Symptoms of depression in people with impaired glucose metabolism or Type 2 diabetes mellitus: The Hoorn Study

Sex differences in the association between stroke risk factors and pre-clinical predictors of stroke in the childhood determinants of Adult Health study

BACKGROUND AND AIMS

It is unclear why blood pressure (BP), metabolic markers and smoking increase stroke incidence in women more than men. We examined these associations with carotid artery structure and function in a prospective cohort study.

METHODS

Participants in the Australian Childhood Determinants of Adult Health study at ages 26-36 years (2004-06) were followed-up at 39-49 years (2014-19). Baseline risk factors included smoking, fasting glucose, insulin, systolic and diastolic BP. Carotid artery plaques, intima-media thickness [IMT], lumen diameter and carotid distensibility [CD] were assessed at follow up. Log binomial and linear regression with risk factor × sex interactions predicted carotid measures. Sex-stratified models adjusting for confounders were fitted when significant interactions were identified.

RESULTS

Among 779 participants (50% women), there were significant risk factor × sex interactions with baseline smoking, systolic BP and glucose associated with carotid measures in women only. Current smoking was associated with incidence of plaques (RRunadjusted 1.97 95% CI 1.4, 3.39), which reduced when adjusted for sociodemographics, depression, and diet (RRadjusted 1.82 95% CI 0.90, 3.66). Greater systolic BP was associated with lower CD adjusted for sociodemographics (βadjusted -0.166 95% CI -0.233, -0.098) and hypertension with greater lumen diameter (βunadjusted 0.131 95% CI 0.037, 0.225), which decreased when adjusted for sociodemographics, body composition and insulin (βadjusted 0.063 95% CI -0.052, 0.178). Greater glucose (βunadjusted -0.212 95% CI -0.397, -0.028) was associated with lower CD, which decreased when adjusted for sociodemographics, BP, depression and polycystic ovary syndrome (βadjusted -0.023 95% CI -0.249, 0.201).

CONCLUSIONS

Smoking, SBP and glucose affect carotid structure and function more in women than men with some of this risk due to co-occurring risk factors.

Developing a nomogram for predicting depression in diabetic patients after COVID-19 using machine learning

Objective

This study identified major risk factors for depression in community diabetic patients using machine learning techniques and developed predictive models for predicting the high-risk group for depression in diabetic patients based on multiple risk factors.

Methods

This study analyzed 26,829 adults living in the community who were diagnosed with diabetes by a doctor. The prevalence of a depressive disorder was the dependent variable in this study. This study developed a model for predicting diabetic depression using multiple logistic regression, which corrected all confounding factors in order to identify the relationship (influence) of predictive factors for diabetic depression by entering the top nine variables with high importance, which were identified in CatBoost.

Results

The prevalence of depression was 22.4% (n = 6,001). This study calculated the importance of factors related to depression in diabetic patients living in South Korean community using CatBoost to find that the top nine variables with high importance were gender, smoking status, changes in drinking before and after the COVID-19 pandemic, changes in smoking before and after the COVID-19 pandemic, subjective health, concern about economic loss due to the COVID-19 pandemic, changes in sleeping hours due to the COVID-19 pandemic, economic activity, and the number of people you can ask for help in a disaster situation such as COVID-19 infection.

Conclusion

It is necessary to identify the high-risk group for diabetes and depression at an early stage, while considering multiple risk factors, and to seek a personalized psychological support system at the primary medical level, which can improve their mental health.

Glycemic status and health-related quality of life (HRQOL) in populations at risk of diabetes in two Latin American cities

PURPOSE

To estimate the health-related quality of life (HRQOL) according to glycemic status, and its relationship with sociodemographic and clinical factors in a population at risk of developing type 2 diabetes (T2D).

METHODS

Cross-sectional study, using cluster sampling. Data were collected from 1135 participants over 30 years of age, at risk of developing T2D from the PREDICOL project. Participants' glycemic status was defined using an oral glucose tolerance test (OGTT). Participants were divided into normoglycemic subjects (NGT), prediabetes and diabetics do not know they have diabetes (UT2D). HRQOL was assessed using the EQ-5D-3L questionnaire of the EuroQol group. Logistic regression and Tobit models were used to examine factors associated with EQ-5D scores for each glycemic group.

RESULTS

The mean age of participants was 55.6 ± 12.1 years, 76.4% were female, and one in four participants had prediabetes or unknown diabetes. Participants reported problems most frequently on the dimensions of Pain/Discomfort and Anxiety/Depression in the different glycemic groups. The mean EQ-5D score in NGT was 0.80 (95% CI 0.79-0.81), in prediabetes, 0.81 (95% CI 0.79-0.83), and in participants with UT2D of 0.79 (95% CI 0.76-0.82), respectively. Female sex, older age, city of residence, lower education, receiving treatment for hypertension, and marital status were significantly associated with lower levels of HRQOL in the Tobit regression analysis.

CONCLUSIONS

HRQOL of NGT, prediabetes, and UT2D participants was statistically similar. However, factors such as gender, age. and place of residence were found to be significant predictors of HRQOL for each glycemic group.

Dynamic relationships between depressive symptoms and insulin resistance over 20 years of adulthood

BACKGROUND

Bidirectional longitudinal relationships between depression and diabetes have been observed, but the dominant direction of their temporal relationships remains controversial.

METHODS

The random-intercept cross-lagged panel model decomposes observed variables into a latent intercept representing the traits, and occasion-specific latent 'state' variables. This permits correlations to be assessed between the traits, while longitudinal 'cross-lagged' associations and cross-sectional correlations can be assessed between occasion-specific latent variables. We examined dynamic relationships between depressive symptoms and insulin resistance across five visits over 20 years of adulthood in the population-based Coronary Artery Risk Development in Young Adults (CARDIA) study. Possible differences based on population group (Black v. White participants), sex and years of education were tested. Depressive symptoms and insulin resistance were quantified using the Center for Epidemiologic Studies Depression (CES-D) scale and the homeostatic model assessment for insulin resistance (HOMA-IR), respectively.

RESULTS

Among 4044 participants (baseline mean age 34.9 ± 3.7 years, 53% women, 51% Black participants), HOMA-IR and CES-D traits were weakly correlated (r = 0.081, p = 0.002). Some occasion-specific correlations, but no cross-lagged associations were observed overall. Longitudinal dynamics of these relationships differed by population groups such that HOMA-IR at age 50 was associated with CES-D score at age 55 (β = 0.076, p = 0.038) in White participants only. Longitudinal dynamics were consistent between sexes and based on education.

CONCLUSIONS

The relationship between depressive symptoms and insulin resistance was best characterized by weak correlations between occasion-specific states and enduring traits, with weak evidence that insulin resistance might be temporally associated with subsequent depressive symptoms among White participants later in adulthood.

The influence of emotion regulation and family involvement on diabetes distress among adults with type 2 diabetes

Adults with diabetes frequently experience diabetes related distress, which is associated with negative health outcomes. Family members are commonly involved in patients' diabetes self-management. However, family involvement can have helpful and/or harmful effects on patients' diabetes outcomes. Use of interpersonal strategies to regulate negative emotions may play a role in patients' interactions with family members and experience of diabetes distress. This study examined the influences of interpersonal emotion regulation and family and friend involvement on diabetes distress among 373 adults with type 2 diabetes. Two separate three-step sequential linear regression models were used to test the main and interactive effects of harmful and helpful family involvement and interpersonal emotion regulation on diabetes distress. Greater use of interpersonal strategies to regulate negative emotions (p = .006) and greater harmful family involvement (p < .001) were significantly associated with greater diabetes distress. Interpersonal emotion regulation moderated the relationship of helpful (p = .007), but not harmful (p = .171) family involvement on diabetes distress. Specifically, greater helpful family involvement was associated with lower diabetes distress among adults with low (p = .017) but not high (p = .419) use of interpersonal strategies to regulate negative emotions. Helpful family involvement appears to be associated with lower diabetes distress, but only among patients with low levels of interpersonal emotion regulation.

Health-related quality of life (HRQoL) in a population at risk of type 2 diabetes: a cross-sectional study in two Latin American cities

Purpose

The purpose of this study was to describe the health-related quality of life (HRQoL) characteristics in a population at risk of developing type 2 diabetes in Barranquilla and Bogotá, Colombia.

Methods

A cross-sectional study with 1135 participants older than 30 years-of-age recruited in Bogotá D.C., and Barranquilla by cluster sampling in 2018 to 2019. The Finnish Diabetes Risk Score (FINDRISC) was used to detect participants at risk of developing type 2 diabetes (T2D). HRQoL was assessed using the EQ-5D-3L questionnaire. Unadjusted and adjusted logistic regression models were used to calculate odds ratios (OR) and their corresponding 95% confidence intervals CI).

Results

Moderate or extreme problems appeared more frequently in the dimensions of Pain/Discomfort (60.8%) and Anxiety/Depression (30.8%). The mean score of the EQ-VAS was 74.3 (± 17.3), significantly larger in the state of complete health (11111) compared with those with problems in more than one of the quality-of-life dimensions. Being female and living in Bogota D.C., were associated with greater odds of reporting problems in the Pain (OR 1.6; 95% CI 1.2–2.2) and Discomfort dimensions (OR 1.6; 95% CI 1.2–2.0) respectively and Anxiety/Depression (OR 1.9; 95% CI 1.3–2.7), (OR 9.1; 95% CI 6.6–12.4), respectively.

Conclusions

As living place and sex were associated with dimensions of Pain/Discomfort and Anxiety/Depression in the HRQoL in people at risk of T2D, greater attention should be paid to these determinants of HRQoL to design and reorient strategies with a territorial and gender perspective to achieve better health outcomes.

Plain English summary

Diabetes is one of the four non-communicable diseases with increasing prevalence in the world, which has made it a serious public health problem. In Colombia, in 2019 diabetes affected 8.4% of the Colombian adult population and more than one million Colombian adults of this age group have hidden or undetected diabetes. This disease is not only characterized by increased premature mortality, loss of productivity, and economic impact, but it also involves a deterioration in the quality of life of people with diabetes with their respective families. However, very Little is known about health-related quality of life (HRQoL) in a population at risk or with prediabetes. This study has evaluated the quality of life in patients at risk of diabetes and their behavior with some variables as sociodemographic, lifestyle, history, and established their difference in two territories of the Colombian Caribbean. The results of this study indicate that the HRQoL of people at risk of type 2 diabetes is affected by factors such as gender, city, dysglycemia, medication for hypertension and education level. Therefore, greater attention should be paid to these determinants of HRQL to design and implement strategies that reduce this risk of developing type 2 diabetes, prevent prediabetes and improve the quality of life in prediabetic or diabetic patients.

Association between BDNF Polymorphism and Depressive Symptoms in Patients Newly Diagnosed with Type 2 Diabetes Mellitus

PURPOSE

Little is known about the relationship between brain-derived neurotrophic factor (BDNF) gene polymorphisms and psychiatric symptoms in diabetes patients. We investigated the effects of BDNF Val/66/Met polymorphism, glucose status, psychological susceptibility, and resilience on anxiety and depression symptoms in patients newly diagnosed with type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

We examined biochemical factors and BDNF polymorphism in 89 patients who were newly diagnosed with T2DM. Psychiatric symptoms were investigated with the Hospital Anxiety and Depression Scale (HADS), and the Connor-Davidson Resilience Scale (CD-RISC) and Impact of Event Scale (IES) were used to assess psychological resilience and susceptibility to psychological distress, respectively. Logistic regression analyses were conducted to investigate factors associated with psychiatric symptoms.

RESULTS

We determined that 62 patients (70%) were Met-carriers. No significant differences were found between the Val/Val homozygous and Met-carrier groups regarding age, sex, body mass index, and clinical factors related to glycemic control and lipid profiles. HADS-anxiety and HADS-depression scores and IES factor scores were higher in the Met-carrier than the Val/Val homozygous group. Hemoglobin A1c (HbA1c) level was significantly inversely correlated with the severity of depressive symptoms. Resilience factors showed significant inverse correlations, and IES factors showed positive correlations with depressive symptom severity. In the logistic regression analysis model, depressive symptoms were significantly associated with HbA1c and BDNF polymorphism, whereas only the hyperarousal factor of the IES scale was associated with anxiety.

CONCLUSION

Depressive symptoms are associated with the presence of the Met-carriers and lower HbA1c in patients newly diagnosed with T2DM.

Evidence of hypoglycemic anhedonia and modulation by bupropion in rats

BACKGROUND

Disorders characterized by dysfunction of glucose metabolism are often comorbid with depression. The current study investigated whether a hypoglycemic state caused by 2-deoxy-d-glucose (2-DG) can result in anhedonic behaviors responsive to stimulation of monoamine activity.

METHODS

In experiment 1, male Sprague-Dawley rats were tested for maintenance of intra-oral self-administration (IOSA) of a sweet solution after pre-treatment with 300 or 500 mg/kg 2-DG, a blocker of glucose metabolism. Experiment 2 determined whether exposure to an environment previously paired with the effects of 2-DG (0, 200 or 300 mg/kg) can influence IOSA, and whether 2-DG can modify taste reactivity to same sweet solution. Finally, experiment 3 examined whether 0 or 30 mg/kg bupropion, a monoamine-reuptake blocker, would attenuate the effect of 300 mg/kg 2-DG on IOSA and taste reactivity.

RESULTS

It was found that 2-DG produced a sustained decrease in IOSA when animals were tested drug-free. This decrease in IOSA did not appear linked to place conditioning or to alterations in taste reactivity, and it was partially normalized by pre-treatment with bupropion.

CONCLUSIONS

Taken together, these results in rats suggest that rapid hypoglycemia can induce an anhedonic state characterized by impaired consummatory responses to nutritional incentive stimuli and that can be alleviated by the antidepressant bupropion.

The prevalence of depressive symptoms and related risk factors among diabetic patients with retinopathy attending the Jordan University Hospital

OBJECTIVES

To investigate the prevalence of depressive symptoms among diabetic patients suffering from retinopathy, and to identify crucial risk factors that affect patients' quality of life and whether social support mediates the relationship between retinopathy and depression.

METHODS

The sample comprises 155 participants with diabetic retinopathy recruited from the Jordan University Hospital during the year 2017. Arabic versions of all study tools were employed as follows: the Beck Depression Inventory; the short form of the health survey; the Berlin social support scale; ophthalmic examinations; patients' records; and a demographic questionnaire.

ANALYSES

Descriptive statistics, the Pearson correlation, linear regression using SPSS, and mediation analysis using the Sobel test were applied. In addition, the odds ratio analysis and qualitative analyses for the open-ended questions were included.

RESULTS

In general, 13 (8.9%) of our patients did not manifest any symptoms of depression while 42 (27.1%) had a mild mood disturbance, 26 (16.8%) were on the borderline of clinical depression, 47 (30.3%) had moderate depression, 22 (14.2%) with severe depression, and 5 (3.2%) had extreme depression. The results indicate a nonsignificant positive correlation between social support and health-related quality of life and a nonsignificant positive relationship between retinopathy severity and depression. Meanwhile, our results revealed a significant negative relationship between depression and social support and a nonsignificant negative relationship between retinopathy severity and social support.

CONCLUSION

Our findings suggest that diabetic patients with retinopathy have a higher risk of developing depression. Hence, psychological interventions are highly needed to meet the mental health needs of these patients.

Synergistic effects of depression and obesity on type 2 diabetes incidence in Chinese adults

BACKGROUND

Cross-sectional studies have supported the association among depression, obesity, and type 2 diabetes, but the causality remains controversial in Chinese adults. In this longitudinal study, we evaluated the synergistic effect of depression and obesity on the risk of type 2 diabetes.

METHODS

This study included 2809 participants randomly selected from the Qingdao Diabetes Prevention Program, and their type 2 diabetes incidence was determined over a follow-up period of 3 years. The WHO 2006 criteria and the Zung Self-Rating Depression Scale score were employed to identify type 2 diabetes and depression at baseline, respectively. Multivariable-adjusted logistic regression was used to evaluate the synergistic effects of depression and obesity indicators on type 2 diabetes, with adjustment for age, sex, family history of diabetes, and other potential risk factors.

RESULTS

During 3-year follow-up, 316 new incident cases were identified. The relative risk and 95% confidence interval of depression for diabetes incidence was 1.52 (1.05-2.21), after controlling for potential confounders. Sensitivity analysis showed that depression was significantly associated with diabetes incidence in women, younger people, and obese people (1.82 [1.14-2.92], 1.94 [1.25-3.02], and 4.29 [1.44-12.78], respectively]. The synergistic effects of positive depression and body mass index ≥30 kg/m² on type 2 diabetes incidence were observed, with a synergy index of 5.49 (1.75-17.19).

CONCLUSIONS

Depression was associated with a 52% increased risk of type 2 diabetes incidence and exerts synergistic effects with obesity on diabetes incidence in Chinese adults. Early identification and intervention for depression and obesity can reduce the risk of diabetes.

The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies

AIMS

Depression is a common co-morbidity in patients with type 2 diabetes mellitus (T2DM). Untreated depression in these patients adversely affects self-care activities and other diabetes complications. The aim of this study is to estimate the prevalence of depression among patients with T2DM by conducting a meta-analysis of observational studies.

METHODS

MEDLINE, Web of Science, Science Direct, and Google Scholar databases were searched for all observational studies that assessed depression in T2DM. Relevant articles were searched using the combination of Medical Subject Heading (MeSH) terms of "depression", "depressive disorder", and "diabetes mellitus" published between January 2007 and July 2018. Random effects model was used to estimate the weighted prevalence rates and 95% CI using "metaprop program in STATA 11".

RESULTS

In total, the 248 included studies (with 273 reported prevalence) identified 83,020,812 participants; of them, 23,245,827 (28%; 95% CI 27, 29) suffered from different severity levels of depressive disorders. The prevalence of depression was separately reported in 137,372 males and 134,332 females. Of them, 31,396 males (23%, 95% CI: 20, 26) and 45,673 females (34%, 95% CI: 31, 38) were depressed. Compared with global estimate, depression prevalence was lower in Europe (24%) and Africa (27%), but higher in Australia (29%) and Asia (32%). The prevalence in America was equal to the estimated prevalence in the world (28%). Depression was more common in subjects younger than 65 compared with elderlies (31% vs. 21%).

CONCLUSION

Our findings demonstrated that almost one in four adults with T2DM experienced depression. Given the high prevalence of depressive disorders in diabetic patients, screening these patients for co-morbid depression and its relevant risk factors is highly recommended.

Risk of Depression and Suicidality among Diabetic Patients: A Systematic Review and Meta-Analysis

The purpose of this study is to conduct a systematic review and meta-analysis to evaluate the risk of depression and suicidality among diabetic patients.

METHODS

Medline, PubMed, EMBASE, Cochrane library, and Psych INFO were searched for studies published from 2008 onwards. Meta-analysis was conducted to estimate the pooled effect size. Sources of heterogeneity were investigated by subgroup analysis and meta-regression.

RESULTS

In total, 5750 articles were identified and of those, 17 studies on suicidality and 36 on depression were included in this study. Our analysis suggests a positive relationship between diabetes and depression (cohort studies odds ratio (OR) 1.49, 95% confidence interval (CI): 1.36⁻1.64 and cross-sectional studies OR 2.04, 95% CI, 1.73⁻2.42). Pooled OR values for suicidal ideation, attempted suicide, and completed suicide were 1.89 (95% CI: 1.36⁻2.63), 1.45 (95% CI: 1.07⁻1.96), and 1.85 (95% CI: 0.97⁻3.52), respectively. All findings were statistically significant except for completed suicide.

CONCLUSIONS

The increased risk of depression and suicidality in diabetic patients highlights the importance of integrating the evaluation and treatment of depression with diabetes management in primary healthcare settings. Further research in this area is needed.

Comparison of health-related quality of Life (HRQOL) among patients with pre-diabetes, diabetes and normal glucose tolerance, using the 15D-HRQOL questionnaire in Greece: the DEPLAN study

BACKGROUND

Diabetes mellitus is usually preceded by a pre-diabetic stage before the clinical presentation of the disease, the influence of which on persons' quality of life is not adequately elucidated. The purpose of this study was to compare the Health-Related Quality of Life (HRQOL) of persons with pre-diabetes with that of diabetes or normal glucose tolerance (NGT), using the validated HRQOL-15D questionnaire.

METHODS

The HRQOL-15D scores of 172 people with pre-diabetes (108 with Impaired Fasting Glucose [IFG], 64 with Impaired Glucose Tolerance [IGT], aged 58.3 ± 10.3 years) and 198 with NGT (aged 54.4 ± 10.1 years) from the Greek part of the DEPLAN study (Diabetes in Europe - Prevention using Lifestyle, Physical Activity and Nutritional Intervention), were compared to 100 diabetes patients' scores (aged 60.9 ± 12.5 years, diabetes duration 17.0 ± 10.0 years, HbA1c 7.2 ± 1.2%), derived from the outpatient Diabetes Clinic of a University Hospital.

RESULTS

The diabetes patients' HRQOL-15D score (0.8605) was significantly lower than the pre-diabetes' (0.9008) and the controls' (0.9092) (p < 0.001). There were no differences in the total score between the controls and the group with pre-diabetes. However, examination of individual parameters of the score showed that people with IGT had lower scores compared to the control group, as related to the parameters of "mobility" and "psychological distress". No differences were found in any component of the HRQOL-15D score between the control group and the IFG group, nor between the two groups with pre-diabetes (IFG vs. IGT).

CONCLUSIONS

Persons with pre-diabetes had a similar HRQOL score with healthy individuals, and a higher score than persons with diabetes. Specific components of the score, however, were lower in the IGT group compared to the controls. These findings help clarify the issue of HRQOL of persons with pre-diabetes and its possible impact on prevention.

Risk of depressive symptoms associated with impaired glucose metabolism, newly diagnosed diabetes, and previously diagnosed diabetes: a meta-analysis of prospective cohort studies

AIMS

Patients with diabetes had a higher risk of developing depressive symptoms. Little is known about the risk of depressive symptoms associated with different glucose metabolism status. We performed a meta-analysis of prospective cohort studies to investigate the risk of depressive symptoms among individuals with impaired glucose metabolism (IGM), newly diagnosed diabetes (NDM), and previously diagnosed diabetes (PDM), compared with those with normal glucose metabolism (NGM), and further examined the influence of diabetes-related comorbidities on the association.

METHODS

PubMed and EMBASE were searched for relevant studies through 5 September 2015. The random-effects model was used to calculated overall relative risk (RR) and confidence interval (CI). Three separated meta-analyses were conducted by estimating the risk of depressive symptoms among people with IGM, NDM, and PDM, with NGM as a common reference category. Secondary analyses were conducted to examine whether adjustment for diabetes-related comorbidities affected the association.

RESULTS

Five prospective cohort studies were included in the analyses, with a total of 18,051 participants involved. People with IGM (RR = 1.08, 95 % CI 0.84-1.38) and NDM (RR = 1.07, 95 % CI 0.74-1.55) were not associated with risk of developing depressive symptoms, whereas patients with PDM were associated with a modest increased risk of depressive symptoms (RR = 1.29, 95 % CI 1.03-1.63), after adjustment for demographic/socioeconomic factors. The risk of depressive symptoms associated with PDM was attenuated to be non-significant after pooling RRs that were adjusted for diabetes-related comorbidities.

CONCLUSIONS

Our meta-analysis suggested people with PDM, but not IGM or NDM had an increased risk of developing depressive symptoms, and the risk was partially explained by diabetes-related comorbidities. Our findings indicated that routine diabetes care should put more emphasis on psychological problems of diabetic patients with complications.

Financial Barriers to Health Care Among Mexican Americans With Chronic Disease and Depression or Anxiety in El Paso, Texas

PURPOSE

To determine the barriers to health care access by chronic disease and depression/anxiety diagnosis in Mexican Americans living in El Paso, TX.

DESIGN

A secondary analysis was conducted using data for 1,002 Hispanics from El Paso, TX (2009-2010). Logistic regression was conducted for financial barriers by number of chronic conditions and depression/anxiety diagnosis. Interaction models were conducted between number of chronic conditions and depression or anxiety.

RESULTS

Depressed/anxious individuals reported more financial barriers than those with chronic conditions alone. There were significant interactions between number of chronic conditions and depression/anxiety for cost, denied treatment because of an inability to pay, and an inability to pay $25 for health care.

CONCLUSION

Financial barriers should be considered to maintain optimal care for both mental and physical health in this population.

IMPLICATIONS FOR PRACTICE

There should be more focus on the impact of depression or anxiety as financial barriers to compliance.

Association of depression with pre-diabetes, undiagnosed diabetes, and previously diagnosed diabetes: a meta-analysis

We performed a meta-analysis to analyze the associations of depression with pre-diabetes (PreDM), undiagnosed diabetes (UDM), and previously diagnosed diabetes (PDM), and whether the association was affected by important study characteristics. We searched relevant articles published in PubMed and EMBASE up to August, 2015. Studies reporting cross-sectional associations of depression with PreDM, UDM, or PDM compared with normal glucose metabolism (NGM) were included. Odds ratios (ORs) were pooled with random-effect and fixed-effect models. Subgroup analyses by sex, study mean age, different degrees of adjustment, publication year, quality score, and depression assessment scales were also performed. Twenty studies were eligible and included in current analysis. Summary estimates showed that compared with NGM individuals, prevalence of depression was moderately increased in PreDM (random-effect odds ratio (OR) 1.11, 95 % confidence interval (CI) 1.03-1.19) and UDM (OR 1.27, 95 % CI 1.02-1.59), and markedly increased in PDM (OR 1.80, 95 % CI 1.40-2.31). Subgroup analyses showed that the positive association remained only among studies with mean age <60 years old but not among those with mean age ≥60 years old. Summary estimates of ORs with cardiovascular disease adjustment substantially attenuated the association. Our findings suggested that risk of prevalent depression was gradually increased with the deterioration of glucose metabolism among younger age groups but not among older age groups. Comorbid cardiovascular diseases might be an important intermediate factor underlying the association between depression and diabetes.

Neighbourhood Walkability and Daily Steps in Adults with Type 2 Diabetes

Introduction

There is evidence that greater neighbourhood walkability (i.e., neighbourhoods with more amenities and well-connected streets) is associated with higher levels of total walking in Europe and in Asia, but it remains unclear if this association holds in the Canadian context and in chronic disease populations. We examined the relationships of different walkability measures to biosensor-assessed total walking (i.e., steps/day) in adults with type 2 diabetes living in Montreal (QC, Canada).

Materials and Methods

Participants (60.5±10.4 years; 48.1% women) were recruited through McGill University-affiliated clinics (June 2006 to May 2008). Steps/day were assessed once per season for one year with pedometers. Neighbourhood walkability was evaluated through participant reports, in-field audits, Geographic Information Systems (GIS)-derived measures, and the Walk Score^®. Relationships between walkability and daily steps were estimated using Bayesian longitudinal hierarchical linear regression models (n = 131).

Results

Participants who reported living in the most compared to the least walkable neighbourhoods completed 1345 more steps/day (95% Credible Interval: 718, 1976; Quartiles 4 versus 1). Those living in the most compared to the least walkable neighbourhoods (based on GIS-derived walkability) completed 606 more steps per day (95% CrI: 8, 1203). No statistically significant associations with steps were observed for audit-assessed walkability or the Walk Score^®.

Conclusions

Adults with type 2 diabetes who perceived their neighbourhoods as more walkable accumulated more daily steps. This suggests that knowledge of local neighborhood features that enhance walking is a meaningful predictor of higher levels of walking and an important component of neighbourhood walkability.

Association of Depressive and Anxiety Disorders With Diagnosed Versus Undiagnosed Diabetes: An Epidemiological Study of 90,686 Participants

OBJECTIVE

To compare the odds of depressive and anxiety disorders for participants with diagnosed diabetes, participants with diabetes but unaware of this, and participants without diabetes. Such knowledge might improve etiological insight into psychopathology in diabetes.

METHODS

Data of 90,686 participants (mean age = 45 years; 59% female) from the LifeLines cohort was used. Depressive and anxiety disorders were assessed by the Mini-International Neuropsychiatric Interview. The odds of depression and anxiety were assessed for three groups: a) diagnosed diabetes, diabetes medication use and/or self-reported "diabetes"; b) undiagnosed diabetes, fasting blood glucose ≥7.0 mmol/l, but no diabetes medication use and self-reported "no diabetes"; and c) no diabetes, fasting blood glucose <7.0 mmol/l and self-reported "no diabetes." Logistic regression was performed to compare the odds of depression and anxiety in these groups, adjusting for age, sex, diabetes-related diseases, comorbid depressive or anxiety disorders, and glycosylated hemoglobin.

RESULTS

A total of 3002 (3.3%) participants were diagnosed as having depression and 9018 (9.9%) as having anxiety; 1781 (2.0%) had diagnosed and 786 (0.9%) had undiagnosed diabetes. Both diagnosed (odds ratio [OR] = 1.4:1.1-1.8, p = .006) and undiagnosed (OR = 1.8:1.3-2.6, p = .001) diabetes were independently associated with depression. The odds of depression did not differ between diagnosed and undiagnosed diabetes (OR = 0.7, p = .17). Diagnosed diabetes was independently associated with anxiety (OR = 1.4:1.2-1.7, p < .001), but undiagnosed diabetes was not (OR = 0.8:0.6-1.1, p = .20). The odds of anxiety were significantly higher in diagnosed compared with undiagnosed diabetes (1.68:1.23-2.31, p = .001).

CONCLUSIONS

Depression was more prevalent in participants with diagnosed and undiagnosed diabetes, whereas anxiety was more prevalent only in participants who were aware of their diabetes. Longitudinal research is needed to assess the causal pathways of these associations.

Demographic, lifestyle, and health characteristics of older adults with prediabetes in England

OBJECTIVE

To describe the demographic, lifestyle, and health characteristics of older adults with prediabetes compared to those with normal glucose levels or diabetes.

METHOD

Participants were from the English Longitudinal Study of Aging 2004-2005 (n=4168). Statistical analyses examined differences between people with prediabetes and 1) people with normal glucose levels and 2) people with diabetes. Design-based F-statistics and t-tests tested differences for each characteristic individually and multinomial logistic regression examined adjusted associations. Survey weighting and cluster information was used to generalize to the older English population.

RESULTS

Compared to people with normal glucose levels, people with prediabetes were older (RR=1.05 95% CI 1.04-1.07), more likely to be employed (RR=1.27 95% CI 1.01-1.60), more likely to smoke (RR=2.21 95% CI 1.74-2.80), and had higher BMIs (RR=1.08 95% CI 1.06-1.10). Compared to people with diabetes, people with prediabetes were more likely to be women (RR=2.12 95% CI 1.57-2.86), more likely to be employed (RR=1.54 95% CI 1.02-2.33), had lower BMIs (RR=0.95 95% CI 0.93-0.98), were less likely to have a cardiovascular condition (RR=0.34 95% CI 0.24-0.47), and had higher self-rated health (χ(2)=26.08, p<0.001).

CONCLUSION

Older adults with prediabetes have a unique set of characteristics that may inform prevention or intervention schemes.

Depression, anxiety disorders, and metabolic syndrome in a population at risk for type 2 diabetes mellitus

BACKGROUND

Depressive symptoms have been associated with type 2 diabetes mellitus (T2DM), but less is known about anxiety disorders that can be comorbid or exist without depression.

METHODS

We evaluated the prevalence of psychiatric disorders in subjects consecutively examined at an outpatient clinic for diabetes prevention who were at-risk for T2DM, defined by FINDRISK scores, and compared metabolic syndrome (MetS) frequencies between subjects with and without psychiatric morbidity, entering also relevant variables for MetS into multivariate analyses. All subjects underwent an oral glucose tolerance test (OGTT). Psychiatric diagnosis was confirmed using a Structured Clinical Interview for DSM-IV.

RESULTS

Of 260 consecutively screened subjects, 150 (56.9±8.1 years old, males=56.7%, BMI=27.2±4.1 kg/m2) were at-risk for T2DM and were included. MetS, present in 27% of males and 25% of females, was significantly associated with having a current anxiety disorder (P<0.001) and lifetime major depression (P<0.001). In logistic regression analysis, MetS was significantly associated with lifetime major depression, presence of any anxiety disorder, body weight, and physical activity.

CONCLUSIONS

Our data in a high-risk group for T2DM support the association between depressive disorders and MetS, pointing to a similar role of anxiety disorders. Screening for anxiety and depression is recommended in this group at risk for T2DM.

Longitudinal changes in health-related quality of life in normal glucose tolerance, prediabetes and type 2 diabetes: results from the KORA S4/F4 cohort study

PURPOSE

The aim of this study was to examine how transition between normal glucose tolerance, prediabetes and diabetes over a 7 year period is associated with change in health-related quality of life (HRQL) in an elder German population-based cohort.

METHODS

We used data from 1,046 participants of the KORA S4/F4 cohort study aged 55-74 years at baseline. Based on an oral glucose tolerance test, prediabetes was defined as impaired fasting glucose and/or impaired glucose tolerance. HRQL was assessed with the SF-12 questionnaire. Using linear regression, we estimated mean change in HRQL over time, depending on glucose status at baseline and follow-up, adjusted by demographic and lifestyle variables.

RESULTS

Individuals progressing to prediabetes or diabetes experienced a greater loss in the physical component score than patients with persistent normal glucose tolerance (-2.31 and -7.44 vs. -1.08), but the difference was only significant for subjects converting to diabetes. Subjects with prediabetes at baseline and diabetes at follow-up had a significant loss in mental health compared to subjects with persistent prediabetes.

CONCLUSIONS

There is first evidence that worsening of glucose metabolism over time is associated with deteriorating HRQL, however, further and larger longitudinal studies are needed to confirm these findings.

Depression and type 2 diabetes: a causal association?

There is a controversy regarding whether depression and type 2 diabetes are causally linked. To assess this issue, we review key findings for the association between depression and diabetes, and its underlying mechanisms. Findings from meta-analyses of cohort studies show a modestly sized bidirectional association between depression and type 2 diabetes (ie, depression predicts diabetes onset and diabetes predicts future depression). However, depression-related biological alterations in the hypothalamic-pituitary-adrenal cortex axis and the sympathetic nervous system, and subclinical inflammation, are not consistently linked with increased diabetes risk. The evidence for an association between depression and glycaemic traits (eg, glucose, insulin, insulin sensitivity, and insulin secretion) is also mixed. Diabetes increases the risk of depression to the same extent as do other chronic disorders (eg, cardiac diseases, osteoarthritis, lung disease, and poor hearing). At present, the available evidence suggests that pathophysiological changes preceding the onset of type 2 diabetes might not cause depression, nor might depression directly increase the risk of developing type 2 diabetes. Despite insufficient robust causal evidence, treating physicians should be aware of the co-occurrence of depression and type 2 diabetes.

Glucose Levels and Depression in Hispanic Patients Admitted to the Cardiovascular Intensive Care Unit

Depression is frequently associated with diabetes mellitus (DM) and may worsen DM-related morbidity and mortality. We determined the potential association of glucose levels with depression in Hispanic patients admitted to the Cardiovascular Intensive Care Unit. Patients were given the Center for Epidemiologic Studies—Depression scale survey within 24 hours of admission. Glycated hemoglobin and fasting blood glucose levels within 30 days of admission were extracted. The HbA1c levels remained significantly associated with both presence of depression and depression levels. Histories of DM, myocardial infarction, and percutaneous coronary intervention as well as baseline brain natriuretic peptide levels were also significantly associated with depression levels. The presence of a significant association between glucose levels and depression in Hispanic patients indicates that there is a need for optimal management of glycemic levels. This may then lead to better health outcomes in Hispanics with cardiovascular disease.

Glycemia, insulin resistance, insulin secretion, and risk of depressive symptoms in middle age

OBJECTIVE

The extent to which abnormal glucose metabolism increases the risk of depression remains unclear. In this study, we investigated prospective associations of levels of fasting glucose and fasting insulin and indices of insulin resistance and secretion with subsequent new-onset depressive symptoms (DepS).

RESEARCH DESIGN AND METHODS

In this prospective cohort study of 3,145 adults from the Whitehall II Study (23.5% women, aged 60.6 ± 5.9 years), baseline examination included fasting glucose and insulin level, the homeostasis model assessment of insulin resistance (HOMA2-%IR), and the homeostasis model assessment of β-cell insulin secretion (HOMA2-%B). DepS (Center for Epidemiologic Studies Depression Scale ≥16 or use of antidepressive drugs) were assessed at baseline and at 5-year follow-up.

RESULTS

Over the 5-year follow-up, DepS developed in 142 men and 84 women. Women in the lowest quintile of insulin secretion (HOMA2-%B ≤55.3%) had 2.18 (95% CI 1.25-3.78) times higher odds of developing DepS than those with higher insulin secretion. This association was not accounted for by inflammatory markers, cortisol secretion, or menopausal status and hormone replacement therapy. Fasting insulin measures were not associated with DepS in men, and fasting glucose measures were not associated with new-onset DepS in either sex.

CONCLUSIONS

Low insulin secretion appears to be a risk factor for DepS in middle-aged women, although further work is required to confirm this finding.

Ethnic aspects of emotional distress in patients with diabetes--the Amsterdam Health Monitor Study

AIMS

Depression and anxiety are relatively common in patients with diabetes, but it is unclear whether migrant patients with diabetes are at increased risk for emotional distress. We determined levels of emotional distress in patients with diabetes with a Turkish, Moroccan or Dutch ethnic background and compare distress levels with healthy control subjects. Among patients with diabetes, we examined demographic and clinical correlates of higher levels of emotional distress.

METHODS

Cross-sectional data were collected within the framework of the population-based Amsterdam Health Monitor Survey. Adult participants were interviewed to assess demographics, presence of chronic disease(s) and ethnic background. Emotional distress was determined with the Kessler psychological distress scale. Blood was drawn to determine HbA(1c) , glucose, HDL and total cholesterol. Anthropometrics and blood pressure were assessed during a medical examination.

RESULTS

The total sample comprised of 1736 participants. The prevalence of emotional distress was significantly higher in participants with diabetes (31%) compared with healthy participants (19%). Increased levels of emotional distress were reported by 38% of the Turkish, 35% of the native Dutch and 29% of the Moroccan patients with diabetes. Among patients with diabetes, the presence of two or more co-morbid chronic diseases was most strongly associated with higher levels of emotional distress, whereas glycaemic control, cholesterol, blood pressure or waist circumference were not.

CONCLUSIONS

Emotional distress affects approximately one third of adult patients with diabetes living in Amsterdam. Having multiple co-morbid diseases seems related to more emotional distress among these patients, while ethnicity and diabetes-related characteristics are not.

Haemoglobin A1c, fasting glucose and future risk of elevated depressive symptoms over 2 years of follow-up in the English Longitudinal Study of Ageing

BACKGROUND

The cross-sectional association between impaired glucose/diabetes and depression is inconsistent. We examined the longitudinal associations between diabetes, indicators of glucose metabolism and depressive symptoms over 2 years of follow-up.

METHOD

Participants were 4338 men and women from the English Longitudinal Study of Ageing, a prospective study of community-dwelling older adults [aged 62.9 (s.d.=9.0) years, 45.2% men]. Depressive symptoms were assessed at baseline and after 2 years of follow-up using the eight-item Centre of Epidemiological Studies--Depression (CES-D) scale. Glycated haemoglobin (HbA1c) levels, fasting glucose and other biological and behavioural risk factors were also assessed at baseline.

RESULTS

Approximately 11.5% of the sample were categorized with elevated depressive symptoms at follow-up (a score ≥ 4 on the CES-D). There was an association between HbA1c and depressive symptoms at follow-up [per unit increase, odds ratio (OR) 1.17, 95% confidence interval (CI) 1.03-1.33] after adjustment for age and baseline CES-D. Cross-sectionally, the probability of depressive symptoms increased with increasing HbA1c levels until the value of 8.0% after which there was a plateau [p(curve)=0.03]. Compared with those with normal fasting glucose, participants with diabetes (confirmed through self-report or elevated fasting blood glucose) at baseline had an elevated risk of depressive symptoms at follow-up (OR 1.52, 95% CI 1.01-2.30) after adjusting for depressive symptoms at baseline, behavioural and sociodemographic variables, adiposity and inflammation.

CONCLUSIONS

These data suggest that poor glucose metabolism and diabetes are risk factors for future depression in older adults. There was no evidence of a U-shaped association.

Sexual function in women with type 1 diabetes matched with a control group: depressive and psychosocial aspects

INTRODUCTION

Sexual dysfunction in women with diabetes, despite its important consequences to their quality of life, has been investigated only recently with conflicting results about its prevalence and association with complications and psychological factors.

AIMS

To assess the prevalence of the alteration of sexual function and the influence of metabolic control and psychological factors on female sexuality.

METHODS

Seventy-seven adult Italian women with type 1 diabetes, matched with a control group (n=77), completed questionnaires evaluating sexual function (Female Sexual Function Index, FSFI), depressive symptoms (Self-Rating Depression Scale, SRDS), social and family support (Multidimensional Scale of Perceived Social Support), and diabetes-related quality of life (Diabetes Quality of Life). Clinical and metabolic data were collected.

MAIN OUTCOME MEASURES

Prevalence and magnitude of sexual dysfunction in terms of alteration of sexual functioning as measured by the FSFI scores.

RESULTS

The prevalence of sexual dysfunction was similar in diabetes and control groups (33.8% vs. 39.0%, not significant), except for higher SRDS scores in the diabetes group (47.39 ± 11.96 vs. 43.82 ± 10.66; P=0.047). Diabetic patients with an alteration of sexual function showed a significantly higher SRDS score (53.58 ± 14.11 vs. 44.24 ± 9.38, P=0.004). Depression symptoms and good glycemic control (A1C<7.0%) were predictors of alteration of sexual function only in diabetic patients (odds ratio [OR]=1.082; 95% confidence interval [CI]: 1.028-1.140; OR=5.085; 95% CI: 1.087-23.789), since we have not found any significant predictor of sexual dysfunction in the control group.

CONCLUSIONS

The prevalence of sexual dysfunction in our type 1 diabetes patients' sample is similar to those reported in other studies. Diabetic patients are similar to healthy people except for higher depression scores. Further studies are necessary to understand whether the correlation between an alteration of sexual function and good glycemic control may be related to the role of control as a mental attitude.

Prevalence of depression in individuals with impaired glucose metabolism or undiagnosed diabetes: a systematic review and meta-analysis of the European Depression in Diabetes (EDID) Research Consortium

OBJECTIVE

Meta-analyses have shown that the risk for depression is elevated in type 2 diabetes. Whether this risk in individuals with impaired glucose metabolism (IGM) or undiagnosed diabetes (UDD) is elevated relative to normal glucose metabolism (NGM) or decreased relative to previously diagnosed type 2 diabetes (PDD) has not been the subject of a systematic review/meta-analysis. This study examined the prevalence of depression in IGM and UDD subjects relative to each other and to NGM and PDD subjects by reviewing the literature and conducting a meta-analysis of studies on this topic.

RESEARCH DESIGN AND METHODS

EMBASE and MEDLINE databases were searched for articles published up to May 2010. All studies that compared the prevalence of depression in subjects with IGM and UDD were included. Odds ratios (ORs) were calculated using fixed and random-effects models.

RESULTS

The meta-analysis showed that the risk for depression was not increased in IGM versus NGM subjects (OR 0.96, 95% CI 0.85-1.08). Risk for depression did not differ between individuals with UDD and individuals with either NGM (OR 0.94, 95% CI 0.71-1.25) or IGM (OR 1.16, 95% CI 0.88-1.54). Finally, individuals with IGM or UDD both had a significantly lower risk of depression than individuals with PDD (OR 0.59, 95% CI 0.48-0.73, and OR 0.57, 95% CI 0.45-0.74, respectively).

CONCLUSIONS

Results of this meta-analysis show that the risk of depression is similar for NGM, IGM, and UDD subjects. PDD subjects have an increased risk of depression relative to IGM and UDD subjects.

Fasting Blood Glucose and Depressive Mood among Patients with Mental Illness in a Medicaid Managed Care Program

Objective. This study explores the relationship between depressive symptoms, as measured by the PHQ-9 depression screen and blood glucose levels among patients with diabetes enrolled in Gold Choice, a Medicaid managed care program for individuals with mental illness and/or substance abuse. Methods. The PHQ-9 was mailed to 454 Gold Choice members and a questionnaire was mailed to their physicians requesting current HbA1c% and fasting blood glucose (FBG) levels. The pearson product-moment correlation was used to describe the association between PHQ-9 scores and FBG levels. Results. The PHQ-9 response rate was 55% (N = 249). Laboratory results were received for 141 patients. The correlation between FBG and PHQ-9 scores was modest but statistically significant: r = 0.21 , P = 0.015. Conclusion. A statistically significant association was found between FBG and PHQ-9 depression scores. This finding supports current recommendations that physicians be alert to depressive symptoms among patients with diabetes or impaired glucose metabolism.

Confirmatory factor analysis of the depressive cognition scale

The purpose of this study was to validate the single-factor structure of the Depressive Cognition Scale (DCS) among individuals from the U.S. general population. The sample was composed of 629 adults from 42 states of the United States. All measures of model fit of the DCS exceeded the recommended criteria for the good model fit (χ(2)/df = 2.57, goodness-of-fitness index = .98, adjusted goodness-of-fitness index = .96, comparative fit index = .99, Tucker Lewis index = .98, root mean square error of approximation = .05, root mean residual = .01, and the P value for test of close fit = .464). Thus, the DCS was found to be a reliable and valid instrument to measure depressive cognitions among individuals from the general population.

Psychological distress, glycated hemoglobin, and mortality in adults with and without diabetes

OBJECTIVE

To examine associations between psychological distress, glucose metabolism, and death. There is limited information about the long-term prognosis of diabetic patients with psychological distress.

METHODS

In a representative cohort of 11,546 adults (6.2% with high-risk/undiagnosed diabetes and 4.8% with physician-diagnosed diabetes), we measured glycated hemoglobin A1C as an indicator of glucose metabolism and psychological distress with the 12-item General Health Questionnaire (GHQ-12).

RESULTS

During the mean follow-up of 4.7 years, there were 682 deaths (93 among diabetic, 88 in high-risk/undiagnosed diabetic [A1C ≥6.0% without physician-diagnosed diabetes], and 501 in nondiabetic participants). Psychological distress was apparent in 18.9%, 16.5%, and 13.4% of diabetic, high-risk/undiagnosed diabetic, and nondiabetic participants, respectively. In participants with diabetes, a unit increase in GHQ-12 score was associated with higher risk of death at follow-up (multivariate adjusted hazard ratio, 1.16; 95% confidence interval, 1.09-1.24). Levels of A1C were also higher in diabetic participants with distress (GHQ-12 score of >3) compared with those without (7.86% versus 7.40%; p = .008), although adjustment for A1C did alter the association between distress and mortality. In the whole sample, the coexistence of diabetes and distress was associated with an elevated risk of death, beyond that due to having either diabetes or distress alone (multivariate adjusted hazard ratio, 3.64; 95% confidence interval, 2.21-5.98).

CONCLUSIONS

Psychological distress is an independent risk factor for death in diabetic patients, although impaired glucose metabolism did not explain the excess risk.

Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in Type 2 Diabetes

Depression is one of the most common psychological problems among individuals diabetes, and it is associated with worse treatment adherence and clinical outcomes. As part of a program of treatment research aimed at integrating interventions for depression and treatment nonadherence, five depressed patients with suboptimally controlled type 2 diabetes were treated with 10-12 sessions of individual cognitive behavioral therapy for adherence and depression (CBT-AD) in a case-series design. The intervention was delivered in a hospital setting by a collaborative team consisting of a psychologist, a nurse educator, and a dietitian. Post-treatment, all participants demonstrated a decrease in depression severity and demonstrated improvements in diabetes self-care. Four of the five demonstrated improved glycemic control. These preliminary results provide evidence for the acceptability, feasibility, and potential utility of CBT-AD for patients with type 2 diabetes and depression.

The prevalence of depressive symptoms in a white European and South Asian population with impaired glucose regulation and screen-detected Type 2 diabetes mellitus: a comparison of two screening tools

AIMS

To compare the identification of prevalent depressive symptoms by the World Health Organization-5 Wellbeing Index (WHO-5) and Centre for Epidemiological Studies Depression Scale (CES-D) for South Asian and white European people, male and female, attending a diabetes screening programme, and to explore the adequacy of the screening tools for this population. An additional aim was to further explore associations of depressive symptoms with impaired glucose regulation (IGR) and Type 2 diabetes mellitus (Type2 DM).

METHODS

Eight hundred and sixty-four white European (40-75 years old) and 290 South Asian people (25-75 years old) underwent an oral glucose tolerance test (OGTT), detailed history and anthropometric measurements and completed the WHO-5 and CES-D. Depressive symptoms were defined by a WHO-5 score <or= 13, and CES-D score >or= 16.

RESULTS

Unadjusted prevalence of depressive symptoms with the WHO-5, for people with Type2 DM was 42.3% (47.4% in white European; 28.6% in South Asian) and for IGR 30.7% (26% in white European; 45.8% in South Asian). With the CES-D, the prevalence in Type2 DM was 27.2% (25.4% in white European; 31.8% in South Asian) and for IGR 30.7% (27.8% in white European; 40.7% in South Asian). Statistically significant differences in the prevalence of depressive symptoms for sex or ethnicity were not identified. Odds ratios adjusted for age, sex and ethnicity showed no significant association of depression with Type2 DM or IGR, with either WHO-5 or CES-D. Agreement was moderate (kappa = 0.48, 95% confidence intervals 0.42-0.54), and reduced when identifying depressive symptoms in people with Type2 DM. For this group, a WHO-5 cut-point of <or= 10 was optimal.

CONCLUSIONS

Depressive symptoms, identified by WHO-5 or CES-D, were not significantly more prevalent in people with Type2 DM or IGR. The WHO-5 and CES-D differed in their identification of depressive symptoms in people with Type2 DM, though discrepancies between sex and ethnicity were not identified.

Depression, anxiety and glucose metabolism in the general dutch population: the new Hoorn study

Background

There is a well recognized association between depression and diabetes. However, there is little empirical data about the prevalence of depressive symptoms and anxiety among different groups of glucose metabolism in population based samples. The aim of this study was to determine whether the prevalence of increased levels of depression and anxiety is different between patients with type 2 diabetes and subjects with impaired glucose metabolism (IGM) and normal glucose metabolism (NGM).

Methodology/Principal Findings

Cross-sectional data from a population-based cohort study of 2667 residents, 1261 men and 1406 women aged 40–65 years from the Hoorn region, the Netherlands. Depressive symptoms and anxiety were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D, score ≥16) and the Hospital Anxiety and Depression Scale – Anxiety Subscale (HADS-A, score ≥8), respectively. Glucose metabolism status was determined by oral glucose tolerance test. In the total study population the prevalence of depressive symptoms and anxiety for the NGM, IGM and type 2 diabetes were 12.5, 12.2 and 21.0% (P = 0.004) and 15.0, 15.3 and 19.9% (p = 0.216), respectively. In men, the prevalence of depressive symptoms was 7.7, 9.5 and 19.6% (p<0.001), and in women 16.4, 15.8 and 22.6 (p = 0.318), for participants with NGM, IGM and type 2 diabetes, respectively. Anxiety was not associated with glucose metabolism when stratified for sex. Intergroup differences (NGM vs. IGM and IGM vs. type 2 diabetes) revealed that higher prevalences of depressive symptoms are mainly manifested in participants with type 2 diabetes, and not in participants with IGM.

Conclusions

Depressive symptoms, but not anxiety are associated with glucose metabolism. This association is mainly determined by a higher prevalence of depressive symptoms in participants with type 2 diabetes and not in participants with IGM.

Symptoms of depression but not anxiety are associated with central obesity and cardiovascular disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study

AIMS/HYPOTHESIS

The aim of the study was to identify risk factors for depression and anxiety in a well-characterised cohort of individuals with type 2 diabetes mellitus.

METHODS

We used baseline data from participants (n = 1,066, 48.7% women, aged 67.9 +/- 4.2 years) from the Edinburgh Type 2 Diabetes Study. Symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Obesity was characterised according to both overall (body mass index, fat mass) and abdominal (waist circumference) measurements. Cardiovascular disease was assessed by questionnaire, physical examination and review of medical records. Stepwise multiple linear regression was performed to identify explanatory variables related to either anxiety or depression HADS scores.

RESULTS

Abdominal obesity (waist circumference) and cardiovascular disease (ischaemic heart disease and ankle-brachial pressure index) were related to depression but not anxiety. Lifetime history of severe hypoglycaemia was associated with anxiety. Other cardiovascular risk factors or microvascular complications were not related to either anxiety or depressive symptoms.

CONCLUSIONS/INTERPRETATION

Depression but not anxiety is associated with abdominal obesity and cardiovascular disease in people with type 2 diabetes mellitus. This knowledge may help to identify depressive symptoms among patients with type 2 diabetes who are at greatest risk.

Prevalence of comorbid depression is high in out-patients with Type 1 or Type 2 diabetes mellitus. Results from three out-patient clinics in the Netherlands

AIMS

Depression is common in diabetes, but the scope of the problem and associated correlates are not well established in specialist diabetes care. We aimed to determine the prevalence of depression among adult outpatients with Type 1 (T1DM) or Type 2 diabetes (T2DM) using both self-report measures and a diagnostic interview, and to establish demographic and clinical characteristics associated with depressive affect.

METHODS

A random sample of 2055 diabetes out-patients from three diabetes clinics was invited to participate. Depressive affect was assessed using the World Health Organization-5 Well Being Index (WHO-5), the Centre for Epidemiologic Studies-Depression scale (CESD) using predefined cut-off scores, and depressive disorder with the Composite International Diagnostic Interview (CIDI). Associations between depression and patient characteristics were explored using regression analyses.

RESULTS

Seven hundred and seventy-two patients completed the depression questionnaires. About one-third of T1DM patients and 37-43% of T2DM patients reported depressive affect (WHO-5). The prevalence of depressive affect (CESD) was 25% and 30% for men and women with T1DM, and 35% and 38% for men and women with T2DM, respectively. Based on the CIDI, 8% of T1DM patients (no gender difference) and 2% of men and 21% of women with T2DM suffered from a depressive disorder. Depressive affect was associated with poor glycaemic control and proliferative retinopathy in T1DM, while non-Dutch descent, obesity and neuropathy were correlates in T2DM.

CONCLUSIONS

Depressive symptoms and major depressive disorder constitute a common comorbid problem among Dutch out-patients with T1DM or T2DM and appear particularly common in migrants and women with T2DM.

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

Emotional problems such as depression, anxiety and diabetes-specific distress are common in patients with type 2 diabetes mellitus (T2DM) but often remain unrecognized and thus untreated. The present Review focuses on the extent of this problem and discusses whether we should screen for depression, anxiety and diabetes-specific distress in patients with this condition. Depression has received by far the greatest attention from researchers. Strong evidence exists that depression affects 10-20% of patients with T2DM, but it is often unrecognized. Several guidelines have therefore recommended periodic assessments of emotional well-being in patients with T2DM. However, this recommendation is not based on strong evidence, as the effects of screening (case-finding) on psychological outcomes and diabetes outcomes have not been tested in a randomized controlled study. Results from studies in patients without T2DM have shown that screening for depression does not improve outcomes. On the other hand, collaborative care approaches for depression in patients with type 1 diabetes mellitus (T1DM) or T2DM seem to be effective. Intervention studies for anxiety or diabetes-specific emotional distress are currently lacking, and further research that can help to optimize antidepressant treatment is also urgently needed.

The influence of depression and anxiety on outcomes after an intervention for prediabetes

OBJECTIVES

To conduct initial analyses and examine ways in which depression and anxiety are associated with outcomes after participation in the Healthy Living Course (HLC), an early-intervention diabetes prevention program for adults with prediabetes.

DESIGN

Randomised controlled study using pre-intervention and postintervention measures to examine relationships between depression, anxiety and diabetes-related program outcomes.

PARTICIPANTS AND SETTING

185 adults from urban and rural Victoria with prediabetes who had completed the HLC program and for whom postintervention measure data were available. Data were collected between 15 June 2006 and 15 June 2008.

MAIN OUTCOME MEASURES

Baseline and postintervention scores on mood (anxiety, depression), biochemical (fasting plasma glucose, oral glucose tolerance), anthropometric (body mass index [BMI], waist circumference), cognitive (self-efficacy, diabetes knowledge) and behavioural (healthy eating, physical activity) measures; correlations between these measures.

RESULTS

The intervention alleviated depression, and improved eating patterns and scores on cognitive, anthropometric and biochemical measures. Cultural group and sex did not influence most results. Baseline mood was not associated with anthropometric or biochemical outcomes; however, more positive baseline mood factors were associated with activity changes, and with greater subsequent activity rates, self-efficacy and diabetes knowledge. In turn, baseline self-efficacy was associated with postintervention healthy eating. Changes towards healthier eating correlated with anthropometric and biochemical changes, while baseline cognitive measures were also associated with physiological outcomes. As expected, reductions in BMI and waist circumference were related to biochemical changes.

CONCLUSION

Our findings highlight the importance of assessing mood factors in prediabetes, and the need to develop theoretical models of change mechanisms for mood in health outcomes.

The relationship between depression and diabetes mellitus: findings from the Hertfordshire Cohort Study

AIMS

To assess the relationship between depression scores and diabetes, glucose and insulin in a cross-sectional population-based study.

METHODS

One thousand, five hundred and seventy-nine men and 1418 women from the Hertfordshire Cohort Study were assessed for diabetes. Plasma glucose and insulin concentrations were measured at 0, 30 and 120 min during a standard 75-g oral glucose tolerance test. Depressive and anxiety symptoms were measured using the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Overall, 431 (14.6%) were diagnosed with diabetes [232 men (14.9%) and 199 women (14.3%)]. One hundred and eight (47%) men and 74 (37%) women had known diabetes. The remainder were previously undiagnosed. Fifty-nine (3.7%) men and 65 (4.6%) women had possible depression (HAD-D scores 8-10) and 17 (1.1%) men and 20 (1.4%) women had probable depression (HAD-D scores > or = 11). Probable depression was associated with an adjusted odds ratio for diabetes of 3.89 [95% confidence interval (CI) 1.28-11.88] in men and 1.51 (95% CI 0.47-4.84) in women. In men without previously diagnosed diabetes, fasting insulin (P = 0.035), 2-h glucose concentrations (P = 0.028) and insulin resistance (P = 0.032) were significantly associated with HAD-D scores. With the exception of 2-h glucose concentrations (P = 0.034), the associations were not significant in women.

CONCLUSIONS

These data support the hypothesis that depression may increase the risk for diabetes. The relationship between depression score and metabolic variables extends across the whole population and is not confined to those with either diagnosed depression or diabetes. This relationship should lead clinicians to consider screening for diabetes in those with depression and vice versa.