Suicide and Self-inflicted Injury in Diabetes: A Balancing Act

The psychosocial burdens of living with diabetes

AIM

To better understand the prevalence of self-reported psychosocial burdens and the unmet needs identified by people with diabetes in relation to routine diabetes visits.

METHODS

An English language, online survey was distributed via social media, key stakeholder networks, charity and advocacy groups to adults with type 1 diabetes or type 2 diabetes. Survey items were designed by members of the FDA RESCUE Collaborative Community Governing Committee prior to pilot testing with potential participants. Descriptive statistical analyses were conducted, as well as thematic analyses on free-text responses using NVivo v14.

RESULTS

Four hundred and seventy-eight participants completed the survey: 373 (78%) had type 1 diabetes, 346 (73%) identified as a woman and 433 (91%) were white. Most participants had experienced self-reported (rather than diagnosed) anxiety and depression (n = 323 and n = 313, respectively), as well as fear of low blood sugars (n = 294), low mood (n = 290) and diabetes-related distress (n = 257). Sixty-eight percent reported that diabetes had negatively affected self-esteem, 62% reported the feelings of loneliness, but 93% reported that friends/family/work colleagues were supportive when needed. Two hundred and seventy-two percent (57%) reported that their diabetes team had never raised the topic of mental health. The overwhelming majority stated that the best thing their diabetes team could do to help was to simply ask about mental well-being, listen with empathy and without judgement, and practice skills to understand psychosocial issues in diabetes.

CONCLUSION

Integrating psychosocial discussions and support within routine healthcare visits is crucial to improve outcomes for people with diabetes. Such a biopsychosocial model of healthcare has long been advocated by regulatory bodies.

Suicide death, suicidal ideation and suicide attempt in patients with diabetes: A systematic review and meta-analysis

AIMS

Diabetes has been indicated to be a risk factor for suicide. We aim to estimate the prevalence of suicide in patients with diabetes.

DESIGN

A meta-analysis using PRISMA methodology was adopted to examine the incidence of suicide in diabetic patients.

DATA SOURCES

From inception to October 2022, three online databases (PubMed, China National Knowledge Infrastructure and Web of Science) were used to search studies.

REVIEW METHODS

We used random-effects model to analysis. And our primary outcome was the incidence of suicide death per 100 person-years, and other outcomes were prevalence of suicidal ideation and suicide attempt. To explore the sources of heterogeneity in our study, we performed subgroup and meta-regression analyses.

RESULTS

The suicide death rate in diabetic patients was 0.027 per 100 person-years, with a higher rate for Type 1 Diabetes Mellitus compared to Type 2 Diabetes Mellitus. The prevalence of suicidal ideation in diabetes patients was 0.175, with a higher prevalence in Type 1 Diabetes Mellitus compared to Type 2 Diabetes Mellitus. The prevalence of suicide attempts in diabetes patients was 0.033, indicating a higher rate for Type 2 Diabetes Mellitus compared to Type 1 Diabetes Mellitus.

CONCLUSIONS

The results indicate a high rate of suicide among people with diabetes, and this study identifies populations and regions at high risk for suicide. Our review emphasizes interventions in mental health and the improvement of suicide prevention programmes.

IMPACT

The study investigated suicide death, suicidal ideation and suicide attempt in diabetic individuals. Suicide rates are elevated among diabetic patients, and various patient groups face distinct suicide risks. It is important to prioritize the mental well-being of diabetic individuals and enhance interventions, including personalized approaches, to inform public health efforts aimed at preventing and addressing suicide among diabetic patients.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public involvement.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Targeting BDNF with acupuncture: A novel integrated strategy for diabetes and depression comorbidity

Diabetes and depression are common comorbid conditions that impose a substantial health burden. Acupuncture may effectively improve symptoms in patients with diabetes and depression, but the underlying mechanism remains unclear. Brain-derived neurotrophic factor (BDNF) may play a vital role in the effects of acupuncture on diabetes and depression comorbidity. This review summarizes the potential role of BDNF in acupuncture for diabetes and depression comorbidity. BDNF appears to exert its effects via the BDNF-TrkB-ERK-CREB signaling pathway. BDNF levels are reduced in diabetes and depression, and acupuncture may increase BDNF expression, improving symptoms and glycemic control. High-quality research is needed to validate the efficacy of acupuncture for diabetes and depression comorbidity. Randomized controlled trials and mechanistic studies should investigate the BDNF pathway and other potential mechanisms. Improved understanding of the links between diabetes, depression and acupuncture may enable targeted and individualized patient care. Earlier diagnosis and management of diabetes and depression comorbidity should also be a priority.

Association rule mining of real-world data: Uncovering links between race, glycemic control, lipid profiles, and suicide attempts in individuals with diabetes

Aims

The increased risk of suicide among individuals with diabetes is a significant public health concern. However, few studies have focused on understanding the relationship between suicide attempts and diabetes. Association rule mining (ARM) is a data mining technique to discover a set of high-risk factors of a given disease. Therefore, this study aimed to utilize ARM to identify a high-risk group of suicide attempts among patients with diabetes using Cerner Real-World Data™ (CRWD).

Methods

The study analyzed a large multicenter electronic health records data of 3,265,041 patients with diabetes from 2010 to 2020. The Least Absolute Shrinkage and Selection Operator regression with ten-fold cross-validation and the Apriori algorithm with ARM were used to uncover groups of high-risk suicide attempts.

Results

Of the 52,217,517 unique patients in the CRWD, 3,266,856 were diagnosed with diabetes. There were 7764 (0.2%) patients with diabetes who had a history of suicide attempts. The study revealed that patients with diabetes who were never married and had average blood glucose levels below 150 mg/dl were more likely to attempt suicide. In contrast, patients with diabetes aged 60 and older who had diabetes for less than five years and A1C levels between 6.5 and 8.9% were less likely to attempt suicide. Risk factors were strongly associated with suicide attempts, including never married, White, blood glucose levels below 150 mg/dl, and LDL levels below 100 mg/dl.

Conclusions

This is the first study utilizing ARM to discover the risk patterns for suicide attempts in individuals with diabetes. ARM showed the potential for knowledge discovery in large multi-center electronic health records data. The results are explainable and could be practically used by providers during outpatient clinic visits. Further studies are needed to validate the results and investigate the cause-and-effect relationship of suicide attempts among individuals with diabetes.

Psychological care of patients during the pancreas transplantation process: issues and prospects

Pancreas transplantation for patients with type 1 diabetes is a therapeutic option when other treatments are not effective and physical complications occur. Psychological burden is prominent in patients, and non-adherence to treatment is often one manifestation of such difficulties. Time projection is an important factor affected by chronic disease. The prospect of transplantation has the potential to repair this disruption. It could re-establish a continuity in the patient's self and history, by connecting the future to a life that was only about past and present. Taking care of oneself, adhering to treatment, being part of a long-term therapeutic project and going through transplantation are all processes that need a good ability to self-project in time. This is specifically a domain of psychotherapeutic interventions. In this article, the psychological implications of pancreas transplantation for patients and caregivers alike will be discussed, as well as the role of the psychiatrist in the transplantation process.

Safety and Efficacy of Eucaloric Very Low-Carb Diet (EVLCD) in Type 1 Diabetes: A One-Year Real-Life Retrospective Experience

A eucaloric very low carbohydrate diet (EVLCD) is a diet with a daily caloric intake equal to the total daily energy expenditure (TDEE) with a carbohydrate content of <50 g/day. The literature on very low carbohydrate diets (VLCD) in type 1 diabetes (DM 1) is limited, although recently published scientific studies have highlighted their safety and efficacy in managing DM 1. In this retrospective analysis, we report the clinical data of 33 patients affected by DM 1 carrying out insulin therapy who switched voluntarily from their usual diet (high carb, low fat) to an EVLCD. Our aim is to evaluate the glycemic control, the amount of insulin needed in order to maintain glycemic control and safety of EVLCD. The switch improved glycemic control (mean glycated hemoglobin decreased from 8.3% to 6.8% (p < 0.01). The number of patients who reached a glycated hemoglobin value of <7% increased statistically from 12% to 57% (p < 0.01), and there was a statistically significant decrease (p < 0.01) in the units of daily insulin (from 36.7± 14.9 IU to 28.9 ±9.1 IU) A reduction from 54% to 24% in clinical level 2 hypoglycemia episodes was reported. No cases of severe hypoglycemia or ketoacidosis were observed. The results of the study support that EVLCD in DM 1 seems safe and effective when adopted under tight medical supervision.

Catalpol Weakens Depressive-like Behavior in Mice with Streptozotocin-induced Hyperglycemia via PI3K/AKT/Nrf2/HO-1 Signaling Pathway

Depression has huge social risks of high incidence, disability, and suicide. Its prevalence and harm in people with hyperglycemia are 2-3 times higher than in normal people. However, antidepressants with precise curative effects and clear mechanisms for patients with hyperglycemia are currently lacking. Prescriptions containing Rehmannia glutinosa, a traditional medicinal herb with a wide range of nutritional and medicinal values, are often used as antidepressants in Chinese clinical medicine. Catalpol is one of the main effective compounds of R. glutinosa, with multiple biological activities such as hypoglycemia. Here, the antidepressant effect of catalpol on the pathological state of streptozotocin (STZ)-induced hyperglycemia and the underlying molecular mechanisms were analyzed. Results showed that administering catalpol orally to hyperglycemic mice for 21 consecutive days significantly reversed the abnormalities in tail suspension, forced swimming, and open field tests. Catalpol also reversed the abnormal phosphorylation of phosphoinositide 3-kinase (PI3K) and protein kinase B (AKT) and the abnormal levels of nuclear factor erythroid 2-related factor 2 (Nrf2) protein, heme oxygenase-1 (HO-1), and antioxidants, including superoxide dismutase, glutathione peroxidase, glutathione-s transferase, reduced glutathione, and malondialdehyde in the hippocampus and frontal cortex of STZ-induced hyperglycemic mice. Thus, catalpol attenuates depressive-like behavior in pathological hyperglycemic state, and the antidepressant mechanism could at least be partly attributed to the upregulation of the PI3K/AKT/Nrf2/HO-1 signaling pathway in both brain regions, thus restoring the balance between oxidative and antioxidant damage. These data expanded the scientific understanding of catalpol and provided preclinical experimental evidence for its application.

Rural-urban scaling of age, mortality, crime and property reveals a loss of expected self-similar behaviour

The urban scaling hypothesis has improved our understanding of cities; however, rural areas have been neglected. We investigated rural-urban population density scaling in England and Wales using 67 indicators of crime, mortality, property, and age. Most indicators exhibited segmented scaling about a median critical density of 27 people per hectare. Above the critical density, urban regions preferentially attract young adults (25-40 years) and lose older people (> 45 years). Density scale adjusted metrics (DSAMs) were analysed using hierarchical clustering, networks, and self-organizing maps (SOMs) revealing regional differences and an inverse relationship between excess value of property transactions and a range of preventable mortality (e.g. diabetes, suicide, lung cancer). The most striking finding is that age demographics break the expected self-similarity underlying the urban scaling hypothesis. Urban dynamism is fuelled by preferential attraction of young adults and not a fundamental property of total urban population.