Impact of anxiety, depression and disease-related distress on long-term glycaemic variability among subjects with Type 1 diabetes mellitus

Association of Physical Activity and Sleep Metrics with Depression in People with Type 1 Diabetes

Objective

This study aimed to investigate the association of physical activity and sleep metrics, measured via wrist-worn accelerometers, with depression in people with type 1 diabetes.

Patients and Methods

People with type 1 diabetes were recruited from the Dasman Diabetes Institute in Kuwait and were invited to wear a wrist-worn accelerometer device for 7 days. Mean physical activity (overall acceleration), inactivity, light activity, moderate activity, vigorous activity, the distribution of physical activity intensity (intensity gradient), sleep duration and sleep efficiency were quantified from the accelerometer data. The associations of these metrics with depression were investigated using multiple linear regression.

Results

A total of 551 people with type 1 diabetes (age 33.1 (9.5) years) were included. Overall physical activity (B = -0.09, CI = -0.14 to -0.04), moderate intensity activity (B = -0.02, CI = -0.02 to -0.01), vigorous intensity activity (B = -0.16, CI = -0.27 to -0.05), and the intensity gradient (B = -2.11, CI = -3.51 to -0.72) were negatively associated with depression score (p < 0.01) and these associations remain significant even after adjustment for age, sex, diabetes duration, and BMI. However, sleep duration and efficiency were not associated with depression. After mutual adjustment overall physical activity (B = -0.07, CI = -0.12 to -0.01), but not the intensity gradient (B = -0.90, CI = -2.47 to 0.68), remained associated with depression.

Conclusion

Overall, moderate and vigorous physical activity, and the intensity gradient were associated with lower symptoms of depression. Overall physical activity, rather than the distribution of activity intensity, appears more important in depression. This information can help guide physical activity interventions to improve depression in people with type 1 diabetes.

Type 1 diabetes-related distress: Current implications in care

Type 1 diabetes (T1D) is a complex chronic disease associated with major health and economic consequences, also involving important issues in the psychosocial sphere. In this regard, T1D-related distress, defined as the emotional burden of living with T1D, has emerged as a specific entity related to the disease. Diabetes distress (DD) is an overlooked but prevalent condition in people living with T1D, and has significant implications in both glycemic control and mental health in this population. Although overlapping symptoms may be found between DD and mental health disorders, specific approaches should be performed for the diagnosis of this problem. In recent years, different DD-targeted interventions have been postulated, including behavioral and psychosocial strategies. Moreover, new technologies in this field may be helpful to address DD in people living with T1D. In this article, we summarize the current knowledge on T1D-related distress, and we also discuss the current approaches and future perspectives in its management.

Sex-driven factors associated with anxiety and depression in autoimmune diabetes

AIM

To analyze the prevalence of anxiety and depression in a large cohort of adults with autoimmune diabetes, identifying sex-driven associated factors.

MATERIALS AND METHODS

In this cross-sectional study, we enrolled 553 consecutive adults with Type 1 diabetes mellitus or latent autoimmune diabetes in adults who came to the Division of Endocrinology of the S.Orsola-Malpighi Polyclinic, Bologna (Italy), to receive their second dose of SARS-CoV-2 vaccine. We administered the questionnaires: Hospital Anxiety and Depression Scale, Diabetes Distress Scale, Diabetes-related Quality of Life, Diabetes Treatment Satisfaction Questionnaire. We collected clinical and biochemical data and 14 days glucose metrics in patients with sensor use > 70% in a time span of ± 4 months from the questionnaires' administration. We excluded 119 patients from our analyses with missing data (final cohort n = 434: 79% of those enrolled).

RESULTS

Anxiety and depression prevalence was respectively 30.4% and 10.8%. According to the multivariate analysis, higher diabete-related emotional burden, lower treatment satisfaction, but not physician-related distress, were risk factors for anxiety and depression; female sex was associated with anxiety (OR 0.51, 95% 0.31-0.81; p = 0.005); in women, depression was associated with increasing age (males vs. females OR 0.96 per 1 year increase, 95% CI 0.92-1.00; p = 0.036), whilst in men with HbA1c (OR 1.08 per 1 mmol/mol increase, 95% CI 1.03-1.13; p = 0.002).

CONCLUSION

Nearly 1/3 of patients with autoimmune diabetes suffers from anxiety and 1/10 from depression. These conditions are associated with independent modifiable and non-modifiable characteristics. For depression, these characteristics differ between males and females.

Diabetes Stigma and Psychosocial Outcomes in Adolescents and Young Adults: The SEARCH for Diabetes in Youth Study

OBJECTIVE

To examine the association between diabetes stigma, socioeconomic status, psychosocial variables, and substance use in adolescents and young adults (AYAs) with type 1 or type 2 diabetes.

RESEARCH DESIGN AND METHODS

This is a cross-sectional analysis of AYAs from the SEARCH for Diabetes in Youth study who completed a survey on diabetes-related stigma, generating a total diabetes stigma score. Using multivariable modeling, stratified by diabetes type, we examined the relationship of diabetes stigma with variables of interest.

RESULTS

Of the 1,608 AYAs who completed the diabetes-related stigma survey, 78% had type 1 diabetes, and the mean age was 21.7 years. Higher diabetes stigma scores were associated with food insecurity (P = 0.001), disordered eating (P < 0.0001), depressive symptoms (P < 0.0001), and decreased health-related (P < 0.0001) and diabetes-specific quality of life (P < 0.0001).

CONCLUSIONS

Diabetes stigma is associated with food insecurity, disordered eating, and lower psychosocial well-being.

Diabetes management, dietary supplements use and the effect of coronavirus pandemic on diabetes patients in Serbia: a cross-sectional study

OBJECTIVES

Diabetes mellitus (DM) is a significant public health challenge in Serbia, mirroring the situation in other European middle-income countries. The aims of this study were to examine the disease-related characteristics and management of diabetes, as well as the prevalence of use of dietary supplements (DS) among diabetes patients in Serbia, and to analyze the effects of the coronavirus pandemic on DM patients in Serbia.

METHODS

The study was carried out as an online, observational, cross-sectional study involving 422 adult diabetes type 1 (DM1) and type 2 (DM2) patients residing in Serbia.

RESULTS

DM1 patients were more likely than DM2 patients to self-control glucose levels (p < 0.001). Almost one-third of DM2 patients (31.4%) did not know their HbA1c value. Polypharmacy has been reported by 9.7% of DM1 patients and 23.5% of DM2 patients. During the coronavirus pandemic increased anxiety levels for one-third of respondents was noticed. The prevalence of DS use among DM patients was very high (95.3%), with vitamin C, zinc, vitamin D and magnesium being the most commonly used. Women were more likely to use vitamin D (p = 0.001) and magnesium DS (p = 0.005) than men. Most patients (76.9%) faced limited access to healthcare services during the coronavirus pandemic with, sometimes, detrimental consequences. A significant portion of respondents (41.2%) consulted a pharmacist more often in 2021 than in previous years.

CONCLUSIONS

Special caution is needed regarding the potential interactions of DS with chronic therapy. To enhance diabetes care, Serbia needs more accessible mental health support, improved diabetes education, expanded CGM availability, and carefully planned emergency healthcare measures for chronic patients.

Association of Long-Term HbA1c Variability with Anxiety and Depression in Patients with Type 2 Diabetes: A Cross-Sectional Retrospective Study

Purpose

To explore the relationship between long-term glycemic variability and anxiety and depression in patients with type 2 diabetes.

Participants and Methods

A cohort comprising 214 individuals diagnosed with type 2 diabetes participated in this study. Comprehensive demographic and laboratory information was gathered for them. The evaluation of anxiety relied on the 7-item Generalized Anxiety Disorder Scale (GAD-7), while depression was assessed utilizing the 9-item Health Questionnaire (PHQ-9). Based on the presence or absence of anxiety and depression, participants were categorized into either the mood disorder or control groups. Subsequently, univariate and stepwise multiple binary logistic regression analyses were conducted to investigate the potential correlations between factors and the presence of anxiety and depression.

Results

The prevalence of anxiety disorders is 23%, and depression is 32%. The prevalence of smoking, diabetic autonomic neuropathy, stroke, and osteoporosis in the mood disorder group was significantly higher than that in the control group (P < 0.05), the glycated hemoglobin A1c variability score (HVS), mean hemoglobin A1c value, total cholesterol, urinary albumin/creatinine and systemic immune-inflammatory index (SII) were significantly higher in the control group (P < 0.05). The level of high-density lipoprotein in the mood disorder group was significantly lower than the control group (P < 0.05). In stepwise multiple binary logistic regression analyses, the main factors associated with anxiety were depression (P < 0.001, OR=117.581) and gender (P < 0.001, OR=9.466), and the main factors related to depression included anxiety (P < 0.001, OR=49.424), smoking (P=0.042, OR=2.728), HVS (P=0.004, OR=8.664), and SII (P=0.014, OR=1.002).

Conclusion

Persistent fluctuations in blood glucose levels have been linked to anxiety and depression. Consequently, maintaining an optimal level of glycemic control and minimizing fluctuations becomes imperative in the comprehensive management of diabetes.

The Interaction of Glycemia with Anxiety and Depression Is Related to Altered Cerebellar and Cerebral Functional Correlations

Depression, type 2 diabetes (T2D), and obesity are comorbid, and prevention and treatment of all three diseases are needed. We hypothesized an inverse relationship between the connectivity of the cingulo-opercular task control network with the somatosensory mouth network and the interaction between HbA1c and depression. Three-hundred and twenty-five participants (BMI: 26.11 ± 0.29; Achenbach adult self-report (ASR) DSM depressive problems T-score (depression): 54.60 ± 6.77; Age: 28.26 ± 3.90 y; adult self-report anxiety and depression scale (anxiety and depression): 54.69 ± 7.27; HbA1c: 5.26 ± 0.29; 68% white) were sampled from the Human Connectome Project 1200 subjects PTN release. Inclusion criteria were: four (15 min) resting state fMRI scans; BMI; hemoglobin A1c (HbA1c); and complete adult self-report data. The following models were run to assess the connectivity between 15 independent fMRI components: the interaction of depression with HbA1c; anxiety and depression with HbA1c; depression with BMI; and anxiety and depression with BMI. All models were corrected for a reported number of depressive symptoms, head motion in the scanner, age, and race. Functional connectivity was modeled in FSLNets. Corrected significance was set at pFWE < 0.05. The interaction HbA1c and anxiety and depression was positively related to the connectivity of the cerebellum with the visual network (t = 3.76, pFWE = 0.008), frontoparietal network (t = 3.45, pFWE = 0.02), and somatosensory mouth network (t = 4.29, pFWE = 0.0004). Although our hypotheses were not supported, similar increases in cerebellar connectivity are seen in patients with T2D and overall suggest that the increased cerebellar connectivity may be compensatory for an increasingly poor glycemic control.

Comparison of diabetes distress and depression screening results of emerging adults with type 1 diabetes onset at different ages: findings from the German early-onset T1D study and the German Diabetes Study (GDS)

BACKGROUND

Diabetes distress is increasingly considered one of the most important psychosocial issues in the care of people with type 1 diabetes (T1D). We analyse whether diabetes distress and depression screening results of emerging adults are associated with the age at T1D onset.

METHODS

Data were taken from two cohort studies conducted at the German Diabetes Center, Düsseldorf, Germany. The 18-30-year-old participants had an age at onset either before the age of 5 years (childhood-onset long-term T1D study group, N = 749) or during adulthood (adult-onset short-term T1D study group from the German Diabetes Study (GDS), N = 163). Diabetes distress and depression screening were analysed by means of the 20-item Problem Areas in Diabetes (PAID-20) scale and the nine-item depression module from the Patient Health Questionnaire (PHQ-9). The average causal effect of age at onset was estimated by a doubly robust causal inference method.

RESULTS

The PAID-20 total scores were increased in the adult-onset study group [potential outcome mean (POM) 32.1 (95% confidence interval 28.0; 36.1) points] compared to the childhood-onset study group [POM 21.0 (19.6; 22.4) points, difference 11.1 (6.9; 15.3) points, p<0.001] adjusted for age, sex and haemoglobin A1c (HbA1c) levels. Moreover, more participants in the adult-onset group [POM 34.5 (24.9; 44.2) %] than in the childhood-onset group [POM 16.3 (13.3; 19.2) %] screened positive for diabetes distress [adjusted difference 18.3 (8.3; 28.2) %, p<0.001]. The PHQ-9 total score [difference 0.3 (-1.1; 1.7) points, p=0.660] and the proportion of participants with a positive screening result for depression [difference 0.0 (-12.7; 12.8) %, p=0.994] did not differ between the groups in the adjusted analyses.

CONCLUSIONS

Emerging adults with short-term type 1 diabetes screened positive for diabetes distress more often than adults with type 1 diabetes onset during early childhood when age, sex and HbA1c values were considered confounding factors. Accounting for age at onset or the duration of diabetes may help explain the heterogeneity in the data when psychological factors are examined.