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Li DX, Wang CN, Wang Y, Ye CL, Jiang L, Zhu XY, Liu YJ. NLRP3 inflammasome-dependent pyroptosis and apoptosis in hippocampus neurons mediates depressive-like behavior in diabetic mice. Behav Brain Res 2020; 391:112684. [PMID: 32454054 DOI: 10.1016/j.bbr.2020.112684] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/22/2020] [Accepted: 04/27/2020] [Indexed: 12/21/2022]
Abstract
A relatively large number of diabetic patients risk complications of clinical depression that lead to poorer quality of life, however the precise mechanisms for diabetes-associated depression are not fully understood. Links between hyperglycemia-induced oxidative stress and NACHT, LRR, and PYD domains-containing protein 3 (NLRP3) inflammasome activation have been reported in the pathogenesis of diabetes. The present study aimed to elucidate the contribution of NLRP3-mediated apoptotic/pyroptotic neuronal cell death to diabetes-associated depression. We found that depressive-like behavior in streptozotocin (STZ)-induced diabetic mice was associated with hippocampal NLRP3 inflammasome activation. Hyperglycemia increased reactive oxygen species (ROS) production, thus leading to NLRP3 inflammasome activation in hippocampal neurons. It was found that STZ treatment induced apoptotic and pyroptotic cell death in the hippocampus as evidenced by increases of cleaved caspase 3 positive hippocampal neurons, TUNEL-positive cells, protein levels of p53, Bax, Puma, and the cleaved GSDMD N-terminal fragment, all of which were decreased in NLRP3 deficient mice. Using murine hippocampal neuronal cell line HT22, we found that high glucose induced apoptotic and pyroptotic cell death in a NLRP3 inflammasome-dependent manner in vitro. In addition, NLRP3 deficiency alleviated depressive-like behavior in STZ-induced diabetic mice. Our results suggest that hyperglycemia results in apoptosis and pyroptosis of hippocampal neuron cells in a NLRP3-dependent manner, which was associated with the depressive phenotypes evoked by STZ-induced diabetes. The study identifies a novel function of NLRP3 activation in high glucose-induced neuronal cell death, which sheds further light on the pathogenesis and new therapeutic targets of diabetes-associated depression.
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Affiliation(s)
- Dong-Xia Li
- School of Kinesiology, The Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, PR China; Department of Physiology, Navy Medical University, Shanghai 200433, PR China
| | - Chang-Nan Wang
- Department of Physiology, Navy Medical University, Shanghai 200433, PR China; Dongfang Hospital Affiliated to Shanghai Tongji University, Shanghai 200120, PR China
| | - Yan Wang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, PR China
| | - Chang-Lin Ye
- School of Kinesiology, The Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, PR China
| | - Lai Jiang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, PR China.
| | - Xiao-Yan Zhu
- Department of Physiology, Navy Medical University, Shanghai 200433, PR China.
| | - Yu-Jian Liu
- School of Kinesiology, The Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, PR China.
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Duarte-Silva E, Filho AJMC, Barichello T, Quevedo J, Macedo D, Peixoto C. Phosphodiesterase-5 inhibitors: Shedding new light on the darkness of depression? J Affect Disord 2020; 264:138-149. [PMID: 32056743 DOI: 10.1016/j.jad.2019.11.114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Phosphodiesterase-5 inhibitors (PDE5Is) are used to treat erectile dysfunction (ED). Recently, the antidepressant-like effect of PDE5Is was demonstrated in animal models of depression. In clinical settings, PDE5Is were studied only for ED associated depression. Hence, there are no studies evaluating the effects of PDE5Is for the treatment of major depressive disorder (MDD) without ED. In this review article, we aimed to discuss the use of PDE5Is in the context of MDD, highlighting the roles of PDE genes in the development of MDD, the potential mechanisms by which PDE5Is can be beneficial for MDD and the potentials and limitations of PDE5Is repurposing to treat MDD. METHODS We used PubMed (MEDLINE) database to collect the studies cited in this review. Papers written in English language regardless the year of publication were selected. RESULTS A few preclinical studies support the antidepressant-like activity of PDE5Is. Clinical studies in men with ED and depression suggest that PDE5Is improve depressive symptoms. No clinical studies were conducted in subjects suffering from depression without ED. Antidepressant effect of PDE5Is may be explained by multiple mechanisms including inhibition of brain inflammation and modulation of neuroplasticity. LIMITATIONS The low number of preclinical and absence of clinical studies to support the antidepressant effect of PDE5Is. CONCLUSIONS No clinical trial was conducted to date evaluating PDE5Is in depressed patients without ED. PDE5Is' anti-inflammatory and neuroplasticity mechanisms may justify the potential antidepressant effect of these drugs. Despite this, clinical trials evaluating their efficacy in depressed patients need to be conducted.
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Affiliation(s)
- Eduardo Duarte-Silva
- Laboratory of Ultrastructure, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (FIOCRUZ-PE), Recife, PE, Brazil; Graduate Program in Biosciences and Biotechnology for Health (PPGBBS), Aggeu Magalhães Institute (IAM), Recife, PE, Brazil.
| | - Adriano José Maia Chaves Filho
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Tatiana Barichello
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX 77054, United States; Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina-UNESC, Criciúma, SC, Brazil; Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.
| | - João Quevedo
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX 77054, United States; Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina-UNESC, Criciúma, SC, Brazil; Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.
| | - Danielle Macedo
- Neuropsychopharmacology Laboratory, Drug Research and Development Center, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil; Department of Physiology and Pharmacology, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil; National Institute for Translational Medicine (INCT-TM, CNPq), Ribeirão Preto, Brazil
| | - Christina Peixoto
- Laboratory of Ultrastructure, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (FIOCRUZ-PE), Recife, PE, Brazil; National Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM), Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Buin E, Pavin EJ, Silveira MSVM. High anxiety and depressive symptoms in partners of type 1 diabetes persons in a sample of the Brazilian population. Diabetol Metab Syndr 2020; 12:23. [PMID: 32211074 PMCID: PMC7092427 DOI: 10.1186/s13098-020-00531-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/13/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) affects psychologically not only the persons with diabetes themselves but affects their family members. Few studies were conducted to investigate mental health in T1D partners. This study aims: (1) to investigate the frequency of depressive and anxiety symptoms in T1D partners and, (2) to investigate the associations among partners' depressive and anxiety symptoms and their sociodemographic and behavioral characteristics, and (3) to investigate the associations among partners' depressive and anxiety symptoms and clinical, laboratory and demographic characteristics of their T1D spouses in a Brazilian population. METHODS In a transversal study 72 T1D partners were interviewed. Partners were invited to take part in the study during their T1D spouses' routine consultations. Those who consented to take part in the study signed the consent form. This study followed the principles of the Declaration of Helsinki and was approved by the University Ethics in Research Committee. Inclusion criteria were T1D partners age ≥ 18 and T1D diagnosis > 6 months. Exclusion criteria were cognitive impairment, history of major psychiatric disorders, and severe chronic and terminal diseases. Depressive symptoms were evaluated by the depression subscale of the Hospital Anxiety and Depression scale (HADD) and anxiety symptoms were evaluated by the anxiety subscale of the same instrument (HADA). T1D partners were divided into subgroups according to score ≥ 8 and < 8 in both subscales. Demographic and clinical data were obtained from interview. Descriptive analyses were undertaken using means and percentages, as appropriate. Differences between groups were assessed by the Mann-Whitney test for numerical variables, by the Chi Square test or by Fisher's exact test for categorical variables, as appropriate. All analyses were undertaken using SAS version 9.2 for Windows. Statistical significance was set at 0.05. RESULTS Of all 72 T1D partners, 72.2% were male, mean age was 42.7 ± 14.1 years old, years of school attendance were 11.8 ± 3.9 years, and 48.5% had income reaching until 3 Brazilian minimal wages. Forty-three percent reported high anxiety symptoms (HADA ≥ 8) and 18.1% reported high depressive symptoms (HADD ≥ 8). Comparing T1D partners group with HADA ≥ 8 and < 8, the first one was associated with CGM use (41.94% vs 19.51%; p = 0.03). Similarly, comparing T1D partners group with HADD ≥ 8 and < 8, the first one was associated with (1) longer duration of T1D of their spouses (28.6 ± 7.1 vs 22.4 ± 12.2; p = 0.02); (2) less years of school attendance of T1D partners (9.3 ± 3.2 vs 12.3 ± 3.8; p = 0.02), and (3) higher number of hypoglycemic episodes requiring other person's intervention (6.3 ± 8.9 vs 2.4 ± 4.7; p = 0.009). Seventy-six percent of partners who helped personally in their spouses' hypoglycemia recovery had HADD ≥ 8 vs 44.7% with HADD < 8 (p = 0.03). Likewise, 84.6% vs 54.2% of partners in which their spouses have T1D chronic complications had HADD ≥ 8 and < 8, respectively (p = 0.04). CONCLUSION This study showed a high frequency of relevant anxiety and depressive symptoms in this T1D partner population. Several issues related to T1D of their spouses were associated with these symptoms. These results emphasize the need to incorporate the psychological and psychiatric aspects into T1D partners' education and care.
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Affiliation(s)
- E Buin
- 1Internal Medicine Postgraduate Program, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | - E J Pavin
- 2Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | - M S V M Silveira
- 2Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
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McCarthy MM, Whittemore R, Gholson G, Grey M. Diabetes Distress, Depressive Symptoms, and Cardiovascular Health in Adults With Type 1 Diabetes. Nurs Res 2019; 68:445-452. [PMID: 31693550 PMCID: PMC6852792 DOI: 10.1097/nnr.0000000000000387] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prevalence of adults with Type 1 diabetes (T1D) is increasing, and their risk of cardiovascular disease is high. Comorbid diabetes distress and depressive symptoms may affect their cardiovascular health. OBJECTIVES The purpose of this study was to describe the relationship between diabetes distress and depressive symptoms with cardiovascular health factors. METHODS This was a cross-sectional survey of a sample of adults with T1D. Valid and reliable instruments were used to collect the data on sociodemographics, diabetes-related complications, psychological factors, and cardiovascular health factors. Independent-sample t tests, analysis of variance, chi-square analyses, and linear regression were used to compare the cardiovascular health factors among the three levels of diabetes distress scores and the two levels of depressive symptom scores. RESULTS Our sample included 83 adults with a mean age of 45.2 years and a mean duration of T1D of 20 years. The majority scored low in the Diabetes Distress Scale, whereas 18% scored moderate and 18% scored high. Twenty-two percent had increased levels of depressive symptoms. There were significant correlations between diabetes distress and fear of hypoglycemia, depressive symptom scores, hemoglobin A1c, and total cholesterol. Depressive symptom scores were significantly correlated with hemoglobin A1c. Hemoglobin A1c and total cholesterol were significantly higher in those with higher levels of diabetes distress. There were no significant differences in cardiovascular health between those who scored below or above the cut point for depressive symptoms, but there was a finding toward higher mean body mass index, hemoglobin A1c, and a lower weekly step count in those who had elevated depressive symptoms. In the linear regression, only diabetes distress was significantly associated with hemoglobin A1c. DISCUSSION This is a sample with elevated diabetes distress and depressive symptoms, both of which may affect their risk of cardiovascular disease.
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Affiliation(s)
- Margaret M McCarthy
- Margaret M. McCarthy, PhD, RN, FNP-BC, is an Assistant Professor, the New York University Rory Meyers College of Nursing, New York. Robin Whittemore PhD, APRN, is Professor and Codirector, the National Clinician Scholars Program, Yale School of Nursing, West Haven, Connecticut. Margaret Grey, DrPH, RN, is Annie Goodrich Professor of Nursing, Yale School of Nursing, West Haven, Connecticut. Georica Gholson, PhD, is Psychologist, Walter Reed Medical Center, Bethesda, Maryland
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Trief PM, Foster NC, Chaytor N, Hilliard ME, Kittelsrud JM, Jaser SS, Majidi S, Corathers SD, Bzdick S, Adkins DW, Weinstock RS. Longitudinal Changes in Depression Symptoms and Glycemia in Adults With Type 1 Diabetes. Diabetes Care 2019; 42:1194-1201. [PMID: 31221694 DOI: 10.2337/dc18-2441] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/25/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study assessed longitudinal change in depression symptoms over ≥4 years in adults with type 1 diabetes and examined the association between change in depression symptom status and glycemia. RESEARCH DESIGN AND METHODS Adults in the T1D Exchange registry with HbA1c and Patient Health Questionnaire (PHQ-8) at 1 year (baseline) and 5 years post-enrollment (follow-up; n = 2,744, mean age, 42 years; 57% female, 92% white; mean HbA1c, 7.6% [58 mmol/mol]) were included. Depression status was defined as Persistent Elevated Depression Symptoms (EDS) (EDS at baseline and follow-up), Resolved EDS (EDS at baseline, no EDS at follow-up), New Onset EDS (no EDS at baseline, EDS at follow-up), and Not Depressed (no EDS at baseline or follow-up). RESULTS Overall, 131 (5%) had Persistent EDS, 122 (4%) had Resolved EDS, 168 (6%) had New Onset EDS, and 2,323 (85%) were Not Depressed. Of those with EDS (PHQ ≥ 10) at baseline, 53% had EDS at follow-up; of those not depressed at baseline, 7% had EDS at follow-up. An increase in PHQ-8 was associated with an increase in HbA1c (P < 0.001). Although HbA1c increased in all groups, the increase was less in the Resolved EDS and Not Depressed groups (P = 0.001). Persistent EDS and New Onset EDS groups were more likely to experience diabetic ketoacidosis (DKA) (P < 0.001). CONCLUSIONS T1D Exchange registry data provide evidence for relationships over time between persistently, and newly developing EDSs and worsening glycemic control, and suggest relationships between depression symptoms and the occurrence of severe hypoglycemia and DKA. Successful treatment of depression symptoms may lead to better long-term diabetes outcomes.
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Affiliation(s)
- Paula M Trief
- State University of New York Upstate Medical University, Syracuse, NY
| | | | - Naomi Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | | | | | | | - Sarah D Corathers
- Cinncinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| | - Suzan Bzdick
- State University of New York Upstate Medical University, Syracuse, NY
| | | | - Ruth S Weinstock
- State University of New York Upstate Medical University, Syracuse, NY
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Silveira MSVM, Moura Neto A, Sposito AC, Siminerio L, Pavin EJ. Low empowerment and diabetes regimen distress are related to HbA1c in low income type 1 diabetes patients in a Brazilian tertiary public hospital. Diabetol Metab Syndr 2019; 11:6. [PMID: 30679959 PMCID: PMC6341746 DOI: 10.1186/s13098-019-0404-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/17/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adults with type 1 diabetes (T1D) have a high risk of developing depressive symptoms and diabetes-related distress (DD). Low socioeconomic level is associated with increased risk of poor self-management, treatment difficulties and psychological distress. The goals of this study were to document the frequency of major depressive disorder (MDD), high depressive symptoms and high DD, to assess levels of empowerment and to determine the association with each of these measures and glycemic control in a low-income Brazilian sample of adults with T1D. METHODS In a cross-sectional study, inclusion criteria were age > 18 years and diagnosis of T1D > 6 months. Exclusion criteria were cognitive impairment, history of major psychiatric disorders, severe diabetes-related complications and pregnancy. Diagnoses of MDD were made using interview-based DSM-5 criteria. Depressive symptoms were evaluated by the depression subscale of the Hospital Anxiety and Depression Scale (HAD-D). The Diabetes Distress Scale (DDS) assessed DD. Empowerment levels were evaluated by the Diabetes Empowerment Scale short form (DES-SF). Glycemic control was measured by HbA1c. The latest lipid panel results were recorded. Number of complications was obtained from medical records. RESULTS Of the 63 T1D patients recruited, 36.5% were male, mean age was 31.5 (± 8.9), mean number of complications was 1 (± 1.1), and mean HbA1c was 10.0% (± 2). Frequency of MDD was 34.9% and 34.9% reported high depressive symptoms. Fifty-seven percent reported clinically meaningful DD. High diabetes regimen distress and low empowerment were associated to HbA1c (p = 0.003; p = 0.01, respectively). In multivariate analyses, lower empowerment levels were associated to higher HbA1c (beta - 1.11; r-partial 0.09; p value 0.0126). MDD and depressive symptoms were not significantly correlated with HbA1c in this expected direction (p = 0.72; p = 0.97, respectively). CONCLUSIONS This study showed high rates of MDD, high depressive symptoms and high DD and low levels of empowerment in this low income population. Empowerment and diabetes regimen distress were linked to glycemic control. The results emphasize the need to incorporate the psychological and psychosocial side of diabetes into strategies of care and education for T1D patients.
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Affiliation(s)
- M. S. V. M. Silveira
- Internal Medicine Postgraduate Program, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo Brazil
- University of Pittsburgh, Pittsburgh, PA USA
| | - A. Moura Neto
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo Brazil
| | - A. C. Sposito
- Cardiology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo Brazil
| | - L. Siminerio
- Diabetes Division, University of Pittsburgh, Pittsburgh, PA USA
| | - E. J. Pavin
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo Brazil
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Liu X, Russell A, Kabir E, Brown W. A Pilot Study to Assess the Effects of Tai Chi on Health Indicators in Type 1 Diabetes Patients. Health (London) 2019. [DOI: 10.4236/health.2019.113030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kampling H, Mittag O, Herpertz S, Baumeister H, Kulzer B, Petrak F. Can trajectories of glycemic control be predicted by depression, anxiety, or diabetes-related distress in a prospective cohort of adults with newly diagnosed type 1 diabetes? Results of a five-year follow-up from the German multicenter diabetes cohort study (GMDC-Study). Diabetes Res Clin Pract 2018; 141:106-117. [PMID: 29698712 DOI: 10.1016/j.diabres.2018.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/06/2018] [Indexed: 01/30/2023]
Abstract
AIMS The longitudinal association between glycemic control with depression, anxiety or diabetes-related distress in type 1 diabetes is poorly understood. Therefore, we examined long-term trajectories of HbA1c in a new-onset cohort of adults with type 1 diabetes, and analyzed associations with depression, anxiety, and diabetes-related distress. METHODS We included 313 newly diagnosed adults with type 1 diabetes in a prospective multicenter cohort study. Depression, anxiety, and diabetes-related distress were assessed starting with the diabetes diagnosis and at five annual surveys. HbA1c-measurements started with the one-year follow-up. HbA1c trajectories were analyzed applying Growth mixture modeling, while prediction of membership in the trajectories classes was analyzed using multiple regression, and one-way ANOVA/Chi2 to identify differences between classes. RESULTS Average HbA1c increased constantly: follow-up at 1-year 6.5% (48 mmol/mol), 2-years 6.9% (52 mmol/mol), 3-years 7.1% (54 mmol/mol), 4-years 7.1% (54 mmol/mol), and 5-years 7.4% (57 mmol/mol). HbA1c trajectories included one 'good control' and three 'poor control' (52% of patients) classes. At the five-year follow-up, mean HbA1c was 6.3% (45 mmol/mol) in the 'good control' class, and ranging from 7.9% (63 mmol/mol) to 9.0% (75 mmol/mol) in the three 'poor control' classes. Classes were neither predicable, nor differentiated by depression, anxiety, or diabetes-related distress. CONCLUSIONS We identified distinct trajectories of glycemic control. Depression and anxiety were highly prevalent but they neither predicted 'poor'/'good' glycemic control trajectories nor were they associated with glycemic control at any assessment point.
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Affiliation(s)
- Hanna Kampling
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, D-79115 Freiburg, Germany.
| | - Oskar Mittag
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, D-79115 Freiburg, Germany.
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum - Ruhr-University Bochum, Alexandrinenstrasse 1-3, D-44791 Bochum, Germany.
| | - Harald Baumeister
- University of Ulm, Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Albert-Einstein-Allee 47, D-89069 Ulm, Germany.
| | - Bernd Kulzer
- Diabetes Center Mergentheim, Klotzbücher Str. 12, D-97980 Bad Mergentheim, Germany; Research Institute of the Diabetes Academy Mergentheim, Klotzbücher Str. 12, D-97980 Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Markusplatz 3, D-96047 Bamberg, Germany.
| | - Frank Petrak
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum - Ruhr-University Bochum, Alexandrinenstrasse 1-3, D-44791 Bochum, Germany; Center for Psychotherapy Wiesbaden, Sonnenberger Str. 20, D-65193 Wiesbaden, Germany.
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Kampling H, Petrak F, Farin E, Kulzer B, Herpertz S, Mittag O. Trajectories of depression in adults with newly diagnosed type 1 diabetes: results from the German Multicenter Diabetes Cohort Study. Diabetologia 2017; 60:60-68. [PMID: 27787619 DOI: 10.1007/s00125-016-4123-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/31/2016] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS There is a paucity of longitudinal data on type 1 diabetes and depression, especially in adults. The present study prospectively analysed trajectories of depressive symptoms in adults during the first 5 years of living with type 1 diabetes. We aimed to identify distinct trajectories of depressive symptoms and to examine how they affect diabetes outcome. METHODS We reanalysed data from a prospective multicentre observational cohort study including 313 adults with newly diagnosed type 1 diabetes. At baseline and in annual postal surveys over 5 consecutive years, we gathered patient characteristics and behavioural and psychosocial data (e.g. Symptom Checklist-90-R [SCL-90-R]). Medical data (e.g. HbA1c levels) was obtained from the treating physicians. We applied growth mixture modelling (GMM) to identify distinct trajectories of depression over time. RESULTS Five years after diagnosis, 7.8% (n = 20) of patients were moderately depressed and 10.2% (n = 26) were severely depressed. GMM statistics identified three possible models of trajectories (class 1, 'no depressive symptoms'; class 2, 'worsening depressive symptoms that improve after 2 years'; class 3, 'worsening depressive symptoms'). Severity of depression symptoms at baseline (subscale of the SCL-90-R questionnaire) significantly predicted membership of classes 2 and 3 vs class 1. After 5 years, higher HbA1c values were detected in class 3 patients (mean = 8.2%, 66 mmol/mol) compared with class 1 and class 2 (both: mean = 7.2%, 55 mmol/mol). CONCLUSIONS/INTERPRETATION We identified distinct trajectories of depressive symptoms that are also relevant for diabetes outcome. Patients with worsening depressive symptoms over time exhibited poor glycaemic control after the first 5 years of living with diabetes. They also exhibited a reduced quality of life and increased diabetes-related distress.
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Affiliation(s)
- Hanna Kampling
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 49, 79106, Freiburg, Germany.
| | - Frank Petrak
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum - Ruhr-University Bochum, Bochum, Germany
- Center for Psychotherapy Wiesbaden, Wiesbaden, Germany
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 49, 79106, Freiburg, Germany
| | - Bernd Kulzer
- Diabetes Center Mergentheim, Germany; Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum - Ruhr-University Bochum, Bochum, Germany
| | - Oskar Mittag
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 49, 79106, Freiburg, Germany
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