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Barnard-Kelly K, Marrero D, de Wit M, Pouwer F, Khunti K, Hermans N, Pierce JS, Laffel L, Holt RIG, Battelino T, Naranjo D, Fosbury J, Fisher L, Polonsky W, Weissberg-Benchell J, Hood KK, Schnell O, Messer LH, Danne T, Nimri R, Skovlund SE, Mader JK, Sherr JL, Schatz D, O'Neill S, Doble E, Town M, Lange K, de Beaufort C, Gonder-Frederick L, Jaser SS, Liberman A, Klonoff D, ElSayed NA, Bannuru RR, Parkin CG, Snoek F. Towards the standardisation of adult person-reported outcome domains in diabetes research: A Consensus Statement development panel. Diabet Med 2024; 41:e15332. [PMID: 38751219 DOI: 10.1111/dme.15332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 07/23/2024]
Abstract
Diabetes is unique among chronic diseases because clinical outcomes are intimately tied to how the person living with diabetes reacts to and implements treatment recommendations. It is further characterised by widespread social stigma, judgement and paternalism. This physical, social and psychological burden collectively influences self-management behaviours. It is widely recognised that the individual's perspective about the impact of trying to manage the disease and the burden that self-management confers must be addressed to achieve optimal health outcomes. Standardised, rigorous assessment of mental and behavioural health status, in interaction with physical health outcomes is crucial to aid understanding of person-reported outcomes (PROs). Whilst tempting to conceptualise PROs as an issue of perceived quality of life (QoL), in fact health-related QoL is multi-dimensional and covers indicators of physical or functional health status, psychological and social well-being. This complexity is illuminated by the large number of person reported outcome measures (PROMs) that have been developed across multiple psychosocial domains. Often measures are used inappropriately or because they have been used in the scientific literature rather than based on methodological or outcome assessment rigour. Given the broad nature of psychosocial functioning/mental health, it is important to broadly define PROs that are evaluated in the context of therapeutic interventions, real-life and observational studies. This report summarises the central themes and lessons derived in the assessment and use of PROMs amongst adults with diabetes. Effective assessment of PROMs routinely in clinical research is crucial to understanding the true impact of any intervention. Selecting appropriate measures, relevant to the specific factors of PROs important in the research study will provide valuable data alongside physical health data.
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Affiliation(s)
| | | | | | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Norbert Hermans
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Mergentheim, Germany
| | - Jessica S Pierce
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Orlando, Florida, USA
| | - Lori Laffel
- Joslin Diabetes Center, Boston, Massachusetts, USA
| | | | - Tadej Battelino
- Faculty of Medicine, University Medical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Diana Naranjo
- Stanford University School of Medicine, San Francisco, California, USA
| | | | - Lawrence Fisher
- University of California San Francisco, San Francisco, California, USA
| | | | - Jill Weissberg-Benchell
- Pritzker Department of Psychiatry and Behavioral Health, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Korey K Hood
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Laurel H Messer
- Barbara Davis Center, University of Colorado, Boulder, Colorado, USA
- Tandem Diabetes Care, San Diego, California, USA
| | - Thomas Danne
- Diabetes-Center for Children and Adolescents, Hannover, Germany
| | - Revital Nimri
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Israel and Sacker Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Desmond Schatz
- Diabetes Institute, University of Florida College of Medicine, Gainesville, Florida, USA
- American Diabetes Association, Gainesville, Florida, USA
| | | | | | - Marissa Town
- Children with Diabetes, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Karin Lange
- Hannover Medical School, Department Medical Psychology, Hannover, Germany
| | - Carine de Beaufort
- Centre Hospitalier de Luxembourg, GD de Luxembourg, Technology and Medicine, University of Luxembourg, Luxembourg, Belgium
| | - Linda Gonder-Frederick
- Center for Diabetes Technology, Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Sarah S Jaser
- Vanderbilt University Medical Center, Department of Pediatrics, Nashville, Tennessee, USA
| | - Alon Liberman
- Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
| | - David Klonoff
- Mills-Peninsula Medical Center, San Mateo, California, USA
| | - Nuha A ElSayed
- Health Care Improvement, American Diabetes Association, Arlington, Virginia, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Raveendhara R Bannuru
- Medical Affairs and QI Outcomes, American Diabetes Association, Arlington, Virginia, USA
| | | | - Frank Snoek
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Psychology, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health, Amsterdam, The Netherlands
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Alqahtani YA, Shati AA, Alhawyan FS, Alhanshani AA, Al-Garni AM, Al-Qahtani SM, Alshehri MA. Assessment of depression in children and adolescents with Type 1 diabetes mellitus: Impact and intervention strategies. Medicine (Baltimore) 2024; 103:e38868. [PMID: 39029074 DOI: 10.1097/md.0000000000038868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
Depression is a common comorbidity in children and adolescents with type 1 diabetes mellitus (T1DM), yet its prevalence, impact, and intervention strategies remain underexplored. This study aims to assess the prevalence of depression among children and adolescents with T1DM, investigate its impact on health outcomes, and explore potential intervention strategies. A convenient sampling method was employed to recruit 229 participants aged 6 to 18 years from a single center. Data collection involved validated assessments, demographic surveys, and diabetes-related factor examinations during routine clinic visits. The patient health questionnaire-9 was utilized to evaluate the severity of depressive symptoms. Associations between depression and sociodemographic variables, diabetes management factors, and health behaviors were analyzed using chi-squared tests and logistic regression analysis. The prevalence of depression among participants was 43.23%. Older age, lower parental education levels, lower household income, smoking, and comorbidities were identified as significant risk factors for depression. Associations were found between depression and diabetes management factors, including glycemic control and frequency of glucose monitoring. Depression is highly prevalent among children and adolescents with T1DM and is associated with sociodemographic factors, health behaviors, and diabetes management. Integrated approaches to care that address both physical and mental health aspects are crucial for improving outcomes in this population.
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Affiliation(s)
- Youssef A Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ayed A Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Fatimah S Alhawyan
- Department of Internal Medicine, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ahmad A Alhanshani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Abdulaziz M Al-Garni
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Saleh M Al-Qahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Mohammed A Alshehri
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Gillett AC, Hagenaars SP, Handley D, Casanova F, Young KG, Green H, Lewis CM, Tyrrell J. The impact of major depressive disorder on glycaemic control in type 2 diabetes: a longitudinal cohort study using UK Biobank primary care records. BMC Med 2024; 22:211. [PMID: 38807170 PMCID: PMC11134616 DOI: 10.1186/s12916-024-03425-9] [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: 05/12/2023] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND This study evaluates longitudinal associations between glycaemic control, measured by mean and within-patient variability of glycated haemaglobin (HbA1c) levels, and major depressive disorder (MDD) in individuals with type 2 diabetes (T2D), focusing on the timings of these diagnoses. METHODS In UK Biobank, T2D was defined using self-report and linked health outcome data, then validated using polygenic scores. Repeated HbA1c measurements (mmol/mol) over the 10 years following T2D diagnosis were outcomes in mixed effects models, with disease duration included using restricted cubic splines. Four MDD exposures were considered: MDD diagnosis prior to T2D diagnosis (pre-T2D MDD), time between pre-T2D MDD diagnosis and T2D, new MDD diagnosis during follow-up (post-T2D MDD) and time since post-T2D MDD diagnosis. Models with and without covariate adjustment were considered. RESULTS T2D diagnostic criteria were robustly associated with T2D polygenic scores. In 11,837 T2D cases (6.9 years median follow-up), pre-T2D MDD was associated with a 0.92 increase in HbA1c (95% CI: [0.00, 1.84]), but earlier pre-T2D MDD diagnosis correlated with lower HbA1c. These pre-T2D MDD effects became non-significant after covariate adjustment. Post-T2D MDD individuals demonstrated increasing HbA1c with years since MDD diagnosis ( β = 0.51 , 95% CI: [0.17, 0.86]). Retrospectively, across study follow-up, within-patient variability in HbA1c was 1.16 (95% CI: 1.13-1.19) times higher in post-T2D MDD individuals. CONCLUSIONS The timing of MDD diagnosis is important for understanding glycaemic control in T2D. Poorer control was observed in MDD diagnosed post-T2D, highlighting the importance of depression screening in T2D, and closer monitoring for individuals who develop MDD after T2D.
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Affiliation(s)
- Alexandra C Gillett
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK.
| | - Saskia P Hagenaars
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Dale Handley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Francesco Casanova
- Clinical and Biomedical Science, Institute of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Katherine G Young
- Clinical and Biomedical Science, Institute of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Harry Green
- Clinical and Biomedical Science, Institute of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Jess Tyrrell
- Clinical and Biomedical Science, Institute of Health and Life Sciences, University of Exeter, Exeter, UK
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Cherrington AL, Bebu I, Krause-Steinrauf H, Hoogendoorn CJ, Crespo-Ramos G, Presley C, Naik AD, Balasubramanyam A, Gramzinski MR, Killean T, Arends VL, Gonzalez JS. Does Emotional Distress Predict Worse Glycemic Control Over Time? Results From the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care 2024; 47:620-628. [PMID: 38252848 PMCID: PMC10973910 DOI: 10.2337/dc23-0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/09/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To evaluate whether baseline levels of depressive symptoms and diabetes-specific distress are associated with glycemic control in Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), a large randomized controlled trial comparing the metabolic effects of four common glucose-lowering medications when combined with metformin in individuals with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS The primary and secondary outcomes were defined as an HbA1c value ≥7%, subsequently confirmed, and an HbA1c value >7.5%, subsequently confirmed, respectively. Separate Cox proportional hazards models assessed the association between baseline levels of each exposure of interest (depressive symptoms measured with the eight-item Patient Health Questionnaire and diabetes distress measured with the Diabetes Distress Scale) and the subsequent risk of metabolic outcomes. RESULTS This substudy included 1,739 participants (56% of whom were non-Hispanic White, 18% non-Hispanic Black, 17% Hispanic, and 68% male; mean [SD] age 58.0 [10.2] years, diabetes duration 4.2 [2.8] years, and HbA1c 7.5% [0.48%]). A total of 1,157 participants reached the primary outcome, with time to event of 2.1 years on average, while 738 participants reached the secondary outcome at 3 years on average. With adjustment for sex, race/ethnicity, treatment group, baseline age, duration of T2DM, BMI, and HbA1c, there were no significant associations between the depressive symptoms or diabetes distress and the subsequent risk of the primary or secondary outcomes. CONCLUSIONS The current findings suggest that, at least for individuals with diabetes of relatively short duration, baseline levels of emotional distress are not associated with glycemic control over time.
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Affiliation(s)
- Andrea L. Cherrington
- General Internal and Preventive Medicine, Department of Medicine, University of Alabama, Birmingham, Birmingham, AL
| | - Ionut Bebu
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Heidi Krause-Steinrauf
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Claire J. Hoogendoorn
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Gladys Crespo-Ramos
- Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Caroline Presley
- Division of Preventative Medicine, University of Alabama, Birmingham, AL
| | - Aanand D. Naik
- University of Texas Health Science Center (UTHealth) School of Public Health, Houston, TX
| | - Ashok Balasubramanyam
- University of Texas Health Science Center (UTHealth) School of Public Health, Houston, TX
| | - Michaela R. Gramzinski
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Tina Killean
- Obesity and Diabetes Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Valerie L. Arends
- Advanced Research and Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Jeffrey S. Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
- New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY
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Gonzalez JS, Bebu I, Krause-Steinrauf H, Hoogendoorn CJ, Crespo-Ramos G, Presley C, Naik AD, Kuo S, Johnson ML, Wexler D, Crandall JP, Bantle AE, Arends V, Cherrington AL. Differential Effects of Type 2 Diabetes Treatment Regimens on Diabetes Distress and Depressive Symptoms in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care 2024; 47:610-619. [PMID: 38416773 PMCID: PMC10973899 DOI: 10.2337/dc23-2459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/19/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE We evaluated whether adding basal insulin to metformin in adults with early type 2 diabetes mellitus (T2DM) would increase emotional distress relative to other treatments. RESEARCH DESIGN AND METHODS The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) of adults with T2DM of <10 years' duration, HbA1c 6.8-8.5%, and taking metformin monotherapy randomly assigned participants to add insulin glargine U-100, sulfonylurea glimepiride, the glucagon-like peptide-1 receptor agonist liraglutide, or the dipeptidyl peptidase 4 inhibitor sitagliptin. The Emotional Distress Substudy enrolled 1,739 GRADE participants (mean [SD] age 58.0 [10.2] years, 32% female, 56% non-Hispanic White, 18% non-Hispanic Black, 17% Hispanic) and assessed diabetes distress and depressive symptoms every 6 months. Analyses examined differences at 1 year and over the 3-year follow-up. RESULTS Across treatments, diabetes distress (-0.24, P < 0.0001) and depressive symptoms (-0.67, P < 0.0001) decreased over 1 year. Diabetes distress was lower at 1 year for the glargine group than for the other groups combined (-0.10, P = 0.002). Diabetes distress was also lower for liraglutide than for glimepiride or sitagliptin (-0.10, P = 0.008). Over the 3-year follow-up, there were no significant group differences in total diabetes distress; interpersonal diabetes distress remained lower for those assigned to liraglutide. No significant differences were observed for depressive symptoms. CONCLUSIONS Contrary to expectations, this randomized trial found no evidence for a deleterious effect of basal insulin on emotional distress. Glargine lowered diabetes distress modestly at 1 year rather than increasing it. Liraglutide also reduced diabetes distress at 1 year. Results can inform treatment decisions for adults with early T2DM.
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Affiliation(s)
- Jeffrey S. Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Division of Endocrinology and Fleischer Institute for Diabetes and Metabolism, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY
- New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Ionut Bebu
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Claire J. Hoogendoorn
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Division of Endocrinology and Fleischer Institute for Diabetes and Metabolism, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Gladys Crespo-Ramos
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Division of Endocrinology and Fleischer Institute for Diabetes and Metabolism, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Caroline Presley
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Aanand D. Naik
- School of Public Health, University of Texas Health Science Center, Houston, TX
| | - Shihchen Kuo
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | | | - Deborah Wexler
- Diabetes Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jill P. Crandall
- Division of Endocrinology and Fleischer Institute for Diabetes and Metabolism, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Anne E. Bantle
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Valerie Arends
- Advanced Research and Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Andrea L. Cherrington
- Department of Medicine (General Internal and Preventive Medicine), University of Alabama at Birmingham, Birmingham, AL
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Hermanns N, Kulzer B, Ehrmann D. Person-reported outcomes in diabetes care: What are they and why are they so important? Diabetes Obes Metab 2024; 26 Suppl 1:30-45. [PMID: 38311448 DOI: 10.1111/dom.15471] [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: 11/26/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/06/2024]
Abstract
In this review, we aim to show how person-reported outcomes (PROs) and person-reported experiences (PREs) can significantly contribute to the way diabetes care is delivered, the involvement of people with diabetes in diabetes care, and the collaboration between health care professionals and people with diabetes. This review focuses on the definition and measurement of PROs and PREs, the importance of PROs and PREs for person-centred diabetes care, and integrating the perspectives of people with diabetes in the evaluation of medical, psychological and technological interventions. PROs have been increasingly accepted by Health Technology Assessment bodies and are therefore valued in the context of reimbursement decisions and consequently by regulators and other health care stakeholders for the allocation of health care resources. Furthermore, the review identified current challenges to the assessment and use of PROs and PREs in clinical care and research. These challenges relate to the combination of questionnaires and ecological momentary assessment for measuring PROs and PREs, lack of consensus on a core outcome set, limited sensitivity to change within many measures and insufficient standardization of what can be considered a minimal clinically important difference. Another issue that has not been sufficiently addressed is the involvement of people with diabetes in the design and development of measures to assess PROs and PREs.
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Affiliation(s)
- Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
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Schmitt A, Beran M, Geraets A, Iversen MM, Nefs G, Nouwen A, Pouwer F, Huber JW, Schram MT. Associations between HbA1c Reduction and Change in Depressive Symptoms following Glucose-lowering Treatment in Adults: A Systematic Review of Intervention Studies. Curr Diabetes Rev 2024; 20:e020623217607. [PMID: 37278034 DOI: 10.2174/1573399820666230602124223] [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: 11/07/2022] [Revised: 04/18/2023] [Accepted: 05/03/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Hyperglycemia constitutes a likely pathway linking diabetes and depressive symptoms; lowering glycemic levels may help reduce diabetes-comorbid depressive symptoms. Since randomized controlled trials can help understand temporal associations, we systematically reviewed the evidence regarding the potential association of hemoglobin HbA1c lowering interventions with depressive symptoms. METHODS PubMed, PsycINFO, CINAHL, and EMBASE databases were searched for randomized controlled trials evaluating HbA1c-lowering interventions and including assessment of depressive symptoms published between 01/2000-09/2020. Study quality was evaluated using the Cochrane Risk of Bias tool. PROSPERO registration: CRD42020215541. RESULTS We retrieved 1,642 studies of which twelve met our inclusion criteria. Nine studies had high and three unclear risks of bias. Baseline depressive symptom scores suggest elevated depressive symptoms in five studies. Baseline HbA1c was <8.0% (<64 mmol/mol) in two, 8.0-9.0% (64-75 mmol/mol) in eight, and ≥10.0% (≥86 mmol/mol) in two studies. Five studies found greater HbA1c reduction in the treatment group; three of these found greater depressive symptom reduction in the treatment group. Of four studies analyzing whether the change in HbA1c was associated with the change in depressive symptoms, none found a significant association. The main limitation of these studies was relatively low levels of depressive symptoms at baseline, limiting the ability to show a lowering in depressive symptoms after HbA1c reduction. CONCLUSIONS We found insufficient available data to estimate the association between HbA1c reduction and depressive symptom change following glucose-lowering treatment. Our findings point to an important gap in the diabetes treatment literature. Future clinical trials testing interventions to improve glycemic outcomes might consider measuring depressive symptoms as an outcome to enable analyses of this association.
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Affiliation(s)
- Andreas Schmitt
- Research Institute Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Johann-Hammer- Straße 24, 97980 Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
| | - Magdalena Beran
- Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Anouk Geraets
- Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, MHeNs School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Marjolein M Iversen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 27, 6525 EZ Nijmegen, The Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with Type 1 Diabetes, Blaak 6, 3011 TA Rotterdam, The Netherlands
| | - Arie Nouwen
- Department of Psychology, Middlesex University London, The Burroughs, London NW4 4BT, United Kingdom
- School of Health, Wellbeing and Social Care, The Open University, Walton Hall, Milton Keynes MK7 6AA, United Kingdom
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Steno Diabetes Center Odense (SDCO), Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Jörg W Huber
- School of Sport and Health Sciences, University of Brighton, Westlain House, Brighton BN1 9PH, United Kingdom
| | - Miranda T Schram
- Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, MHeNs School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
- Heart and Vascular Centre, Maastricht University Medical Center, Professor Debyelaan 25, 6229HX Maastricht, The Netherlands
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Pouwer F, Mizokami-Stout K, Reeves ND, Pop-Busui R, Tesfaye S, Boulton AJM, Vileikyte L. Psychosocial Care for People With Diabetic Neuropathy: Time for Action. Diabetes Care 2024; 47:17-25. [PMID: 38117989 DOI: 10.2337/dci23-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/23/2023] [Indexed: 12/22/2023]
Abstract
Psychological factors and psychosocial care for individuals with diabetic neuropathy (DN), a common and burdensome complication of diabetes, are important but overlooked areas. In this article we focus on common clinical manifestations of DN, unremitting neuropathic pain, postural instability, and foot complications, and their psychosocial impact, including depression, anxiety, poor sleep quality, and specific problems such as fear of falling and fear of amputation. We also summarize the evidence regarding the negative impact of psychological factors such as depression on DN, self-care tasks, and future health outcomes. The clinical problem of underdetection and undertreatment of psychological problems is described, together with the value of using brief assessments of these in clinical care. We conclude by discussing trial evidence regarding the effectiveness of current pharmacological and nonpharmacological approaches and also future directions for developing and testing new psychological treatments for DN and its clinical manifestations.
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Affiliation(s)
- Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Kara Mizokami-Stout
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI
- Lieutenant Colonel Charles S. Kettles Veteran Affairs Medical Center, Ann Arbor, MI
| | - Neil D Reeves
- Department of Life Sciences, Faculty of Science and Engineering, Manchester, U.K
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
| | - Andrew J M Boulton
- Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, U.K
- Department of Dermatology, University of Miami, Miami, FL
| | - Loretta Vileikyte
- Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, U.K
- Department of Dermatology, University of Miami, Miami, FL
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9
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Kang GA, Won CW, Kim M, Yoon JY. Sex differences in the reciprocal relationship between glycemic control and depressive symptoms among older adults with diabetes: Using a nationwide population-based sample. Geriatr Gerontol Int 2024; 24:32-39. [PMID: 38012020 DOI: 10.1111/ggi.14744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/12/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
AIM As life expectancy increases worldwide, the prevalence and the disease burden of diabetes in older adults are also increasing. This study aimed to examine sex differences in the reciprocal relationship between glycemic control and depressive symptoms among older adults with diabetes by using longitudinal data at two timepoints. METHODS Wave 1 (W1, 2016-2017) and wave 2 (W2, 2018-2019) data from the Korean Frailty and Aging Cohort Study were used. Finally, 416 older adults with diabetes who satisfied the inclusion criteria were analyzed (215 males, 201 females). The reciprocal relationship between depressive symptoms and glycosylated hemoglobin A1c (HbA1c) levels was examined using a cross-lagged panel model. RESULTS HbA1c levels and depressive symptoms at earlier time points were the most significant factors contributing to HbA1c levels and depressive symptoms at later timepoints. The relationship between HbA1c level and depressive symptoms differed according to sex. The cross-path from depressive symptoms (W1) to HbA1c levels (W2) was positively statistically significant in males (β = 0.18, SD = 0.05, P = 0.001). The path from HbA1c levels (W1) to depressive symptoms (W2) was positively statistically significant in females (β = 0.12, SD = 0.06, P = 0.032). CONCLUSIONS Early management of blood glucose levels and depressive symptoms is important in older adults with diabetes. Moreover, glycemic control through social activities in the community could be effective in relieving depressive symptoms in older females with diabetes, and managing depressive symptoms and glucose levels together could be effective in glycemic control in older males with diabetes. Geriatr Gerontol Int 2024; 24: 32-39.
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Affiliation(s)
- Gyeong A Kang
- College of Nursing, Seoul National University, Seoul, Republic of Korea
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Chang Won Won
- Department of Family Medicine, Elderly Frailty Research Center, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Miji Kim
- Department of Family Medicine, Elderly Frailty Research Center, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ju Young Yoon
- College of Nursing, Seoul National University, Seoul, Republic of Korea
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul, Republic of Korea
- Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
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10
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Reinauer C, Tittel SR, Müller-Stierlin A, Baumeister H, Warschburger P, Klauser K, Minden K, Staab D, Gohlke B, Horlebein B, Schwab KO, Meißner T, Holl RW. Outpatient screening for anxiety and depression symptoms in adolescents with type 1 diabetes - a cross-sectional survey. Child Adolesc Psychiatry Ment Health 2023; 17:142. [PMID: 38129890 PMCID: PMC10740232 DOI: 10.1186/s13034-023-00691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The daily demands of type 1 diabetes management may jeopardize adolescents' mental health. We aimed to assess anxiety and depression symptoms by broad-scale, tablet-based outpatient screening in adolescents with type 1 diabetes in Germany. METHODS Adolescent patients with type 1 diabetes mellitus (n = 2,394; mean age 15.4 y [SD 2.0]; 50.7% male) were screened for anxiety (GAD-7) and depression symptoms (PHQ-9) by self-report questionnaires and linked to clinical data from the DPV patient registry. Logistic regression was used to estimate the contribution of clinical parameters to positive screening results. RESULTS Altogether, 30.2% showed a positive screening (score ≥ 7 in either test), and 11.3% reported suicidal ideations or self-harm. Patients with anxiety and depression symptoms were older (15.7 y [CI 15.5-15.8] vs. 15.3 y [CI 15.2-15.4]; p < 0.0001), had higher HbA1c levels (7.9% [CI 7.8-8.0] (63 mmol/mol) vs. 7.5% [CI 7.4-7.5] (58 mmol/mol); p < 0.0001), and had higher hospitalization rates. Females (adjusted odds ratio (aOR) 2.66 [CI 2.21-3.19]; p < 0.0001), patients > 15 years (aOR 1.40 [1.16-1.68]; p < 0.001), who were overweight (aOR 1.40 [CI 1.14-1.71]; p = 0.001), with HbA1c > 9% (> 75 mmol/mol; aOR 2.58 [1.83-3.64]; each p < 0.0001), with a migration background (aOR 1.46 [CI 1.17-1.81]; p < 0.001), or smoking (aOR 2.72 [CI 1.41-5.23]; p = 0.003) had a higher risk. Regular exercise was a significant protective factor (aOR 0.65 [CI 0.51-0.82]; p < 0.001). Advanced diabetes technologies did not influence screening outcomes. CONCLUSIONS Electronic mental health screening was implemented in 42 centers in parallel, and outcomes showed an association with clinical parameters from sociodemographic, lifestyle, and diabetes-related data. It should be integrated into holistic patient counseling, enabling early recognition of mild mental health symptoms for preventive measures. Females were disproportionally adversely affected. The use of advanced diabetes technologies did not yet reduce the odds of anxiety and depression symptoms in this cross-sectional assessment.
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Affiliation(s)
- Christina Reinauer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Sascha R Tittel
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, 89081, Ulm, Germany
- German Center for Diabetes Research (DZD), 85764, Munich-Neuherberg, Germany
| | - Annabel Müller-Stierlin
- Department of Psychiatry and Psychotherapy II, Regional Hospital Günzburg, Ulm University, 89312, Günzburg, Germany
| | - Harald Baumeister
- Clinical Psychology and Psychotherapy, Ulm University, 89081, Ulm, Germany
| | - Petra Warschburger
- Department of Psychology, University of Potsdam, 14476, Potsdam, Germany
| | - Katharina Klauser
- Social Pediatric Center (SPZ), German Center for Pediatric and Adolescent Rheumatology, 82467, Garmisch-Partenkirchen, Germany
| | - Kirsten Minden
- Epidemiology Unit, German Rheumatism Research Center Berlin, a Leibniz Institute and Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin and Berlin Institute of Health, 10117, Berlin, Germany
| | - Doris Staab
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, CF Center Charité - Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Bettina Gohlke
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, 53127, Bonn, Germany
| | - Bettina Horlebein
- Buerger Hospital and Clementine Children Hospital, 60316, Frankfurt, Germany
| | - Karl Otfried Schwab
- Faculty of Medicine, Center for Pediatrics and Adolescent Medicine, Division of Pediatric Diabetes, Medical Center, University of Freiburg, 79110, Freiburg, Germany
| | - Thomas Meißner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, 89081, Ulm, Germany
- German Center for Diabetes Research (DZD), 85764, Munich-Neuherberg, Germany
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11
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Weiss F, Brancati GE, Elefante C, Petrucci A, Gemmellaro T, Lattanzi L, Perugi G. Type 2 diabetes mellitus is associated with manic morbidity in elderly patients with mood disorders. Int Clin Psychopharmacol 2023:00004850-990000000-00101. [PMID: 37824397 DOI: 10.1097/yic.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
The association between mood disorders, especially bipolar disorder (BD), and metabolic disorders, is long known. However, to which extent metabolic disorders affect the course of mood disorders in late life is still open to inquiring. To assess the impact of type 2 diabetes mellitus (T2DM) on late-life mood disorders a retrospective chart review was performed. Elderly depressive patients (≥ 65 years) diagnosed with Major Depressive Disorder (N = 57) or BD (N = 43) and followed up for at least 18 months were included and subdivided according to the presence of T2DM comorbidity. Vascular encephalopathy (39.1% vs. 15.6%, P = 0.021) and neurocognitive disorders (21.7% vs. 5.2%, P = 0.028), were more frequently reported in patients with T2DM than in those without. Patients with T2DM showed a greater percentage of follow-up time in manic episodes (r = -0.23, P = 0.020) and a higher rate of manic episode(s) during follow-up (21.7% vs. 5.2%, P = 0.028) than those without. When restricting longitudinal analyses to patients with bipolar spectrum disorders, results were confirmed. In line with the well-known connection between BD and metabolic disorders, our data support an association between T2DM and unfavorable course of illness in the elderly with BD.
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Affiliation(s)
- Francesco Weiss
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | | | - Camilla Elefante
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | | | - Teresa Gemmellaro
- Department of Psychiatry, North-Western Tuscany Region, NHS, Local Health Unit, Cecina-LI
| | | | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
- Institute of Behavioral Science 'G. De Lisio', Pisa, Italy
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12
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McIntyre RS, Alsuwaidan M, Baune BT, Berk M, Demyttenaere K, Goldberg JF, Gorwood P, Ho R, Kasper S, Kennedy SH, Ly-Uson J, Mansur RB, McAllister-Williams RH, Murrough JW, Nemeroff CB, Nierenberg AA, Rosenblat JD, Sanacora G, Schatzberg AF, Shelton R, Stahl SM, Trivedi MH, Vieta E, Vinberg M, Williams N, Young AH, Maj M. Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World Psychiatry 2023; 22:394-412. [PMID: 37713549 PMCID: PMC10503923 DOI: 10.1002/wps.21120] [Citation(s) in RCA: 71] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD with demonstrated predictive utility in terms of clinical decision-making and health outcomes does not currently exist. Instead, a plethora of definitions have been proposed, which vary significantly in their conceptual framework. The absence of a consensus definition hampers precise estimates of the prevalence of TRD, and also belies efforts to identify risk factors, prevention opportunities, and effective interventions. In addition, it results in heterogeneity in clinical practice decision-making, adversely affecting quality of care. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have adopted the most used definition of TRD (i.e., inadequate response to a minimum of two antidepressants despite adequacy of the treatment trial and adherence to treatment). It is currently estimated that at least 30% of persons with depression meet this definition. A significant percentage of persons with TRD are actually pseudo-resistant (e.g., due to inadequacy of treatment trials or non-adherence to treatment). Although multiple sociodemographic, clinical, treatment and contextual factors are known to negatively moderate response in persons with depression, very few factors are regarded as predictive of non-response across multiple modalities of treatment. Intravenous ketamine and intranasal esketamine (co-administered with an antidepressant) are established as efficacious in the management of TRD. Some second-generation antipsychotics (e.g., aripiprazole, brexpiprazole, cariprazine, quetiapine XR) are proven effective as adjunctive treatments to antidepressants in partial responders, but only the olanzapine-fluoxetine combination has been studied in FDA-defined TRD. Repetitive transcranial magnetic stimulation (TMS) is established as effective and FDA-approved for individuals with TRD, with accelerated theta-burst TMS also recently showing efficacy. Electroconvulsive therapy is regarded as an effective acute and maintenance intervention in TRD, with preliminary evidence suggesting non-inferiority to acute intravenous ketamine. Evidence for extending antidepressant trial, medication switching and combining antidepressants is mixed. Manual-based psychotherapies are not established as efficacious on their own in TRD, but offer significant symptomatic relief when added to conventional antidepressants. Digital therapeutics are under study and represent a potential future clinical vista in this population.
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Affiliation(s)
- Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Mohammad Alsuwaidan
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Berk
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
- Deakin University IMPACT Institute, Geelong, VIC, Australia
| | - Koen Demyttenaere
- Department of Psychiatry, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip Gorwood
- Department of Psychiatry, Sainte-Anne Hospital, Paris, France
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Institute for Health Innovation and Technology, National University of Singapore, Singapore
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy and Center of Brain Research, Molecular Neuroscience Branch, Medical University of Vienna, Vienna, Austria
| | - Sidney H Kennedy
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Josefina Ly-Uson
- Department of Psychiatry and Behavioral Medicine, University of The Philippines College of Medicine, Manila, The Philippines
| | - Rodrigo B Mansur
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - R Hamish McAllister-Williams
- Northern Center for Mood Disorders, Translational and Clinical Research Institute, Newcastle University, and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua D Rosenblat
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Gerard Sanacora
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Alan F Schatzberg
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Richard Shelton
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen M Stahl
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Maj Vinberg
- Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Nolan Williams
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Allan H Young
- Department of Psychological Medicine, King's College London, London, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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13
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Iverson GL, Kissinger-Knox A, Huebschmann NA, Castellani RJ, Gardner AJ. A narrative review of psychiatric features of traumatic encephalopathy syndrome as conceptualized in the 20th century. Front Neurol 2023; 14:1214814. [PMID: 37545715 PMCID: PMC10401603 DOI: 10.3389/fneur.2023.1214814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Some ultra-high exposure boxers from the 20th century suffered from neurological problems characterized by slurred speech, personality changes (e.g., childishness or aggressiveness), and frank gait and coordination problems, with some noted to have progressive Parkinsonian-like signs. Varying degrees of cognitive impairment were also described, with some experiencing moderate to severe dementia. The onset of the neurological problems often began while they were young men and still actively fighting. More recently, traumatic encephalopathy syndrome (TES) has been proposed to be present in athletes who have a history of contact (e.g., soccer) and collision sport participation (e.g., American-style football). The characterization of TES has incorporated a much broader description than the neurological problems described in boxers from the 20th century. Some have considered TES to include depression, suicidality, anxiety, and substance abuse. Purpose We carefully re-examined the published clinical literature of boxing cases from the 20th century to determine whether there is evidence to support conceptualizing psychiatric problems as being diagnostic clinical features of TES. Methods We reviewed clinical descriptions from 155 current and former boxers described in 21 articles published between 1928 and 1999. Results More than one third of cases (34.8%) had a psychiatric, neuropsychiatric, or neurobehavioral problem described in their case histories. However, only 6.5% of the cases were described as primarily psychiatric or neuropsychiatric in nature. The percentages documented as having specific psychiatric problems were as follows: depression = 11.0%, suicidality = 0.6%, anxiety = 3.9%, anger control problems = 20.0%, paranoia/suspiciousness = 11.6%, and personality change = 25.2%. Discussion We conclude that depression, suicidality (i.e., suicidal ideation, intent, or planning), and anxiety were not considered to be clinical features of TES during the 20th century. The present review supports the decision of the consensus group to remove mood and anxiety disorders, and suicidality, from the new 2021 consensus core diagnostic criteria for TES. More research is needed to determine if anger dyscontrol is a core feature of TES with a clear clinicopathological association. The present findings, combined with a recently published large clinicopathological association study, suggest that mood and anxiety disorders are not characteristic of TES and they are not associated with chronic traumatic encephalopathy neuropathologic change.
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Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
| | | | - Rudolph J. Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Andrew J. Gardner
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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14
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Ahmed A, Zeng G, Azhar M, Wang F, Wang J, Fan B, Liu X, Jiang D, Wang Q. Combination of Shengmai San and Radix puerariae ameliorates depression-like symptoms in diabetic rats at the nexus of PI3K/BDNF/SYN protein expression. Animal Model Exp Med 2023; 6:211-220. [PMID: 37317044 PMCID: PMC10272924 DOI: 10.1002/ame2.12333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/03/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Hyperglycemia is a characteristic feature of diabetes that often results in neuropsychological complications such as depression. Diabetic individuals are more vulnerable to experience depression compared to the normal population. Thus, novel treatment approaches are required to reduce depressive symptoms among diabetic individuals. Traditional Chinese medicines (TCMs) such as Shengmai San (SMS) and Radix puerariae (R) are usually widely used to treat ailments such as neurological complications since ancient time. METHODS In this study, SMS was combined with R to prepare an R-SMS formulation and screened for their antidepressant activity in diabetic rats. The antidepressant potential of the prepared combination was evaluated behaviorally using open field test, novelty-induced hypophagia, and forced swim test in diabetic rats with biochemical and protein expression (PI3K, BDNF [brain-derived neurotrophic factor], and SYN [presynaptic vesicle protein]) analysis. RESULTS Diabetic rats (streptozotocin, 45 mg/kg) showed elevated fasting blood glucose (FBG) >12 mM with depressive symptoms throughout the study. Treatment with R-SMS (0.5, 1.5, and 4.5 g/kg) significantly reverted depressive symptoms in diabetic rats as evinced by significantly (p < 0.05) reduced immobility time with an increased tendency to eat food in a novel environment. Treatment with R-SMS also significantly increased the protein expression of PI3K, BDNF, and SYN protein, which play a crucial role in depression. CONCLUSION This study showed that R-SMS formulation antagonized depressive symptoms in diabetic rats; thus, this formulation might be studied further to develop as an antidepressant.
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Affiliation(s)
- Ayaz Ahmed
- Institute of Food Science and TechnologyChinese Academy of Agricultural SciencesBeijingChina
- Hunan Key Laboratory of Pharmacodynamics and Safety Evaluation of New Drugs & Hunan Provincial Research Center for Safety Evaluation of DrugsChangshaChina
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological SciencesUniversity of KarachiKarachiPakistan
| | - Guirong Zeng
- Hunan Key Laboratory of Pharmacodynamics and Safety Evaluation of New Drugs & Hunan Provincial Research Center for Safety Evaluation of DrugsChangshaChina
- Institute of Drug Discovery TechnologyNingbo UniversityNingboChina
- Research Center for Pharmacodynamic, Material Basis and Mechanism of ActionCollege of Pharmacy, Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Mudassar Azhar
- Hunan Key Laboratory of Pharmacodynamics and Safety Evaluation of New Drugs & Hunan Provincial Research Center for Safety Evaluation of DrugsChangshaChina
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological SciencesUniversity of KarachiKarachiPakistan
| | - Fengzhong Wang
- Institute of Food Science and TechnologyChinese Academy of Agricultural SciencesBeijingChina
| | - Jingru Wang
- Research Center for Pharmacodynamic, Material Basis and Mechanism of ActionCollege of Pharmacy, Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Bei Fan
- Institute of Food Science and TechnologyChinese Academy of Agricultural SciencesBeijingChina
| | - Xinmin Liu
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological SciencesUniversity of KarachiKarachiPakistan
- Institute of Drug Discovery TechnologyNingbo UniversityNingboChina
| | - Dejiang Jiang
- Hunan Key Laboratory of Pharmacodynamics and Safety Evaluation of New Drugs & Hunan Provincial Research Center for Safety Evaluation of DrugsChangshaChina
| | - Qiong Wang
- Institute of Food Science and TechnologyChinese Academy of Agricultural SciencesBeijingChina
- Sino‐Portugal TCM International Cooperation CenterThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhouChina
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15
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Mayhew M, Smith N, Fortmann SP, Fitzpatrick SL. Mental health diagnosis attenuates weight loss among older adults in a digital diabetes prevention program. Obes Sci Pract 2023; 9:320-326. [PMID: 37287521 PMCID: PMC10242247 DOI: 10.1002/osp4.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 06/09/2023] Open
Abstract
Objective Diabetes Prevention Programs (DPP) are effective at reducing diabetes incidence via clinically significant weight loss. Co-morbid mental health condition(s) may reduce the effect of DPP administered in-person and telephonically but this has not been assessed for digital DPP. This report examines the moderating effect of mental health diagnosis on weight change among individuals who enrolled in digital DPP (enrollees) at 12 and 24 months. Methods Secondary analysis of prospective, electronic health record data from a study of digital DPP among adults (N = 3904) aged 65-75 with prediabetes (HbA1c 5.7%-6.4%) and obesity (BMI ≥30 kg/m2). Results Mental health diagnosis only moderated the effect of digital DPP on weight change during the first 7 months (p = 0.003) and the effect attenuated at 12 and 24 months. Results were unchanged after adjusting for psychotropic medication use. Among those without a mental health diagnosis, digital DPP enrollees lost more weight than non-enrollees: -4.17 kg (95% CI, -5.22 to -3.13) at 12 months and -1.88 kg (95% CI, -3.00 to -0.76) at 24 months, whereas among individuals with a mental health diagnosis, there was no difference in weight loss between enrollees and non-enrollees at 12 and 24 months (-1.25 kg [95% CI, -2.77 to 0.26] and 0.02 kg [95% CI, -1.69-1.73], respectively). Conclusions Digital DPP appears less effective for weight loss among individuals with a mental health condition, similar to prior findings for in-person and telephonic modalities. Findings suggest a need for tailoring DPP to address mental health conditions.
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Affiliation(s)
- Meghan Mayhew
- Kaiser Permanente Center for Health Research Northwest in PortlandPortlandOregonUSA
| | - Ning Smith
- Kaiser Permanente Center for Health Research Northwest in PortlandPortlandOregonUSA
| | - Stephen P. Fortmann
- Kaiser Permanente Center for Health Research Northwest in PortlandPortlandOregonUSA
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van Gennip ACE, Schram MT, Köhler S, Kroon AA, Koster A, Eussen SJPM, de Galan BE, van Sloten TT, Stehouwer CDA. Association of type 2 diabetes according to the number of risk factors within the recommended range with incidence of major depression and clinically relevant depressive symptoms: a prospective analysis. THE LANCET. HEALTHY LONGEVITY 2023; 4:e63-e71. [PMID: 36738746 DOI: 10.1016/s2666-7568(22)00291-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Type 2 diabetes is associated with an increased risk of depression, but the extent to which risk factor modification can mitigate this risk is unclear. We aimed to examine the association between the incidence of major depression and clinically relevant depressive symptoms among individuals with type 2 diabetes, according to the number of risk factors within the recommended target range, compared with individuals without diabetes. METHODS We did a prospective analysis of population-based data from the UK Biobank and the Maastricht Study. Individuals with type 2 diabetes were categorised according to the number of risk factors within the recommended target range (non-smoking, guideline-recommended levels of glycated haemoglobin (HbA1c), blood pressure, BMI, albuminuria, physical activity, and diet). The primary outcome, based on data from the UK Biobank, was the incidence of major depression ascertained from hospital records; the secondary outcome, based on data from the UK Biobank and the Maastricht Study, was clinically relevant depressive symptoms based on a score of 10 or higher on the Patient Health Questionnaire (PHQ-9). FINDINGS The study population of the UK Biobank comprised 77 786 individuals (9047 with type 2 diabetes and 68 739 without diabetes; median age 59 years [IQR 51-64]; 34 136 [43·9%] women and 43 650 [56·1%] men). A median of 12·7 years (IQR 11·8-13·4) after recruitment (between March 13, 2006, and Oct 1, 2010), 493 (5·5%) of 9047 individuals with type 2 diabetes and 2574 (3·7%) of 68 739 individuals without diabetes developed major depression. Compared with individuals without diabetes, those with type 2 diabetes had a higher risk of major depression (hazard ratio [HR] 1·61 [95% CI 1·49-1·77]). Among individuals with type 2 diabetes, the excess risk of depression decreased stepwise with an increasing number of risk factors within the recommended target range (HR 2·04 [95% CI 1·65-2·52] for up to two risk factors within the recommended target range; 1·95 [1·65-2·30] for three risk factors within the recommended target range; 1·38 [1·16-1·65] for four risk factors within the recommended target range; and 1·34 [1·12-1·62] for five to seven risk factors within the recommended target range). In the UK Biobank dataset, a median of 7·5 years (IQR 6·8-8·2) after the baseline examination, 147 (7·5%) of 1953 individuals with type 2 diabetes and 954 (4·5%) of 21 413 individuals without diabetes had developed clinically relevant depressive symptoms. The study population of the Maastricht Study comprised 4530 individuals (1158 with type 2 diabetes and 3372 without diabetes; median age 60 years [IQR 53-66]; 2244 [49·5%] women and 2286 [50·1%] men). A median of 5·1 years (IQR 4·1-6·1) after recruitment (between Sept 1, 2010, and Dec 7, 2017), 170 (14·7%) of 1158 individuals with type 2 diabetes and 227 (6·7%) of 3372 individuals without diabetes developed clinically relevant depressive symptoms. Similarly, in both the UK Biobank dataset and the Maastricht Study cohort, among individuals with type 2 diabetes, the excess risk of clinically relevant depressive symptoms decreased stepwise with an increasing number of risk factors within the recommended target range. INTERPRETATION Among individuals with type 2 diabetes, the excess risk of major depression and clinically relevant depressive symptoms decreased stepwise with an increasing number of risk factors within the recommended target range. This study provides further evidence to promote risk factor modification strategies in individuals with type 2 diabetes and to encourage the adoption of a healthy lifestyle. FUNDING ZonMW, Hartstichting, and Diabetes Fonds.
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Affiliation(s)
- April C E van Gennip
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands; School for Mental Health and Neuroscience MHENS, Maastricht University, Maastricht, Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience MHENS, Maastricht University, Maastricht, Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, Netherlands; Department of Social Medicine, Maastricht University, Maastricht, Netherlands
| | - Simone J P M Eussen
- School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands; Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, Netherlands; Department of Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands; Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, Netherlands.
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands
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Lemogne C, Chauvet-Gelinier JC. Depression and the risk of type 2 diabetes. J Psychosom Res 2023; 164:111116. [PMID: 36565616 DOI: 10.1016/j.jpsychores.2022.111116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Cédric Lemogne
- Université Paris Cité, INSERM U1266, Institut de Psychiatrie et Neuroscience de Paris, 75014 Paris, France; Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, 75004 Paris, France.
| | - Jean-Christophe Chauvet-Gelinier
- Service de Psychiatrie d'adultes, CHU Dijon-Bourgogne, 21000 Dijon, France; Unité INSERM, LNC-UMR 1231, Université de Bourgogne, 21000 Dijon, France
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18
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Du Y, Baumert J, Paprott R, Färber F, Nübel J, Hermanns N, Heidemann C, Scheidt-Nave C. Diabetes-related distress and associated factors among adults with diabetes in Germany: Results of the nationwide study "Disease knowledge and information needs - Diabetes mellitus 2017". J Psychosom Res 2023; 164:111073. [PMID: 36370499 DOI: 10.1016/j.jpsychores.2022.111073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/30/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Diabetes-related distress (DRD) can affect diabetes management adversely. In lack of population-based data, the frequency and determinants of DRD among adults with diabetes in Germany remain controversial. METHODS This study included 1367 adults with diabetes who participated in a nationwide health telephone survey conducted among German adults aged 18 years and older in 2017. The short form of the Problem Areas in Diabetes (PAID-5) scale was used to assess DRD. The associations of high DRD (PAID-5 sum score ≥ 8) with socio-demographics, diabetes-related risk factors, diabetes clinical characteristics as well as quality of self-care and chronic illness care assessed by patients were tested in multivariable logistic regression models. RESULTS The overall DRD prevalence was 15.1% (95% confidence intervals, 95% CIs, 12.5-18.0%) with no significant difference between men (14.7%, 95% CIs 11.2-19.1%) and women (15.4%, 11.9-19.8%). In multivariable analyses, DRD was significantly associated with younger age (odds ratio 0.96, 95% CIs 0.94-0.98, per year), immigration background (2.26, 1.16-4.42), current smoking (2.06, 1.14-3.70), insulin use (2.57, 1.45-4.56), and the presence of diabetes-specific complications (1.80, 1.10-2.94) or depressive symptoms (5.34, 3.24-8.81). Among those with depressive symptoms (18,4% of the study population), 38.3% also had DRD, which accounted for 7.0% (95% CIs 5.3-9.3%) of the study population. CONCLUSION DRD is a common health problem among adults with diabetes in Germany, and highly correlates with depressive symptoms, current smoking, immigration background, and insulin use. Addressing DRD needs to become an integrative part of ambulatory diabetes care.
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Affiliation(s)
- Yong Du
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
| | - Jens Baumert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Rebecca Paprott
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Francesca Färber
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Julia Nübel
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Norbert Hermanns
- Research Institute of the Diabetes-Academy Bad Mergentheim (FIDAM), Bad Mergentheim, Baden-Württemberg, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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19
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Sirirak T, Sangsupawanich P, Wongpakaran N, Srisintorn W. The Geriatric Depression Scale Predicts Glycemic Control in Older Adult with Type 2 Diabetes Mellitus: A Longitudinal Study. Healthcare (Basel) 2022; 10:healthcare10101990. [PMID: 36292437 PMCID: PMC9601955 DOI: 10.3390/healthcare10101990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
The presence of comorbid depression and diabetes is associated with worse glycemic control, higher complication and greater mortality risk than expected by each condition alone. The association between various levels of severity of depressive symptoms and glycemic control over time among type 2 diabetic older patients was unclear. This study aimed to investigate a longitudinal association between depression and HbA1c among type 2 diabetic older patients. Type 2 diabetes patients aged 60 years and above with normal cognition were recruited from the outpatient department from 1 June 2020 to 1 July 2021. The Thai Geriatric Depression Scale (TGDS) and HbA1c were assessed at five time points (baseline and every 12 weeks) for 1 year. A linear mixed effect model was used. Of the 161 enrolled participants, 146 completed the study. At baseline, 14% were susceptible to depression or having depression (TGDS score 6 and above), and there was a significant correlation between HbA1c and depression (r = 0.26, p ≤ 0.01). The longitudinal analysis indicated that TGDS was a significant predictor of HbA1c in the next visit, and the relationship was J-shaped. A TGDS below 5 was associated with decreasing HbA1c in the next visit, but the association became positive at a TGDS score at 5 or higher. The presence of significant symptoms of depression was associated with glycemic control in the next 3-month interval OPD visit event, although major depressive disorder has not yet been established.
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Affiliation(s)
- Thanitha Sirirak
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Pasuree Sangsupawanich
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Correspondence: ; Tel.: +66-(81)-5404777
| | - Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wisarut Srisintorn
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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Glintborg D, Petersen TG, Rubin KH, Andersen MS. Diabetes Mellitus Mediates Risk of Depression in Danish Women with Polycystic Ovary Syndrome—A National Cohort Study. Biomedicines 2022; 10:biomedicines10102396. [PMID: 36289658 PMCID: PMC9598722 DOI: 10.3390/biomedicines10102396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 12/04/2022] Open
Abstract
Aim: To investigate the risk of depression in Danish women with PCOS compared to controls and possible mediators for depression in PCOS. National register-based study in Danish women with PCOS (PCOS Denmark, N = 25,203) and age-matched controls (N = 112,414). PCOS Odense University Hospital (PCOS OUH, N = 998) was a sub-cohort of women with PCOS with available clinical and biochemical results. The main study outcome was depression occurring after PCOS diagnosis. Depression was defined according to hospital ICD-10 diagnosis codes and/or inferred from filled medicine prescription of antidepressants. Diabetes, medical comorbidity, infertility, hormonal anti-contraception and low family income were entered as mediators in Cox regression analyses for depression. In PCOS OUH, PCOS characteristics (age, BMI, Ferriman-Gallwey score) were entered in Cox regression analyses. The median age at cohort entry was 28 (interquartile range (IQR) 23; 35) years. The median follow-up time to incident depression or censuring was 4.8 (IQR 2.2; 8.8) years in PCOS Denmark and 5.2 (IQR 2.4; 9.2) years in controls. Women with PCOS had a 40% increased risk of depression compared to controls (Hazard Ratio 1.42 (95% CI 1.38; 1.47). In regression analyses, diabetes, medical comorbidity, infertility, hormonal anticonception, and low family income were significant mediators of depression. Mediation analyses showed that the proportion of the association explained by diabetes was 12.5% (95% CI 10.4; 14.5). In PCOS OUH, BMI, waist and Ferriman-Gallwey score predicted development of depression. Conclusion: The risk of depression was increased in PCOS. Diabetes was an important mediator of depression in PCOS.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, DK-5000 Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
- Correspondence:
| | - Tanja Gram Petersen
- OPEN—Odense Patient Data Explorative Network, Odense University Hospital, DK-5000 Odense, Denmark
| | - Katrine Hass Rubin
- OPEN—Odense Patient Data Explorative Network, Odense University Hospital, DK-5000 Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
| | - Marianne Skovsager Andersen
- Department of Endocrinology, Odense University Hospital, DK-5000 Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
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21
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Waheed U, Heald AH, Stedman M, Solomon E, Rea R, Eltom S, Gibson JM, Grady K, Nouwen A, Rayman G, Paisley A. Distress and Living with Diabetes: Defining Characteristics Through an Online Survey. Diabetes Ther 2022; 13:1585-1597. [PMID: 35831740 PMCID: PMC9281294 DOI: 10.1007/s13300-022-01291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION There is considerable evidence for diabetes reducing quality of life. The impact of such a diagnosis on mental health is less well understood and was subsequently explored here. METHODS Online PHQ-9 scores (which calculate the severity of depression), Diabetes Distress Screening Scale (DDSS) and EQ-5D-5L (quality-of-life) questionnaires were completed by patients with diabetes, followed by the extraction of data where possible from responders' clinical records. RESULTS A total of 133 people submitted questionnaires. However, not all data items could be completed by each patient; 35% (45/130) had type I diabetes mellitus (T1DM); 55% (64/117) were women. The overall median age of 117 responders was 60 (IQR 50-68 years). The median aggregated response scores were: EQ-5D-5L 0.74 (IQR 0.64-0.85) (lower quality of life than UK population median of 0.83), DDSS 1.9 (IQR1.3-2.7) (≥ 2 indicates moderate distress) and PHQ-9 5 (IQR2-11) (≥ 5 indicates depression). Higher diabetes distress (DDSS)/lower quality of life EQ-5D-5L/higher depressive symptoms (PHQ-9) linked to female sex (DDSS 0.5/25% above median), younger age (< 50 years DDSS 0.7/35% above median), fewer years after diagnosis (< 10 years DDSS 0.8/40% above median), and obesity (BMI > 35 DDSS 0.6/30% above median). Additionally, a HbA1c reading of ≤ 48 mmol/mol was associated with higher DDSS scores, as did a reduction of more than 5 mmol/mol in HbA1c over the last three HbA1c measurements. The 30 individuals with a history of prescribed antidepressant medication also showed higher diabetes distress scores (DDSS 0.9, equating to 45% above the median). The DDSS score elevation came from an increase in emotional burden and regimen-related distress. DDSS scores were not significantly linked to diabetes type, insulin use, absolute level/change in blood glucose HbA1c. Physician-related distress showed a similar pattern. CONCLUSIONS A low level of stress in relation to diabetes management may be associated with lower HbA1c. The larger impact of diabetes on mental health in younger women/people with shorter diabetes duration should be noted when considering psychosocial intervention/behavior change messaging. Physician-related distress is a potentially remediable factor. However, this sample was self-selecting, limiting generalization to other samples.
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Affiliation(s)
- Unaiza Waheed
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK
| | - Adrian H Heald
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK.
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
| | | | - Emma Solomon
- Department of Clinical Psychology, Salford Royal Hospital, Salford, UK
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK
| | - Saydah Eltom
- Pharmacy Department, Salford Royal Hospital, Salford, UK
| | - J Martin Gibson
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Katherine Grady
- Research for the Future, Northern Care Alliance NHS Group, Salford, UK
| | - Arie Nouwen
- Department of Psychology, Middlesex University, London, UK
| | - Gerry Rayman
- The Ipswich Diabetes Centre and Research Unit, Ipswich Hospital NHS Trust, Colchester, Essex, UK
| | - Angela Paisley
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, M6 8HD, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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22
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Heikkala E, Hagnäs M, Jokelainen J, Karppinen J, Ferreira P, Ferreira ML, Mikkola I. Association of musculoskeletal pain with the achievement of treatment targets for type 2 diabetes among primary care patients. Prim Care Diabetes 2022; 16:531-536. [PMID: 35523651 DOI: 10.1016/j.pcd.2022.04.006] [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: 11/18/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
AIMS To assess the association of diagnosed musculoskeletal (MS) pain (low back, neck, shoulder, and knee pain; and the number of pain sites) with the achievement of targets for glycosylated haemoglobin A1c (HbA1c), low-density-lipoprotein cholesterol (LDL), and systolic blood pressure (SBP) among primary care patients with type 2 diabetes (T2D). METHODS The cross-sectional study population consisted of 3478 patients with a registry-based T2D diagnosis and available registry-based data on MS pain diagnoses, covariates, and outcomes between 2016 and 2019. Logistic regression analysis was used to evaluate the study aims. RESULTS Overall, 22% had at least one of the four types of MS pain, and 73%, 57%, and 51% achieved the treatment targets of HbA1c, LDL, and SBP, respectively. T2D patients with or without MS pain did not differ in their achievement of T2D treatment goals. Of pain locations, low back pain was associated with higher rates of achievement of the LDL target (OR 1.29, 95% CI 1.01-1.65), but the association was attenuated in the adjusted model. CONCLUSIONS MS pain was relatively prevalent among primary care patients with T2D, but did not influence the achievement of T2D treatment goals.
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Affiliation(s)
- Eveliina Heikkala
- Rovaniemi Health Center, Rovaniemi, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland.
| | - Maria Hagnäs
- Rovaniemi Health Center, Rovaniemi, Finland; Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland; Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
| | - Paulo Ferreira
- School of Health Sciences, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Manuela L Ferreira
- Faculty of Medicine and Health, Kolling Institute, School of Health Sciences, University of Sydney, Sydney, Australia
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Adaptation and Psychometric Evidence of the ARABIC Version of the Diabetes Self-Management Questionnaire (A-DSMQ). Healthcare (Basel) 2022; 10:healthcare10050951. [PMID: 35628088 PMCID: PMC9140770 DOI: 10.3390/healthcare10050951] [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: 04/11/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 12/02/2022] Open
Abstract
(1) Background: Diabetic patients must engage in self-care practices in order to maintain optimal glycemic control, hence reducing the likelihood of developing complications, and enhance the overall quality of their lives. The Diabetes Self-care Management Questionnaire (DSMQ) is a tool for assessing self-management habits that may be used to predict glycemic control in people with diabetes. However, no Arabic language version of the instrument has been found. Therefore, we adapted an Arabic language version of the instrument in Tunisia. The purpose of the current research aimed to assess the psychometric features of the Tunisian version of the DSMQ in patients with type 2 diabetes. (2) Method: Two samples including both genders, one exploratory (n = 208, mean age 53.2 ± 8.3) and one confirmatory (n = 441, mean age 53.4 ± 7.4), completed an adapted Arabic language version of the DSMQ, a sociodemographic questionnaire and information about their HbA1C levels. (3) Results: The exploratory factor analysis revealed that the 15 items of the A-DSMQ fit well with the data. Likewise, the alpha coefficients for the A-DSMQ factors were above 0.80: for “Glucose Management” (GM), “Dietary Control” (DC), “Physical Activity” (PA), and “Heath-Care Use” (HU). The fit indices for the CFA were good, and the four-factor solution was confirmed. The Average Variance Extracted values and Fornell–Larcker criterion established the convergent and discriminant validity, respectively. The concurrent validity of the tool was established through the statistically significant negative relationships between the A-DSMQ factors and HbA1C, in addition to its positive association with the practice of physical activity measured by the IPAQ. (4) Conclusions: Given the high EFA factor loadings, the CFA fit indices, the correlation matrix, the sensitivity analysis, the convergent validity, and the excellent internal consistency of the A-DSMQ, it can be concluded that the A-DSMQ is an effective psychometric tool for diabetes self-management in Tunisia.
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Łukasiewicz A, Kiejna A, Cichoń E, Jodko-Modlińska A, Obrębski M, Kokoszka A. Relations of Well-Being, Coping Styles, Perception of Self-Influence on the Diabetes Course and Sociodemographic Characteristics with HbA1c and BMI Among People with Advanced Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2022; 15:407-418. [PMID: 35177917 PMCID: PMC8846556 DOI: 10.2147/dmso.s320909] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/01/2021] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Assessment of the relationship between psychological and sociodemographic factors with the levels of glycated hemoglobin (HbA1c) and Body Mass Index (BMI) among people with advanced type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS A total of 2574 persons, among them 1381 (53.7%) women, with type 2 diabetes, during the period of switching from biphasic mixtures of human insulin to insulin analogues. The age of participants ranged from 22 to 94 years (M = 63.5; SD = 9.58), and their treatment period was in the time frame from 2 years to 43 years (M = 10.2; SD = 6.1). Participants filled out a Scale for Perception of Self-Influence on the Diabetes Course, Well-Being Index WHO-5, two questions from the Brief Method of Evaluating Coping with a Disease. RESULTS Statistically significant correlations were found between the HbA1c levels and (1) disease duration (rs=0.067; p < 0.001); (2) number of complications (rs = 0.191, p < 0.001) (3) the perception of self-influence on the diabetes course (rs=- 0.16; p < 0.001); (4) well-being (risk of depression) (rs=- 0.10; p < 0.001). The regression analysis showed that 7% of HbA1c variability is explained by age, a perception of self-influence on the diabetes course, the number of complications, place of residence, education, BMI. The most important findings concerning BMI were found in regression analysis, which indicated a week relationship between BMI and a number of complications, perception of self-influence on the diabetes course and coping styles (3% of the resultes' variability). The group at high risk of depression had the highest levels of HbA1c. CONCLUSION Sociodemographic and psychological factors show weak but statistically significant relationships with the current levels of HbA1c and BMI.
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Affiliation(s)
- Agnieszka Łukasiewicz
- Faculty of Nursing in Warsaw, University of Humanities and Economics in Lodz, Warsaw, Poland
| | - Andrzej Kiejna
- Department of Psychology, WSB University in Torun, Torun, Wroclaw, Poland
- Department of Psychology, Faculty of Applied Studies, University of Lower Silesia, Wroclaw, Poland
| | - Ewelina Cichoń
- Department of Psychology, WSB University in Torun, Torun, Wroclaw, Poland
- Department of Psychology, Faculty of Applied Studies, University of Lower Silesia, Wroclaw, Poland
| | | | - Marcin Obrębski
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Kokoszka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
- Correspondence: Andrzej Kokoszka Tel/Fax +48 22 326 58 92 Email
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Jellinger KA. Pathomechanisms of Vascular Depression in Older Adults. Int J Mol Sci 2021; 23:ijms23010308. [PMID: 35008732 PMCID: PMC8745290 DOI: 10.3390/ijms23010308] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
Depression in older individuals is a common complex mood disorder with high comorbidity of both psychiatric and physical diseases, associated with high disability, cognitive decline, and increased mortality The factors predicting the risk of late-life depression (LLD) are incompletely understood. The reciprocal relationship of depressive disorder and age- and disease-related processes has generated pathogenic hypotheses and provided various treatment options. The heterogeneity of depression complicates research into the underlying pathogenic cascade, and factors involved in LLD considerably differ from those involved in early life depression. Evidence suggests that a variety of vascular mechanisms, in particular cerebral small vessel disease, generalized microvascular, and endothelial dysfunction, as well as metabolic risk factors, including diabetes, and inflammation that may induce subcortical white and gray matter lesions by compromising fronto-limbic and other important neuronal networks, may contribute to the development of LLD. The "vascular depression" hypothesis postulates that cerebrovascular disease or vascular risk factors can predispose, precipitate, and perpetuate geriatric depression syndromes, based on their comorbidity with cerebrovascular lesions and the frequent development of depression after stroke. Vascular burden is associated with cognitive deficits and a specific form of LLD, vascular depression, which is marked by decreased white matter integrity, executive dysfunction, functional disability, and poorer response to antidepressive therapy than major depressive disorder without vascular risk factors. Other pathogenic factors of LLD, such as neurodegeneration or neuroimmune regulatory dysmechanisms, are briefly discussed. Treatment planning should consider a modest response of LLD to antidepressants, while vascular and metabolic factors may provide promising targets for its successful prevention and treatment. However, their effectiveness needs further investigation, and intervention studies are needed to assess which interventions are appropriate and effective in clinical practice.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150 Vienna, Austria
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Development and Validation of the Depression Inventory for Type 1 Diabetes (DID-1). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312529. [PMID: 34886259 PMCID: PMC8657055 DOI: 10.3390/ijerph182312529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
People with type 1 diabetes (T1D) are more likely to have depression than the general population and their prognosis is worse. Unfortunately, the characteristics of persons with T1D lead to inadequate screening for depression in this population. To aid in the detection of depression in this population, this study was undertaken to develop a depressive symptoms assessment instrument specific to patients with T1D and to examine its psychometric properties. A total of 207 people with T1D participated in this study. The reliability of the new scale was assessed using Cronbach’s alpha and the Spearman-Brown split-half coefficient. The Depression Inventory for type 1 Diabetes (DID-1), composed of 45 items on a Likert scale (1–7), shows high internal and temporal consistency, as well as adequate concurrent, convergent and discriminant validity. Factor analysis identified 7 factors (Symptoms of depression, Diminished interest, Hopelessness and dissatisfaction, Guilt, Fear, frustration and irritability, Defenselessness, and Interference in daily life) that explained 61.612% of the total variability. The cut-off score for diagnosis was set at 155 points. It was concluded that the DID-1 scale is a reliable, valid and useful tool for the assessment of depressive symptoms, eliminating the bias of other nonspecific diabetes scales.
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