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Arteaga-Zarate G, Demarini-Olivares G, Torres-Slimming PA, Bernabe-Ortiz A. Type 2 diabetes mellitus and anxiety symptoms: a cross-sectional study in Peru. Wellcome Open Res 2022; 6:331. [PMID: 35600247 PMCID: PMC9111365 DOI: 10.12688/wellcomeopenres.17328.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Information about the effect of type 2 diabetes mellitus (T2DM) awareness in the prevalence of anxiety disorders is scarce. Moreover, reports from resource-constrained and semiurban settings are usually focused on hospital-based data, instead of population-based surveys. We aimed to evaluate the association between T2DM and anxiety symptoms, with emphasis on T2DM awareness. METHODS A secondary data analysis was conducted using information from a population-based study. The outcome of interest was the presence of anxiety symptoms assessed by the Goldberg anxiety test, while the exposure variable was T2DM, defined using the oral glucose tolerance test. In addition, another definition was used based on self-reported T2DM awareness of previous diagnosis. Prevalence ratios (PR) and 95% confidence intervals (CI) were reported using Poisson regression models. RESULTS Data from 1,607 participants, of mean age 48.2 (SD: 10.6) years, and 809 (50.3%) females, were analyzed. Of all participants, 176 (11.0%; 95% CI: 9.5%-12.6%) had T2DM, 105 (59.7%) were aware of previous diagnosis, and 674 (41.9%; 95% CI: 39.5%-44.4%) had anxiety symptoms. In multivariable model, T2DM was not associated with anxiety symptoms (PR = 1.16; 95% CI: 0.99-1.36); however, individuals aware of T2DM diagnosis had a 36% (95% CI: 14%-64%) greater prevalence of anxiety symptoms compared to those without T2DM. Additionally, those aware of T2DM diagnosis had a 56% (95% CI: 13%-116%) higher probability to have anxiety symptoms compared to those not aware of T2DM diagnosis. Conclusions: The association between T2DM and anxiety symptoms was present among those participants who self-reported T2DM diagnosis, as opposed to those with T2DM but not aware and to those without T2DM. Evaluation of anxiety symptoms may be relevant among those with previous T2DM diagnosis.
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Affiliation(s)
| | | | | | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
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Arteaga-Zarate G, Demarini-Olivares G, Torres-Slimming PA, Bernabe-Ortiz A. Type 2 diabetes mellitus and anxiety symptoms: a cross-sectional study in Peru. Wellcome Open Res 2021; 6:331. [PMID: 35600247 PMCID: PMC9111365 DOI: 10.12688/wellcomeopenres.17328.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Information about the effect of type 2 diabetes mellitus (T2DM) awareness in the prevalence of anxiety disorders is scarce. Moreover, reports from resource-constrained and semiurban settings are usually focused on hospital-based data, instead of population-based surveys. We aimed to evaluate the association between T2DM and anxiety symptoms, with emphasis on T2DM awareness. METHODS A secondary data analysis was conducted using information from a population-based study. The outcome of interest was the presence of anxiety symptoms assessed by the Goldberg anxiety test, while the exposure variable was T2DM, defined using the oral glucose tolerance test. In addition, another definition was used based on self-reported T2DM awareness of previous diagnosis. Prevalence ratios (PR) and 95% confidence intervals (CI) were reported using Poisson regression models. RESULTS Data from 1,607 participants, of mean age 48.2 (SD: 10.6) years, and 809 (50.3%) females, were analyzed. Of all participants, 176 (11.0%; 95% CI: 9.5%-12.6%) had T2DM, 105 (59.7%) were aware of previous diagnosis, and 674 (41.9%; 95% CI: 39.5%-44.4%) had anxiety symptoms. In multivariable model, T2DM was not associated with anxiety symptoms (PR = 1.16; 95% CI: 0.99-1.36); however, individuals aware of T2DM diagnosis had a 36% (95% CI: 14%-64%) greater prevalence of anxiety symptoms compared to those without T2DM. Additionally, those aware of T2DM diagnosis had a 56% (95% CI: 13%-116%) higher probability to have anxiety symptoms compared to those not aware of T2DM diagnosis. Conclusions: The association between T2DM and anxiety symptoms was present among those participants who self-reported T2DM diagnosis, as opposed to those with T2DM but not aware and to those without T2DM. Evaluation of anxiety symptoms may be relevant among those with previous T2DM diagnosis.
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Affiliation(s)
| | | | | | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
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Pereira MM, de Morais H, Dos Santos Silva E, Corso CR, Adami ER, Carlos RM, Acco A, Zanoveli JM. The antioxidant gallic acid induces anxiolytic-, but not antidepressant-like effect, in streptozotocin-induced diabetes. Metab Brain Dis 2018; 33:1573-1584. [PMID: 29934859 DOI: 10.1007/s11011-018-0264-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/30/2018] [Indexed: 01/12/2023]
Abstract
The physiopathology of anxiety or depression related to diabetes is still poorly understood. The treatment with antidepressant drugs is a huge challenge due to theirs adherence low rate and many adverse effects. Thus, the seeking for a better treatment for these associated diseases is of utmost importance. Given that the oxidative stress in different tissues occurs in diabetes and anxiety or depression as well, the antioxidant gallic acid becomes an interesting compound to be investigated. Thus, the effects of long-term treatment with gallic acid (0, 10, 20 and 40 mg/kg; gavage) were evaluated in diabetic (DBT) animals submitted to the elevated plus-maze (EPM), the light-dark transition (LDT) tests and modified forced swim test (mFST). Also, indirect parameters of oxidative stress, lipid peroxidation (LPO) and reduced glutathione (GSH) levels were evaluated in the hippocampus (HIP) and prefrontal cortex (PFC). The results showed that DBT animals presented a decrease in the spent time in the open arms, in the end arm exploration and head dips when evaluated in the EPM test; moreover, a decrease in the spent time in the lit compartment of LDT test was observed, suggesting an anxiogenic-like behavior. During the mFST, an increase in the mean counts of immobility and a decrease in the mean counts of swimming and climbing were observed, indicating a depressive-like behavior. These aversive behaviors were more pronounced when compared to normoglycemic (NGL) animals and streptozotocin-treated animals that not become DBT. In addition, DBT rats showed an increase in the oxidative stress parameters in the HIP and PFC that was reversed by the gallic acid treatment (lowest dose - 10 mg/kg), i.e., the treatment decreased the elevated LPO levels and increased the reduced GSH in the HIP and PFC. Also, gallic acid treatment was able to produce an anxiolytic-like effect in the EPM and LDT tests, but not antidepressant-like effect in the FST. Taken together, the results suggest that the antioxidant/neuroprotective effect of gallic acid treatment in HIP and PFC of DBT animals may be essential to the anxiolytic-like effect.
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Affiliation(s)
- Mariana Machado Pereira
- Department of Pharmacology, Biological Sciences Building, Federal University of Paraná, Rua Coronel H dos Santos S/N, P.O. Box 19031, Curitiba-PR, 81540-990, Brazil
| | - Helen de Morais
- Department of Pharmacology, Biological Sciences Building, Federal University of Paraná, Rua Coronel H dos Santos S/N, P.O. Box 19031, Curitiba-PR, 81540-990, Brazil
| | - Eldevan Dos Santos Silva
- Departamento de Química, Universidade Federal de São Carlos, Rodovia Washington Luís, Km 235 CP 676, São Carlos, SP, CEP 13565-905, Brazil
| | - Claudia Rita Corso
- Department of Pharmacology, Biological Sciences Building, Federal University of Paraná, Rua Coronel H dos Santos S/N, P.O. Box 19031, Curitiba-PR, 81540-990, Brazil
| | - Eliana Rezende Adami
- Department of Pharmacology, Biological Sciences Building, Federal University of Paraná, Rua Coronel H dos Santos S/N, P.O. Box 19031, Curitiba-PR, 81540-990, Brazil
| | - Rose Maria Carlos
- Departamento de Química, Universidade Federal de São Carlos, Rodovia Washington Luís, Km 235 CP 676, São Carlos, SP, CEP 13565-905, Brazil
| | - Alexandra Acco
- Department of Pharmacology, Biological Sciences Building, Federal University of Paraná, Rua Coronel H dos Santos S/N, P.O. Box 19031, Curitiba-PR, 81540-990, Brazil
| | - Janaina Menezes Zanoveli
- Department of Pharmacology, Biological Sciences Building, Federal University of Paraná, Rua Coronel H dos Santos S/N, P.O. Box 19031, Curitiba-PR, 81540-990, Brazil.
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Rebolledo-Solleiro D, Araiza LFO, Broccoli L, Hansson AC, Rocha-Arrieta LL, Aguilar-Roblero R, Crespo-Ramírez M, Fuxe K, Pérez de la Mora M. Dopamine D1 receptor activity is involved in the increased anxiety levels observed in STZ-induced diabetes in rats. Behav Brain Res 2016; 313:293-301. [PMID: 27374159 DOI: 10.1016/j.bbr.2016.06.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/26/2016] [Accepted: 06/29/2016] [Indexed: 12/31/2022]
Abstract
Epidemiological surveys have indicated that anxiety disorders are more frequent in diabetic patients than in the general population. Similar results have been shown in animal studies using the streptozotocin (STZ)-induced diabetes model. The mechanisms underlying this relationship are not clearly understood, but it has been suggested that alterations in the dopaminergic neurotransmission, which plays an important role in the amygdaloid modulation of fear and anxiety, may be involved. The aim of this study was to ascertain whether or not the amygdaloid DA D1 receptors are involved in the increase of anxiety-like behavior observed in "diabetic" animals. Adult Wistar male rats were injected with STZ (50mg/kg, i.p.) in two consecutive days and subjected to the Shock-Probe Burying Test 10days after the beginning of treatment. STZ-treated rats showed a significant increase in immobility/freezing behavior whereas no effects were elicited in latency to bury, burying behavior itself and the number of shocks received during testing as compared with non-diabetic controls. These results suggest the triggering of a passive coping response in the STZ-treated rats. Interestingly, immobility/freezing behavior was reversed following the intra-amygdaloid dopamine D1 receptor blockade by the local microinfusion of SCH23390 (100ng/side). Autoradiographic experiments showed a selective increase of [(3)H]-SCH23390 binding in the ventral intercalated paracapsular islands of STZ-treated rats when compared to the non-treated control group. Our results suggest that a hyperdopaminergic state involving DA D1 receptors within the amygdala may have a role in the increase of anxiety observed in diabetic rats.
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Affiliation(s)
- Daniela Rebolledo-Solleiro
- Division of Neuroscience, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Laura Broccoli
- Neuroanatomy Research Group, Institute for Psychopharmacology at Central Institute for Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Anita C Hansson
- Neuroanatomy Research Group, Institute for Psychopharmacology at Central Institute for Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Luisa Lilia Rocha-Arrieta
- Department of Pharmacobiology, Instituto de Investigación y Estudios Avanzados (CINVESTAV) Sede Sur, Mexico City, Mexico
| | - Raúl Aguilar-Roblero
- Division of Neuroscience, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Minerva Crespo-Ramírez
- Division of Neuroscience, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Kjell Fuxe
- Division of Cellular and Molecular Neurochemistry, Department of Neuroscience, Karolinska Institutet, Sweden
| | - Miguel Pérez de la Mora
- Division of Neuroscience, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Mexico City, Mexico.
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Gambeta E, de Souza CP, de Morais H, Zanoveli JM. Reestablishment of the hyperglycemia to the normal levels seems not to be essential to the anxiolytic-like effect induced by insulin. Metab Brain Dis 2016; 31:563-71. [PMID: 26608284 DOI: 10.1007/s11011-015-9770-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/17/2015] [Indexed: 01/29/2023]
Abstract
Diabetes is a chronic metabolic disease accompanied by several comorbidities, including neuropsychiatric conditions. Since the hyperglycemia appears to be the primary factor involved in diabetic conditions, we examined the effect of insulin treatment in diabetic rats on behavioral responses related to anxiety and aversive memory extinction. For this, normoglycemic (NGL) or streptozotocin-diabetic (DBT) rats were submitted to the elevated T maze (ETM) and the contextual conditioned fear (CCF) tests. Therefore, animals were subjected to the prolonged treatment with insulin (6 IU/day, s.c.) to investigate the effect of the treatment on distinct behaviors. When anxiety-like responses such as the inhibitory avoidance (IA) on the ETM and the time of freezing in the first session of the CCF test were evaluated, our data showed a more pronounced anxiogenic-like behavior in DBT animals when compared to NGL ones. In addition, an increased freezing time was observed in DBT animals exposed to the CCF test (sessions 2 and 3) when compared to the NGL group, suggestive of an impairment in the extinction of aversive memory. Insulin treatment induced an anxiolytic-like effect when IA and freezing time (session 1) was evaluated, but did not alter the impaired extinction of aversive memory (sessions 2 and 3). To better understand the involvement of a rigorous control of glycaemia, we also investigated the effect of a lower dose of insulin (3 IU/day, s.c.), unable to reestablish the hyperglycemia to the normal levels, on the same behavioral parameters. Our data show that independent of the dose of insulin, the same effects were observed when animals were evaluated in the ETM and CCF tests. However, only the highest dose of insulin was able to reduce the hyperglycemia to the normal levels. To conclude, our data suggest that a severe glycemic control by insulin treatment seems to be important, but not essential in improving diabetes-induced anxiety.
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Affiliation(s)
- Eder Gambeta
- Department of Pharmacology, Biological Sciences Building, Federal University of Paraná, Avenida Coronel H dos Santos S/N, P.O. Box 19031, Curitiba, PR, 81540-990, Brazil
| | - Camila Pasquini de Souza
- Department of Pharmacology, Biological Sciences Building, Federal University of Paraná, Avenida Coronel H dos Santos S/N, P.O. Box 19031, Curitiba, PR, 81540-990, Brazil
| | - Helen de Morais
- Department of Pharmacology, Biological Sciences Building, Federal University of Paraná, Avenida Coronel H dos Santos S/N, P.O. Box 19031, Curitiba, PR, 81540-990, Brazil
| | - Janaina Menezes Zanoveli
- Department of Pharmacology, Biological Sciences Building, Federal University of Paraná, Avenida Coronel H dos Santos S/N, P.O. Box 19031, Curitiba, PR, 81540-990, Brazil.
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Gupta D, Radhakrishnan M, Kurhe Y. Insulin reverses anxiety-like behavior evoked by streptozotocin-induced diabetes in mice. Metab Brain Dis 2014; 29:737-46. [PMID: 24763911 DOI: 10.1007/s11011-014-9540-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 03/27/2014] [Indexed: 02/06/2023]
Abstract
Clinical and preclinical data suggest that diabetes is often associated with anxiety. Insulin, a peptide hormone has been reported to have key functions in the brain and in alleviating several psychological impairments, occur as a consequence of diabetes. However, its effects in diabetes-induced anxiety are scanty. The present study examined whether; insulin can reverse the anxiety-like behavior in streptozotocin (STZ)-induced diabetes in mice. After 8-weeks of diabetes induced by STZ (200 mg/kg, intraperitoneally (i.p.)), mice were given insulin (1-2 IU/kg/day, i.p.)/ diazepam (1 mg/kg/day, i.p.)/ vehicle for 14 days and evaluated for behavioral effects in three validated models of anxiety viz. elevated plus maze (EPM), light-dark (L/D) and hole board (HB) tests. STZ-induced diabetic mice elicited significant behavioral effects which include, decreased percentage open arm entries and time in EPM, reduced latency and time spent in light chamber in L/D, decreased number of head dips, squares crossed and rearings in HB tests respectively. Insulin treatment attenuated the behavioral effects evoked by STZ-induced diabetes in mice as indicated by increased open arms activity in EPM, decreased aversion in light chamber during L/D test and increased exploratory behavior in HB test. In conclusion, this study revealed that insulin can reverse anxiety-like behavior in STZ-induced diabetes in mice.
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Affiliation(s)
- Deepali Gupta
- Department of Pharmacy, Birla Institute of Technology & Science, Pilani, Rajasthan, 333031, India,
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Rebolledo-Solleiro D, Crespo-Ramírez M, Roldán-Roldán G, Hiriart M, Pérez de la Mora M. Role of thirst and visual barriers in the differential behavior displayed by streptozotocin-treated rats in the elevated plus-maze and the open field test. Physiol Behav 2013; 120:130-5. [DOI: 10.1016/j.physbeh.2013.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 04/09/2013] [Accepted: 08/03/2013] [Indexed: 10/26/2022]
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Prevalence of psychiatric disorders in patients with diabetes types 1 and 2. Compr Psychiatry 2012; 53:1169-73. [PMID: 22521330 DOI: 10.1016/j.comppsych.2012.03.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/22/2012] [Accepted: 03/12/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Diabetes mellitus, classified into types 1 and 2, is a chronic disease that shows high comorbidity with psychiatric disorders. Insulin-dependent patients show a higher prevalence of psychiatric disorders than do patients with type 2 diabetes. METHODS This research involved the participation of 200 subjects divided into 2 groups: 100 patients with diabetes type 1 and 100 patients with diabetes type 2. This study used the Mini International Neuropsychiatric Interview for the identification of psychiatric disorders. RESULTS Of the 200 participants, 85 (42.5%) were found to have at least 1 psychiatric disorder. The most prevalent disorders were generalized anxiety disorder (21%), dysthymia (15%), social phobia (7%), current depression (5.5%), lifelong depression (3.5%), panic disorder (2.5%), and risk of suicide (2%). Other disorders with lower prevalence were also identified. The groups showed a statistically significant difference in the presence of dysthymia, current depression, and panic disorder, which were more prevalent in patients with diabetes type 1. CONCLUSION The high prevalence of psychiatric disorders in diabetic patients points to the need for greater investment in appropriate diagnostic evaluation of patients that considers mental issues. The difference identified between the groups shows that preventive measures and therapeutic projects should consider the specific demands of each type of diabetes.
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Moreira RO, Amâncio APRL, Brum HR, Vasconcelos DL, Nascimento GF. [Depressive symptoms and quality of life in type 2 diabetic patients with diabetic distal polyneuropathy]. ACTA ACUST UNITED AC 2010; 53:1103-11. [PMID: 20126868 DOI: 10.1590/s0004-27302009000900007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 08/25/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the impact of depressive symptoms and neuropathic pain in the quality of life (QL) of diabetic patients with diabetic distal polyneuropathy (DDP). METHODS Two hundred and four patients with type 2 diabetes mellitus were evaluated. The diagnosis of DDP was achieved using the Neuropathy Disability Score and Neuropathy Symptom Score questionnaires. The severity of neuropathic pain was assessed by means of a Visual Analogue Scale (VAS); the severity of depression, by means of the Beck Depression Inventory (BDI); and QL was assessed by means of the World Health Organization Quality of Life Instrument-bref (WHOQOLbref). RESULTS Patients with DDP presented significant higher scores in BDI (12.6 +/- 7.2 versus 9.9 +/- 7.3; p = 0.018) and in VAS (5.0 +/- 2.4 versus 2.6 +/- 2.9; p < 0.001). They also presented significant lower scores in the physical (52.8 +/- 15.5 versus 59.2 +/- 17.0; p = 0.027) and environmental domains (56.6 +/- 12.3 versus 59.6 +/- 13.6; p = 0,045). CONCLUSIONS Diabetic patients with DDP presented a worse QL in the physical and environmental domains of the WHOQOL-bref, probably due to more depressive symptoms and the severity of pain.
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Affiliation(s)
- Rodrigo O Moreira
- Faculdade de Medicina, Universidade Presidente Antônio Carlos, Juiz de Fora, MG, Brasil.
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