Are depressive symptoms associated with quality of care in diabetes? Findings from a nationwide population-based study

Antidepressant treatment and mortality in people with comorbid depression and type 2 diabetes: UK electronic health record study

BACKGROUND

Depression is associated with higher rates of premature mortality in people with physical comorbidities, such as type 2 diabetes. Conceptually, the successful treatment of depression in people with type 2 diabetes could prevent premature mortality.

AIMS

To investigate the association between antidepressant prescribing and the rates of all-cause and cause-specific (endocrine, cardiovascular, respiratory, cancer, unnatural) mortality in individuals with comorbid depression and type 2 diabetes.

METHOD

Using UK primary care records between years 2000 and 2018, we completed a nested case-control study in a cohort of people with comorbid depression and type 2 diabetes who were starting oral antidiabetic treatment for the first time. We used incident density sampling to identify cases who died and matched controls who remained alive after the same number of days observation. We estimated incidence rate ratios for the association between antidepressant prescribing and mortality, adjusting for demographic characteristics, comorbidities, medication use and health behaviours.

RESULTS

We included 5222 cases with a recorded date of death, and 18 675 controls, observed for a median of 7 years. Increased rates of all-cause mortality were associated with any antidepressant prescribing during the observation period (incidence rate ratio 2.77, 95% CI 2.48-3.10). These results were consistent across all causes of mortality that we investigated.

CONCLUSIONS

Antidepressant prescribing was highly associated with higher rates of mortality. However, we suspect that this is not a direct causal effect, but that antidepressant treatment is a marker of more severe and unsuccessfully treated depression.

The dangerous "West Coast Swing" by hyperglycaemia and chronic stress in the mouse hippocampus: Role of kynurenine catabolism

Growing epidemiological studies highlight a bi-directional relationship between depressive symptoms and diabetes mellitus. However, the detrimental impact of their co-existence on mental health suggests the need to treat this comorbidity as a separate entity rather than the two different pathologies. Herein, we characterized the peculiar mechanisms activated in mouse hippocampus from the concurrent development of hyperglycaemia, characterizing the different diabetes subtypes, and chronic stress, recognized as a possible factor predisposing to major depression. Our work demonstrates that kynurenine overproduction, leading to apoptosis in the hippocampus, is triggered in a different way depending on hyperglycaemia or chronic stress. Indeed, in the former, kynurenine appears produced by infiltered macrophages whereas, in the latter, peripheral kynurenine preferentially promotes resident microglia activation. In this scenario, QA, derived from kynurenine catabolism, appears a key mediator causing glutamatergic synapse dysfunction and apoptosis, thus contributing to brain atrophy. We demonstrated that the coexistence of hyperglycaemia and chronic stress worsened hippocampal damage through alternative mechanisms, such as GLUT-4 and BDNF down-expression, denoting mitochondrial dysfunction and apoptosis on one hand and evoking the compromission of neurogenesis on the other. Overall, in the degeneration of neurovascular unit, hyperglycaemia and chronic stress interacted each other as the partners of a "West Coast Swing" in which the leading role can be assumed alternatively by each partner of the dance. The comprehension of these mechanisms can open novel perspectives in the management of diabetic/depressed patients, but also in the understanding the pathogenesis of other neurodegenerative disease characterized by the compromission of hippocampal function.

Moderating Effect of Grip Strength in the Association between Diabetes Mellitus and Depressive Symptomatology

Diabetes mellitus and depression rank among the leading causes of disease burden and are present in the top ten causes of disability-adjusted life years worldwide. Numerous studies have shown that both depression and diabetes have a detrimental effect on the quality of life, and when they coexist, the effect is considerably worse. This study aimed to analyse how grip strength moderates the relationship between diabetes and depressive symptoms among middle-aged and older adults. In total, 41,701 participants (18,003 men) in wave 8 of the cross-sectional population-based Survey of Health, Ageing, and Retirement in Europe (2019/2020) data were studied. A dynamometer was used to test grip strength twice on each hand. Depressive symptoms were measured using the 12-item EURO-D scale. The relationship between diabetes and depressive symptoms is negatively moderated by grip strength (male: B = -0.03, 95% CI = -0.04, -0.03; female: B = -0.06, 95% CI = -0.07, -0.06). Furthermore, the significant zone grip strength moderation values for males and females were less than 48.7 kg and 38.9 kg, respectively. Muscular strength was a moderator of depressive symptoms, attenuating its association with diabetes. This supports the premise that physical activity, namely muscle-strengthening exercises, should be included in diabetes treatment programs.

Lower HbA1C of glycemic control is associated with higher risk of depressive symptoms in elderly with type 2 diabetes mellitus-A Nationwide Community-based study

OBJECTIVE

We investigated the correlation between glycemic control status and depressive symptoms in type 2 diabetes elderly.

METHODS

A total of 1527 participants with type 2 diabetes aged 55 years and older from the Healthy Aging Longitudinal Study in Taiwan study were included in this cross-sectional study. The Center for Epidemiologic Studies Depression Scale (CESD) (20 items) score of ≥16 was indicative of depressive symptoms. The participants were divided into HbA1c ≥ 6.5% and < 6.5% representing the glycemic control. Multiple logistic regression (MLR) and Generalized linear model (GLM) were used.

RESULTS

The MLR analysis showed that the low HbA1c group had significant two-fold increased odds of depressive symptoms compared to the high HbA1c group (OR 1.89, 95% CI 1.17-3.05). The risk of depressive symptoms was lower among males (OR 0.49, 95% CI 0.30-0.80) and those with higher BMI (OR 0.93, 95% CI 0.86-1.00); whereas the risk was higher among those who lived alone (OR 2.37, 95% CI 1.31-4.27) and with ADL disability (OR 3.01, 95% CI 1.85-4.89). The GLM showed that the dimension of depressive affect reached statistical significance with lower HbA1c.

CONCLUSION

This nationwide community-based study shows that depressive symptoms are associated with lower HbA1C, reminding us that more attention should be paid to the presence of depressive symptoms in those with lower HbA1C. Further research is needed to clarify the causal relationship.

The risk associated with psychiatric disturbances in patients with diabetes in Indonesia (2018): a cross-sectional observational study

BACKGROUND

The global prevalence of psychiatric disturbances is rising, detrimentally affecting the quality of care and treatment outcomes for individuals, particularly those with diabetes.This study investigated the association of risk factors for psychiatric disturbances among productive-age patients with diabetes (ages 30-59 years), considering sociodemographic characteristics and co-existing diseases. The risk factors considered included sociodemographic factors (e.g., residence, age, sex, marital status, education, and occupation) and co-existing diseases (e.g., hypertension, heart disease, stroke, renal failure, rheumatism, asthma, and cancer).

METHODS

This cross-sectional study utilized data from the 2018 Indonesian National Health Survey (Riskesdas). The study population comprised respondents aged between 30 and 59 years who had diabetes and had completed the 20-question self-reporting questionnaire (SRQ-20). After the exclusion of incomplete SRQ-20 data, the sample included 8,917 respondents. Data were analyzed using logistic regression.

RESULTS

Approximately 18.29% of individuals with diabetes displayed symptoms indicative of psychiatric disturbances. After adjusting for sociodemographic factors such as age, sex, education level, occupation, marital status, and place of residence, patients with diabetes who had co-existing conditions such as hypertension, heart diseases, rheumatic disorders, asthma, or cancer had a higher risk for developing psychiatric disturbances than those with diabetes alone (adjusted odds ratio, 6.67; 95% confidence interval, 4.481-9.928; p<0.001).

CONCLUSION

The elevated risk of psychiatric disturbances among patients with diabetes who had comorbidities underscores the importance of addressing mental health issues in the management of diabetes, especially in patients with concurrent disease conditions.

Depression and Anxiety Trajectories in Chronic Disease: A Systematic Review and Meta-Analysis

INTRODUCTION

People living with chronic diseases are at an increased risk of anxiety and depression, which are associated with poorer medical and psychosocial outcomes. Many studies have examined the trajectories of depression and anxiety in people with specific diseases, including the predictors of these trajectories. This is valuable for understanding the process of adjustment to diseases and informing treatment planning. However, no review has yet synthesised this information across chronic diseases.

METHODS

Electronic databases were searched for studies reporting trajectories of depression or anxiety in chronic disease samples. Data extracted included sample characteristics, results from trajectory analyses, and predictors of trajectories. Meta-analysis of the overall pooled prevalence of depression and anxiety trajectories was conducted, and qualitative synthesis of disease severity predictors was undertaken.

RESULTS

Following search and screening, 67 studies were included (N = 61,201 participants). Most participants followed a stable nonclinical trajectory for depression (69.0% [95% CI: 65.6, 72.2]) and anxiety (73.4% [95% CI: 66.3, 79.5]). Smaller but meaningful subsamples followed a trajectory of depression and anxiety symptoms consistently in the clinical range (11.8% [95% CI: 9.2, 14.8] and 13.7% [95% CI: 9.3, 19.7], respectively). Several clinical and methodological moderators emerged, and qualitative synthesis suggested that few aspects of disease severity were associated with participants' trajectories.

CONCLUSION

Most people with chronic disease follow a trajectory of distress that is low and stable, suggesting that most people psychologically adjust to living with chronic disease. Evidence also suggests that the nature and severity of the disease are not meaningful predictors of psychological distress.

Prior Diagnosis of Diabetes but Not Its Control is Associated with Higher Depression Score Among Older Individuals

Purpose

The study assessed the relationship between prior diagnosis of diabetes and its control with depression score, differences in socioeconomic, lifestyle, health characteristics and diabetes control by adherence to treatment in population-based sample of older individuals.

Patients and Methods

The analysis of the sub-sample of Polish cohort of the HAPIEE (Health, Alcohol, and Psychosocial Factors in Eastern Europe) study was conducted; 464 participants were interviewed and random first 360 (78%) underwent physical examination and blood sample tests. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. The robust regression method was applied to assess the association between depression score and diabetes diagnosis as well as diabetes control.

Results

There were 97 participants (21.0%) at mean age of 73.6 years (SD=6.31 years) with prior diagnosis of diabetes. Mean HbA1c concentration was 6.65% (SD=1.0) The majority of patients (55.7%) used oral medication with diet. Nearly 20% declared the use of oral treatment alone, and 10.3% used combined treatment of oral medications, insulin, and diet. In this study, 86.6% of the participants with diabetes confirmed self-monitoring of blood glucose levels and 58.8% were on high-quality diet. No differences in socioeconomic, lifestyle, health characteristics or control of diabetes by adherence to diabetes treatment were found. After adjustment for age and gender, diagnosis of diabetes was associated with greater depressive score by about 2 points (β=2.02, 95% CI=0.16;3.88). However, no significant association between depression score and any indicator of diabetes control was found.

Conclusion

In older individuals with diabetes, depression score was higher compared to those without diabetes, but it was not related to poorer diabetes control. No differences in socioeconomic, lifestyle, health characteristics and control of diabetes by adherence to diabetes treatment may suggest that in this age group some other, less known factors are substantial for achievement of treatment targets.

Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, multicenter study

Objective

The aim of this study was to investigate the factors associated with hypoglycemia and severe hypoglycemia (SH) in individuals with type 1 diabetes mellitus (T1D) in Brazil.

Materials and Methods

This multicenter, cross-sectional study was conducted between August 2011 and August 2014 across 10 Brazilian cities. The data were obtained from 1,760 individuals with T1D. Sociodemographic and clinical characteristics related to hypoglycemic events in the previous 4 weeks were evaluated.

Results

Of 1,760 individuals evaluated, 1,319 (74.9%) reported at least one episode of hypoglycemia in the previous 4 weeks. The main factors associated with hypoglycemia were lower hemoglobin A1c (HbA1c) level, better adherence to self-monitoring of blood glucose (SMBG), and higher education level. Episodes of SH were reported by 251 (19%) individuals who, compared with subjects with nonsevere hypoglycemia, received lower doses of prandial insulin and higher doses of basal insulin, in addition to reporting less frequent use of long-acting basal insulin analogs. The percentage of SH episodes was evenly distributed across all ranges of HbA1c levels, and there were no correlations between the mean number of nonsevere or severe hypoglycemic events and HbA1c values. Higher alcohol consumption and more frequent hospitalizations were independently associated with SH.

Conclusion

Although individuals presenting with hypoglycemia had lower HbA1c values than those not presenting hypoglycemia, there were no correlations between the number of nonsevere hypoglycemia or SH and HbA1c values. Also, the frequency of SH was evenly distributed across all ranges of HbA1c values. Better adherence to SMBG and higher education level were associated with hypoglycemia, while alcohol consumption, higher doses of basal insulin, and more frequent hospitalizations in the previous year were associated with SH.

Achieving diabetes treatment targets in people with registered mental illness is similar or improved compared with those without: Analyses of linked observational datasets

AIMS

To determine the association between registered mental illness and type 2 diabetes mellitus treatment targets, while taking into account the effects of health expenditure and social determinants of health.

METHODS

This observational cross-sectional study was based on routine primary care data, linked to socio-economic and medical claims data. The main outcomes, analysed by multivariate logistic regression, were achieving primary care guideline treatment targets for HbA1c , systolic blood pressure (SBP) and LDL-cholesterol in 2017. We examined the association with diagnosed mental illness registered by the general practitioner (GP) or treated via specialist' mental healthcare between 2016 and 2018, adjusting for, medication use, body mass index, co-morbidity, smoking, and additionally examining effect-modification of healthcare expenditures, migration status, income and demographics.

RESULTS

Overall (N = 2862), 64.0% of participants achieved their treatment targets for HbA1c , 65.1% for SBP and 53.0% for LDL-cholesterol. Adjusted for migrant background, income and care expenditures, individuals <65 years of age with mental illness achieved their HbA1c treatment target more often than those without (OR (95% CI)): treatment by GP: 1.46 (1.01, 2.11), specialist care: 1.61 (1.11, 2.34), as did men with mental illness for SBP: GP OR 1.61 (1.09, 2.40), specialist care OR 1.59 (1.09, 2.45). LDL-cholesterol target was not associated with mental illness. A migrant background or low income lowered the likelihood of reaching HbA1c targets.

CONCLUSIONS

People with registered mental illness appear comparable or better able to achieve diabetes treatment targets than those without. Achieving HbA1c targets is influenced by social disadvantage.