. Conversely, weight-loss interventions, such as physical exercise and bariatric surgery, have been shown to beneficially affect cognitive function. This convergent phenomenology suggests that currently available agents that target metabolic systems may also be capable of mitigating deficits in cognitive functions, and are, therefore, candidates for repurposing. The incretin glucagon-like peptide-1 (GLP-1) is a hormone secreted by intestinal epithelial cells. GLP-1 receptors (GLP-1R) are widely expressed in the central nervous system. Activation of GLP-1R leads to facilitation of glucose utilization and antiapoptotic effects in various organs. Pre-clinical trials have demonstrated significant neuroprotective effects of GLP-1, including protection from cell death, promotion of neuronal differentiation and proliferation; and facilitation of long-term potentiation. Liraglutide is a GLP-1R agonist that has been approved for the treatment of type 2 diabetes mellitus and obesity. Convergent preclinical and clinical evidence, including a proof-of-concept pilot study from group, has suggested that liraglutide may improve objective measures of cognitive function in adults with mood disorders. The safety and availability of GLP-1R agonists indicate that they are promising candidates for repurposing, and that they may be viable therapeutic options for mood disorders. This article is part of the Special Issue entitled 'Metabolic Impairment as Risk Factors for Neurodegenerative Disorders.'
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Affiliation(s)
- Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; University of Toronto, Toronto, Canada.
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Elisa Brietzke
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; University of Toronto, Toronto, Canada
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14
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Ferløv-Schwensen C, Brix TH, Hegedüs L. Death by Suicide in Graves' Disease and Graves' Orbitopathy: A Nationwide Danish Register Study. Thyroid 2017; 27:1475-1480. [PMID: 29084476 DOI: 10.1089/thy.2017.0365] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Graves' disease (GD) is associated with excess morbidity and mortality, but little is known about unnatural manners of death and the potential relation with Graves' orbitopathy (GO). This study investigated the risk of unnatural death in Graves' patients with and without orbitopathy compared to matched control populations. METHODS This was a cohort study covering all adult Danes (≥18 years) diagnosed with GD or GO during 1995-2012. Median follow-up time was 7.9 years (range 0-17.5 years). Utilizing the Danish Register of Causes of Death and the Danish National Patient Registry, 28,461 subjects with GD and 3965 with GO were identified and matched for age and sex with four subjects from the background population. The manner of death was identified, and hazard ratios (HR) for mortality due to unnatural deaths (accident, suicide, violence/homicide, and unknown) were calculated using Cox regression analyses, adjusted for pre-existing somatic and psychiatric morbidity. RESULTS In Graves' disease overall (GD + GO), there was an increased risk of death from unknown unnatural manners (HR = 2.01 [confidence interval (CI) 1.17-3.45], p = 0.012) and of suicide, although the latter difference was not with certainty statistically significant (HR = 1.43 [CI 1.00-2.04], p = 0.053). There was no significant difference in risk of death from suicide in GD subjects compared to their controls (HR = 1.27 [CI 0.85-1.89], p = 0.253). However, GO patients had a significantly higher risk of death from suicide (HR = 2.71 [CI 1.16-6.32], p = 0.022). CONCLUSIONS Mortality by suicide was increased in Graves' disease overall, most significantly in patients with GO, also after adjustment for pre-existing somatic and psychiatric disease. These findings indicate that GD and GO may have a significant role in the pathophysiological mechanisms of suicidal behavior. Beyond independent confirmation, reasons for this need to be explored in order to introduce preventive measures.
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Affiliation(s)
| | - Thomas Heiberg Brix
- Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark
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15
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Tabb KM, Perez-Flores N, Wang Y, Huang H. The burden of suicidal ideation among persons with type II diabetes: A scoping review. J Psychosom Res 2017; 103:113-118. [PMID: 29167037 DOI: 10.1016/j.jpsychores.2017.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Diabetes is a major global health concern. People with diabetes have worse mental health outcomes than those without diabetes. Researchers have recently sought to examine the relationship between diabetes and suicidal ideation. The aim of this study is to determine the burden of suicidal ideation among adults with type II diabetes from existing literature. METHODS We conducted a scoping review of published literature in PubMed, PsycINFO, CINAHL, Web of Science, and Google Scholar published before March 2017. To identify relevant literature, search terms included suicidal ideation and type II diabetes. The search was limited to English language peer-reviewed journal articles. The main outcome of interest was suicidal ideation captured on a validated scale in a population with type II diabetes. RESULTS This review resulted in 10 relevant studies, which reported the prevalence of suicidal ideation ranging from 2.5-51.4% with a median prevalence of 18.6% among adults with diabetes. Across the five studies reporting the associated risks, all but one study found a significant risk for persons with diabetes to endorse suicidal ideation and only three studies adjusted for depression. CONCLUSIONS This review demonstrates the need for future studies to investigate potential mechanistic pathways of suicidality among persons with diabetes.
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Affiliation(s)
- Karen M Tabb
- University of Illinois at Urbana-Champaign, School of Social Work, Urbana, IL, United States; Identifying Depression through Early Assessment (IDEA) Research Team, University of Illinois at Urbana-Champaign, United States.
| | - Nancy Perez-Flores
- University of Illinois at Urbana-Champaign, School of Social Work, Urbana, IL, United States; Identifying Depression through Early Assessment (IDEA) Research Team, University of Illinois at Urbana-Champaign, United States
| | - Yang Wang
- University of Illinois at Urbana-Champaign, School of Social Work, Urbana, IL, United States; Identifying Depression through Early Assessment (IDEA) Research Team, University of Illinois at Urbana-Champaign, United States
| | - Hsiang Huang
- Identifying Depression through Early Assessment (IDEA) Research Team, University of Illinois at Urbana-Champaign, United States; Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States; Institute of Psychiatry & LIM-23, Faculty of Medicine, University of São Paulo, Brazil
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16
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Hagger V, Hendrieckx C, Cameron F, Pouwer F, Skinner TC, Speight J. Cut Points for Identifying Clinically Significant Diabetes Distress in Adolescents With Type 1 Diabetes Using the PAID-T: Results From Diabetes MILES Youth-Australia. Diabetes Care 2017; 40:1462-1468. [PMID: 28882887 DOI: 10.2337/dc17-0441] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/12/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To establish cut point(s) for the Problem Areas in Diabetes-teen version (PAID-T) scale to identify adolescents with clinically meaningful, elevated diabetes distress. RESEARCH DESIGN AND METHODS Data were available from the Diabetes Management and Impact for Long-term Empowerment and Success (MILES) Youth-Australia Study, a national survey assessing various psychosocial indicators among self-selected National Diabetes Services Scheme registrants. Participants in the current study (n = 537) were (mean ± SD) 16 ± 2 years old, had type 1 diabetes for 6 ± 4 years, and 62% (n = 334) were girls. They completed measures of diabetes distress (PAID-T) and depressive symptoms (Patient Health Questionnaire for Adolescents) and self-reported their most recent HbA1c and frequency of self-monitoring of blood glucose (SMBG). Relationships between the PAID-T and the psychological and clinical variables were examined to identify a clinically meaningful threshold for elevated diabetes distress. ANOVA was used to test whether these variables differed by levels of distress. RESULTS Two cut points distinguished none-to-mild (<70), moderate (70-90), and high (>90) diabetes distress. Moderate distress was experienced by 18% of adolescents and high distress by 36%. Mean depressive symptoms, self-reported HbA1c, and SMBG differed significantly across the three levels of diabetes distress (all P < 0.001), with moderate-to-large effect sizes. CONCLUSIONS Using the PAID-T, this study defined two clinically meaningful cut points to distinguish none-to-mild, moderate, and high diabetes distress in adolescents (aged 13-19). Based on these cut points, most respondents experienced at least moderate diabetes distress, which was clinically significant. Establishing thresholds for elevated diabetes distress will aid clinicians and researchers to interpret PAID-T scores, prompt discussion and intervention for those with unmet needs, and enable the effectiveness of interventions to be evaluated.
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Affiliation(s)
- Virginia Hagger
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Victoria, Australia .,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Christel Hendrieckx
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Victoria, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Fergus Cameron
- Royal Children's Hospital and Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Timothy C Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jane Speight
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Victoria, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia.,Applied Health Psychology Research, Hornchurch, Essex, U.K
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17
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Wang B, An X, Shi X, Zhang JA. MANAGEMENT OF ENDOCRINE DISEASE: Suicide risk in patients with diabetes: a systematic review and meta-analysis. Eur J Endocrinol 2017; 177:R169-R181. [PMID: 28512134 DOI: 10.1530/eje-16-0952] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 05/09/2017] [Accepted: 05/16/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous studies investigating the risk of suicide in diabetes patients reported controversial findings. We did a systematic review and meta-analysis to comprehensively estimate the risk and incidence rate of suicide in diabetic patients. METHODS PubMed, EMBASE and PsycINFO were searched for eligible studies. Random-effects meta-analysis was used to calculate the relative risk (RR) and the incidence rate of suicide in diabetes patients. We also calculated the proportion of deaths attributable to suicide among diabetes patients. RESULTS 54 studies were finally included, including 28 studies on the suicide risk associated with diabetes, 47 studies on the incidence rate of suicide and 45 studies on the proportion of deaths attributable to suicide. Meta-analysis showed that diabetes could significantly increase the risk of suicide (RR = 1.56; 95% CI: 1.29-1.89; P < 0.001). Subgroup analysis showed that the RR of suicide associated with type 1 diabetes was 2.25 (95% CI: 1.50-3.38; P < 0.001). The pooled incidence rate of suicide in patients with diabetes was 2.35 per 10 000 person-years (95% CI: 1.51-3.64). The pooled proportions of long-term deaths attributable to suicide in type 1 diabetes patients and type 2 diabetes patients were 7.7% (95% CI: 6.0-9.8) and 1.3% (95% CI: 0.6-2.6), respectively. CONCLUSION This meta-analysis suggests that diabetes can significantly increase the risk of suicide. Suicide has an obvious contribution to mortality in diabetic patients, especially among type 1 diabetes patients. Effective strategies to decrease suicide risk and improve mental health outcomes in diabetes patients are needed.
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Affiliation(s)
- Bin Wang
- Department of EndocrinologyJinshan Hospital of Fudan University, Shanghai, China
| | - Xiaofei An
- Department of EndocrinologyJinshan Hospital of Fudan University, Shanghai, China
| | - Xiaohong Shi
- Department of EndocrinologyJinshan Hospital of Fudan University, Shanghai, China
| | - Jin-An Zhang
- Department of EndocrinologyJinshan Hospital of Fudan University, Shanghai, China
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18
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Conti C, Mennitto C, Di Francesco G, Fraticelli F, Vitacolonna E, Fulcheri M. Clinical Characteristics of Diabetes Mellitus and Suicide Risk. Front Psychiatry 2017; 8:40. [PMID: 28348533 PMCID: PMC5346593 DOI: 10.3389/fpsyt.2017.00040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/27/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a chronic illness with impaired health-related quality of life and a high risk of psychiatric disorders. We carried out a systematic review analyzing the relationship between DM and suicide by providing a qualitative data synthesis of the studies. METHODS We conducted, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of the literature in PubMed, Scopus, ISI Web of Science, PsycINFO, Google Scholar, and ScienceDirect. Search terms were "suicid*" combined with the Boolean "AND" operator with "diabetes." RESULTS The initial search identified 568 citations. A total of 17 research reports met the predefined inclusion criteria and were analyzed. DM was found to be significantly associated with a marked increase in suicidal behaviors and suicidal ideation (SI), especially in patients with depressive symptoms. Insulin therapy, DM of long duration, and unsatisfactory glycemic control were identified as risk factors for SI in Type 1 (T1DM) and Type 2 (T2DM). CONCLUSION Health-care professionals need to be aware of the higher suicidal risk in patient subgroups based on the clinical characteristics of DM; thus, patients with these characteristics warrant special attention. In this regard, clinical management should include efforts to manage emotional distress in DM care.
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Affiliation(s)
- Chiara Conti
- Department of Psychological, Health, and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Chiara Mennitto
- Department of Psychological, Health, and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Giulia Di Francesco
- Department of Psychological, Health, and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Federica Fraticelli
- Department of Medicine and Aging, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Ester Vitacolonna
- Department of Medicine and Aging, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Mario Fulcheri
- Department of Psychological, Health, and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
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19
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Browne JL, Holmes-Truscott E, Ventura AD, Hendrieckx C, Pouwer F, Speight J. Cohort profiles of the cross-sectional and prospective participant groups in the second Diabetes MILES-Australia (MILES-2) study. BMJ Open 2017; 7:e012926. [PMID: 28246132 PMCID: PMC5337738 DOI: 10.1136/bmjopen-2016-012926] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 01/04/2023] Open
Abstract
PURPOSE More research into the psychosocial aspects of diabetes is needed so that the health and quality of life of people with the condition can be improved. To fill this gap, we conducted the second Diabetes MILES-Australia study (MILES-2), a survey focused on psychological, behavioural and social aspects of diabetes. The aim of the MILES-2 study was to provide a (1) longitudinal follow-up of the original MILES 2011 study cohort; (2) cross-sectional assessment of a new cohort. PARTICIPANTS Eligible participants were English-speaking Australians with type 1 or type 2 diabetes, aged 18-75 years. Longitudinal cohort participants were mailed/emailed study invitations directly by researchers. Random sampling (stratified by diabetes type, insulin use, state) of the National Diabetes Services Scheme (NDSS) database and nationwide advertisements were used to recruit new cohort participants. The final sample included N=2342 eligible respondents (longitudinal cohort: n=504; 2015 new cohort: n=1838); 54% had type 2 diabetes. FINDINGS TO DATE Survey respondents were from an advantaged socioeconomic background compared to the general population. Respondents with type 1 diabetes were over-represented in the new cohort (45%) relative to the planned stratification (40% type 1 diabetes, 60% type 2 diabetes). Respondents with insulin-treated type 2 diabetes were under-represented in the new cohort relative to the stratified sampling (42% invited vs 50% response). Participants who completed both the 2011 and 2015 surveys were more likely than those completing the 2011 survey only to have type 1 diabetes, report a higher education and annual income, and live in metropolitan areas. Participant feedback indicated that the survey was perceived as relevant and valuable. FUTURE PLANS The depth and breadth of the data available in this large sample will highlight unmet needs and priority areas for future investigation and, crucially, will inform policy, programme and intervention development and evaluation in Australia.
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Affiliation(s)
- Jessica L Browne
- School of Psychology, Deakin University, Geelong, VictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, VictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Adriana D Ventura
- School of Psychology, Deakin University, Geelong, VictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Frans Pouwer
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
- AHP Research, Hornchurch, Essex, UK
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20
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Mansur RB, Ahmed J, Cha DS, Woldeyohannes HO, Subramaniapillai M, Lovshin J, Lee JG, Lee JH, Brietzke E, Reininghaus EZ, Sim K, Vinberg M, Rasgon N, Hajek T, McIntyre RS. Liraglutide promotes improvements in objective measures of cognitive dysfunction in individuals with mood disorders: A pilot, open-label study. J Affect Disord 2017; 207:114-120. [PMID: 27721184 DOI: 10.1016/j.jad.2016.09.056] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/16/2016] [Accepted: 09/06/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is a paucity of treatments that are capable of reliably and robustly improving cognitive function in adults with mood disorders. Glucagon-like peptide-1 is synthesized centrally and its receptors are abundantly expressed in neural circuits subserving cognitive function. We aimed to determine the effects of liraglutide, a GLP-1 receptor (GLP-1R) agonist, on objective measures of cognition in adults with a depressive or bipolar disorder. METHODS In this 4-week, pilot, open-label, domain-based study (e.g. cognition), we recruited 19 individuals with major depressive disorder (MDD) or bipolar disorder (BD) and an impairment in executive function, defined as a below-average performance in the Trail Making Test-B (TMTB). Liraglutide 1.8mg/day was added as an adjunct to existing pharmacotherapy. RESULTS Participants had significant increases from baseline to week 4 in the TMTB standard score (age and education corrected) (Cohen's d=0.64, p=0.009) and in a composite Z-score comprising multiple cognitive tests (i.e. Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, Stroop test) (Cohen's d=0.77, p<0.001). Neither changes in mood rating scales nor metabolic parameters were associated with changes in cognitive performance (all p>0.05); however baseline insulin resistance (IR) and body mass index (BMI) moderated the changes in the composite Z-score (p=0.021 and p=0.046, respectively), indicating larger responses in individuals with higher IR and BMI at baseline. There was a significant increase in lipase (p<0.001), but individual values were above the upper limit of normality. LIMITATIONS Small sample size, open-label design, lack of a placebo group. CONCLUSIONS Liraglutide was safe and well tolerated by a sample of non-diabetic individuals with mood disorders and had beneficial effects on objective measures of cognitive function. Larger studies with controlled trial designs are necessary to confirm and expand the results described herein.
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Affiliation(s)
- Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Research Group in Molecular and Behavioral Neuroscience of Bipolar Disorder, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Juhie Ahmed
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Hanna O Woldeyohannes
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Julie Lovshin
- Division of Endocrinology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Jung G Lee
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea
| | - Jae-Hon Lee
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Department of Psychiatry, Samsung Seoul Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Elisa Brietzke
- Research Group in Molecular and Behavioral Neuroscience of Bipolar Disorder, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Kang Sim
- Research Division, Institute of Mental Health, Singapore
| | - Maj Vinberg
- Psychiatric Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Natalie Rasgon
- Department of Psychiatry, Stanford University, Palo Alto, CA, United States
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
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Affiliation(s)
- Gemma C Macdonald
- Diabetes Centre, St Vincent's Hospital, Sydney, NSW 2010, Australia.
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