Type 2 Diabetes and Anxiety Symptoms Among Women in New Delhi, India

Living with diabetes in Northeast India: An exploration of psychosocial factors in management

Purpose

India is the 'Diabetes Capital of the World' and accounts for one in seven adults living with diabetes worldwide. Psychosocial, economic, and cultural correlates of disease have important implications for disease management but are rarely explored in India. The purpose of this study is to address psychosocial and cultural factors in diabetes management in the northeastern region of India which has a high disease burden.

Methods

This study attempts to explore the psychosocial and lived experience of diabetes in the northeastern state of Meghalaya. The sample was selected from individuals attending an outpatient facility of a multi-speciality clinic. Semi-structured interviews were conducted with 25 individuals (13 women and 12 men), above the age of 40 years, who had been diagnosed with diabetes for at least 6 months. The narratives were analysed using thematic analysis.

Results

Using the social cognitive framework, themes were organized in terms of a thematic map linking knowledge of diabetes to the perception of diabetes as 'a silent killer', to coping, leading to self-efficacy. However high self-efficacy, over time, may lead to complacency, disrupting health behaviours and requiring re-establishment of those behaviours. Adequate knowledge along with cognitive adaptation and self-efficacy were important constructs that contributed to behaviour change and maintenance. Elements of the cultural context were observed in the spiritual aspects of adaptation, the socially isolating consequences of diabetes, as well as gender differences in social support and management.

Conclusion

Understanding the lived experiences of patients contributes to planning more effective interventions keeping the social and cultural context in mind for more effective management of diabetes. Additionally, acknowledging and supporting women's needs in diabetes management is called for.

Baseline anxiety disorders are associated with progression of diabetic kidney disease in type 2 diabetes

BACKGROUND

Diabetic kidney disease (DKD) is a leading cause of kidney failure worldwide. Anxiety has been associated with disease progression in non-diabetes patients. We aimed to examine the prospective association between anxiety and progression of DKD in type 2 diabetes.

METHODS

We conducted a prospective cohort study of 2040 participants with type 2 diabetes at the Diabetes Center of Shanghai General Hospital between May 2017 and June 2020. Anxiety disorders at baseline were diagnosed by a structured clinical interview based on the 10th Revision of International Classification of Disease (ICD). Progression of DKD was identified as the transition from one urinary albumin excretion rate (AER) stage to the next or the development of kidney failure during the follow-up period.

RESULTS

At baseline, 403 (19.8%) had a diagnosis of anxiety disorders, of whom 107 (26.6%) also received a depression diagnosis. During a median follow-up time of 3.2 years, deterioration of the kidney status occurred in 340 (16.7%) individuals. After adjustment for potential confounders including depression or an anxiety × depression interaction term, anxiety disorders were independently related to an increased risk of progression of DKD (HR 1.539, 95% CI 1.130-2.095, p = 0.006; HR 1.536, 95% CI 1.111-2.122, p = 0.009, respectively).

CONCLUSIONS

Anxiety disorders at baseline, independent of possible confounders, were associated with the progression of DKD in type 2 diabetes. Whether therapeutic interventions for anxiety reduce the risk needs to be investigated.

Hypoglycemia and anxiolysis mediated by levofloxacin treatment in diabetic rats

Purpose

The present study was designed to determine the effect of levofloxacin (LVX) treatment on the blood glucose level, insulin sensitivity, anxiety level, nitrite and MDA level of STZ induced diabetic rats.

Methods

Wistar rats were used in the present study. The rats were made diabetic by the administration of single dose of STZ (45 mg/kg, i.p.) and NAD (50 mg/kg, i.p.). The rats with the blood glucose level greater than 200 mg/dl were considered as diabetic (confirmed at day-3 of STZ-NAD administration). The non-diabetic rats were considered as control and received saline.Diabetic rats received metformin (50 mg/kg, p.o.) and LVX (20, 25, 30 and 35 mg/kg, i.p.) daily for 14 days (starting from the day at which STZ was injected). Following administration on 14th day,the blood sample was collected and the rats were subjected to behavioral assays for the determination of locomotor activity and anxiety level. Plasma was separated and used for the estimation ofnitrite and malondialdehyde (MDA)level. On 15th day OGTT was performed in the overnight fasted rats for the assessment of insulin sensitivity.

Results

The results obtained suggested that the administration of STZ-NAD induced the hyperglycemia at day-3 of administration. Diabetic rats displayed the significant increase in blood glucose, anxiety related behavior, MDA level while significant decrease in the insulin sensitivity and plasma nitrite level. Daily administration of metformin to the diabetic rats decreased the blood glucose level, increased the time spent at the center of open field, reversed the anxiety related behavior in LDT and EPM, did not affect the plasma nitrite level, decreased the plasma MDA level, decreased the fasting glucose level and AUC in OGTT assay. LVX (30 and 35 mg/kg) treatment significantly decreased the blood glucose level of diabetic rats. LVX (20, 25 and 30 mg/kg) treatment significantly decreased the number of square crossing while LVX (20, 25, 30 and 35) treatment significantly increased the time spent at the center of the field by the diabetic rats. LVX (20 and 35 mg/kg) treatment significantly reversed the STZ induced anxiety in LDT while LVX (20, 30 and 35 mg/kg) treatment significantly reversed the STZ induced anxiety in EPM test. LVX (20, 25 and 35 mg/kg) treatment significantly increased the plasma nitrite level and LVX (20-35 mg/kg) treatment significantly decreased the MDA level of diabetic rats. Further only LVX (35 mg/kg) treatment significantly decreased the fasting glucose level and increased the AUC of diabetic rats.

Conclusion

In conclusion, STZ-NAD administration increased the blood glucose level, anxiety related behavior, decreased the plasma nitrite and increased the MDA level. LVX administration potentiated the diabetogenic effects of STZ-NAD in rats. Daily administration of LVX decreased the blood glucose level of diabetic rats. LVX administration alleviated the STZ induced anxiety in OFT, LDT and EPM test. LVX administration increased the plasma nitrite level and decreased the lipid peroxidation in diabetic rats.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01234-0.

The prevalence and clinical correlates of anxiety in Chinese patients with first-episode and drug-naïve major depressive disorder at different ages of onset

BACKGROUND

Major depressive disorder (MDD) with comorbid anxiety is very common and is associated with worse clinical outcomes. MDD patients at different ages of onset may have different clinical features and associated factors. The aim of this study was to investigate the prevalence of anxiety and related factors in MDD patients at different ages of onset.

METHODS

A total of 1718 first-episode and drug-naïve (FEDN) MDD patients were recruited. The cutoff point for early-adulthood onset (EAO) and mid-adulthood onset (MAO) was the first depressive episode before or after age 45 years. Clinical features (depressive, anxiety and psychiatric symptoms) and some metabolic parameters were collected.

RESULTS

There was no significant difference in the prevalence of anxiety between EAO patients (50.7 %) and MAO patients (55.7 %). For EAO patients, regression analysis showed that TSH levels, TgAb levels, and TC levels were significantly associated with anxiety. For MAO patients, regression analysis showed that anxiety was associated with HDL-c levels and impaired glucose metabolism. Furthermore, suicide attempts, psychotic symptoms, and depression severity were correlated with anxiety in both groups.

LIMITATIONS

Our cross-sectional study cannot explain the causal relationship between anxiety and related factors in MDD patients at different ages of onset.

CONCLUSIONS

This study revealed that the clinical characteristics and factors associated with anxiety in MDD patients differed according to age of onset, and therefore age of onset needs to be considered while treating anxiety.

A bidirectional relationship between diabetes mellitus and anxiety: A systematic review and meta-analysis

BACKGROUND

Due to the existence of inconsistencies in the evidence regarding the direction and extent of association between diabetes and anxiety disorders, the anxiety-diabetes comorbidity remains an issue of debate.

AIM

To estimate the proportion and risk of diabetes among individuals with anxiety disorder and vice versa.

METHODS

A systematic review was conducted using studies retrieved from databases and grey literature, with the last database search being conducted on April 15, 2021. The methodological rigor of studies was assessed using the National Institute of Health quality assessment tool. Prevalence and effect size (ES) estimates were pooled using a random effect model. Heterogeneity was assessed using the Higgins' I² statistical test, and subgroup analysis conducted.

RESULTS

We included 68 studies presenting data from 2,128,029 participants. The prevalence of anxiety disorders in diabetic patients was 28% (95% CI: 26%, 31%); however, subgroup analysis showed significant differences based on type of anxiety assessment scales, study location, and type of diabetes. The prevalence of diabetes among patients with anxiety disorders was 12% (95% CI: 9%, 16%). Patients with anxiety disorders were found to have a 19% higher risk of diabetes (pooled effect size (ES) = 1.19, 95% CI: 1.13, 1.26). Diabetic patients were found to have a 41% higher risk of developing anxiety disorders (ES = 1.41, 95% CI: 1.19, 1.62).

CONCLUSIONS

There is a higher risk of anxiety disorders in patients with diabetes mellitus and vice versa. It is recommended to screen diabetic patients for anxiety at initial diagnosis and follow-up visits. Similarly, patients with anxiety disorders should have regular screening for diabetes.

REVIEW REGISTRATION

PROSPERO registration number CRD42021252475.

Emotional distress, anxiety and depression in South Asians with long-term conditions: a qualitative systematic review

Background

People with physical–mental comorbidity have a poorer quality of life, worse clinical outcomes, and increased mortality compared with people with physical conditions alone. People of South Asian (SA) origin are the largest minority group in the UK and are more likely to have long-term conditions (LTCs) such as diabetes and heart disease. People of SA origin are less likely to recognise symptoms that may represent mental health problems.

Aim

To explore how people of SA origin with LTCs understand, experience, and seek help for emotional distress, depression, and anxiety.

Design and setting

Systematic review of qualitative studies exploring emotional distress in people of SA origin with diabetes or coronary heart disease, within primary and community care settings worldwide.

Method

Comprehensive searches of eight electronic databases from inception to 1 September 2021 were undertaken. Data extracted included study characteristics, and understanding, experience, and help-seeking behaviour for emotional distress. Thematic synthesis was undertaken. The Critical Appraisal Skills Programme (CASP) checklist for qualitative studies was used to assess quality of articles, and Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) used to determine the overall strength of evidence.

Results

Twenty-one studies from 3165 unique citations were included. Three main themes were identified. Understanding of emotional distress: non-medical terminology used, such as ‘tension’, and a complex relationship between emotional and physical illness. Experiences of emotional distress: multiple forms of inequality, distress at diagnosis of their LTC, cultural factors, and sex differences. Help-seeking behaviour: self-management, support from family, friends, and faith, and inadequate clinical support.

Conclusion

This review provides a greater understanding of the conceptualisation of emotional distress in the context of LTCs by people of SA origin, to support improvement in its recognition and management.

Forging just dietary futures: bringing mainstream and critical nutrition into conversation

Despite decades of action to reduce global malnutrition, rates of undernutrition remain stubbornly high and rates of overweight, obesity and chronic disease are simultaneously on the rise. Moreover, while volumes of robust research on causes and solutions to malnutrition have been published, and calls for interdisciplinarity are on the rise, researchers taking different epistemological and methodological choices have largely remained disciplinarily siloed. This paper works to open a scholarly conversation between "mainstream" public health nutrition and "critical" nutrition studies. While critical nutrition scholars collectively question aspects of mainstream nutrition approaches, they also chart a different way to approach malnutrition research by focusing on politics, structural conditions, and the diverse ways people make sense of food and malnutrition. In this paper, we highlight the key research agendas and insights within both mainstream and critical nutrition in order to suggest spaces for their potential conversation. We ultimately argue that global public health nutrition interventions might achieve greater success in more equitable ways if they are informed by critical nutrition research. We aim for this intervention to facilitate more substantial crossing of disciplinary boundaries, critical to forging more socially and environmentally just dietary futures in the global South and beyond.

A systematic review on ethnopharmacology, phytochemistry and pharmacological aspects of Thymus vulgaris Linn

Thymus vulgaris Linn. is a medicinal and culinary herb from the Southern European region known for its anti-infective, cardioprotective, gastroprotective, anti-inflammatory, and immunomodulatory activities since the Egyptian era. The reported pharmacological activities of T. vulgaris L. include antibacterial, antioxidant, anti-inflammatory, antiviral, and anti-cancerous activities. In this review, a comprehensive approach is put forth to scrutinize and report the available data on phytochemistry, ethnopharmacology, pharmacology, and toxicology of the plant. The different extracts and essential oil obtained from the plant have been assessed and reported to treat ailments like microbial infections, inflammation, non-communicable diseases like cancer, and sexually transmitted diseases like HIV-1 and Herpes. The literature review has also indicated the use of volatile oils, phenolic acids, terpenoids, flavonoids, saponins, steroids, tannins, alkaloids, and polysaccharides in pharmacotherapy. Applications of these compounds including antidiabetic, anti-Alzheimer's, cardio, neuro and hepatoprotective, anti-osteoporosis, sedative, immunomodulatory, antioxidant, anti-tyrosinase, antispasmodic, antinociceptive, gastroprotective, anticonvulsant, antihypertensive, antidepressant, anti-amnesia, and anti-helminthic activities have been mentioned. Further, based on research gaps, recommendations have been provided to evaluate T. vulgaris L. systematically to develop plant-based drugs, nutraceuticals, and to evaluate their clinical efficiency and safety.

Challenges in Women with Diabetes During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has created significant challenges for healthcare systems across the world. The disease seems to infect men and women in equal numbers, though trends suggest that men have greater morbidity. This has been attributed to differences in immunological response, expression of angiotensin-converting enzyme 2 (ACE2), prevalence of comorbidities, and health-related behaviours, such as smoking. However, this cannot be taken to mean that women are somehow protected. Advanced age, smoking, diabetes, hypertension, cardiovascular disease and chronic obstructive pulmonary disease have emerged as the leading contributors to increased morbidity and mortality from the disease. Women with diabetes form a vulnerable group as they often receive suboptimal diabetes care and support, even though they have a high burden of comorbidities and complications. While there are challenges in healthcare delivery during the pandemic, cardiometabolic care cannot be compromised, which calls for exploring new avenues of healthcare delivery, such as telemedicine. Pregnant women with diabetes should continue to receive quality care for optimal outcomes, and the psychological health of women also needs special consideration. The management of hyperglycaemia during COVID-19 infection is important to reduce morbidity and mortality from the infection. The gendered impact of outbreaks and quarantine goes beyond biomedical and psychological aspects, and the socioeconomic impact of the pandemic is likely to affect the long-term care of women with diabetes, which creates an urgent need to create effective policies and interventions to promote optimal care in this vulnerable group.

Depression and Diabetes Distress in South Asian Adults Living in Low- and Middle-Income Countries: A Scoping Review

OBJECTIVES

In this study, we conducted a scoping review to identify the prevalence of both depression and diabetes distress in patients with type 2 diabetes in low- and middle-income countries in South Asia.

METHODS

This scoping review was grounded in the methodology of Arksey and O'Malley by searching for relevant studies using Ovid MEDLINE, PsycINFO and Cumulative Index of Nursing and Allied Health Literature databases, as well as grey literature sources and hand searches. Two reviewers independently screened and extracted data from articles that met the inclusion criteria.

RESULTS

A total of 46 studies were included, with only 1 addressing both depression and diabetes distress. We present 42 total articles on depression and 5 on diabetes distress. The prevalence of type 2 diabetes and elevated depressive symptoms ranged from 11.6% to 67.5%, whereas the prevalence of diabetes distress ranged from 18.0% to 76.2%.

CONCLUSIONS

The prevalence of elevated depressive symptoms was found to be much higher than that reported in data from high-income countries and in data on South Asians living in high-income countries. Diabetes distress was found to be lower compared with other studies; however, the scarcity of data makes this observation inconclusive. Variations in depression inventories, lack of culturally tailored inventories and the focus on urban clinic-based populations are identified as limitations and areas requiring further research. Our review provides evidence for the need of increased mental health screening and treatment in diabetes care in South Asian countries.

Diabetes in women and health-related quality of life in the whole family: a structural equation modeling

Background

Although several studies indicate the effects of diabetes type 2 on health-related quality of life (HRQoL) in female subjects, the related impact of the disease on HRQoL in their family members has rarely been the focus of the empirical research. In this study we aim to investigate associations between diabetes in women and the HRQoL in these women and their family members, using the structural equation modeling (SEM).

Methods

This family-based study was conducted on 794 women (11.1% with diabetes) as well as their spouses and children who participated in the Tehran Lipid and Glucose Study (TLGS) from 2014 to 2016. Data on HRQoL were collected using the Iranian version of the Short-Form 12-Item Health Survey version 2 (SF-12v2) and the Pediatric Quality of Life Inventory version™ 4.0 (PedsQL). SEM was conducted to evaluate the network of associations among studied variables. Data were analyzed using IBM SPSS Statistics & AMOS version 23 software.

Results

Mean age of women was 41.37 ± 5.32 years. Diabetes in women significantly affected their mental HRQoL (β = − 0.11, P < 0.01) but showed no significant direct associations with physical and mental HRQoL in their spouses or their children. However, poor mental HRQoL in women with diabetes was associated with decrease in both physical (β = − 0.02, P = 0.013) and mental (β = − 0.03, P < 0.01) HRQoL in their spouses and total HRQoL score in children (β = − 0.02, P < 0.01).

Conclusions

Among women with diabetes type 2, beyond its effect on their mental HRQoL per se, demonstrated a negative association with the self-assessment of health status in their spouses and children. Such familial consequences are mainly attributed to the negative effect of the disease on the mental rather than the physical HRQoL in women with diabetes.

Prevalence of depression among type 2 diabetes mellitus patients in India: A meta-analysis

Depression as a co-morbid condition in type 2 diabetes mellitus (T2DM) patients is associated with significant morbidity, mortality, and rising health economic burden. Indian healthcare system is heavily burdened with T2DM, and it is important to understand the prevalence of depression associated with T2DM. This meta-analysis conducted as per the registered protocol (PROSPERO registration: CRD42016051552), searched for published studies in the databases including MEDLINE and Embase till 31st August 2018. The modified Newcastle-Ottawa Scale was used to assess the methodological quality. The pooled prevalence of depression among T2DM patients was estimated as primary outcomes, while prevalence based on demographic sub-group was estimated as the secondary outcome. In total, 43 studies including 10,270 patients fulfilled the eligibility criteria and were included in the analysis. The pooled prevalence of depression in T2DM patients was found to be 38% (95% CI: 31%-45%). Presence of depression in people with type 2 diabetes was more often associated with the presence of complications with an odds ratio of 2.33, 95% CI: 1.62-3.36, p < 0.00001. Overall, the study found a high prevalence of depression among T2DM patients in India. Diabetes management programs in India may consider early screening of depression in T2DM patients.

The effect of pelvic pain and urinary incontinence on women's self-rated health in northern Mexico

INTRODUCTION AND HYPOTHESIS

This study was designed to assess the effect of gynecological morbidities on Mexican women's self-rated health status and emotional health.

METHODS

A cross-sectional population-based study was conducted among Mexican women aged 25-54. We analyzed information on 1,303 participants living in Hermosillo, Mexico. Multiple logistic regression was used to assess the effect of having any one of three kinds of pelvic pain, urinary incontinence or both of these conditions on women's self-rated health. Additionally, we conducted analysis of variance and multiple linear regression to test the effect of these gynecological morbidities on women's self-reported emotional health.

RESULTS

Nearly one-third (31.2%) of participants rated their health as fair to very poor. Women reporting of at least one gynecological morbidity were more likely to rate their health as fair to very poor. In adjusted analyses, in addition to older age, low educational attainment, marital status other than single, lack of access to medical care, recurrent kidney infection, asthma, diabetes, and, reporting one or concurrent gynecological morbidities were associated with increased odds (adjusted odds ratios = 1.53-3.91) of reporting fair to very poor self-rated health. Women who did not report any gynecological morbidity had significantly lower mean scores for anxiety/fear 0.30 (±0.30) than women with two to four conditions (anxiety/fear 0.45 ± 0.31).

CONCLUSION

Pelvic pain, urinary incontinence, and the co-occurrence of these conditions have a negative impact on women's perception of their health status and their emotional health.

Predictors of Depression Among Adult Women With Diabetes in the United States: An Analysis Using National Health and Nutrition Examination Survey Data From 2007 to 2012

PURPOSE

The purpose of the study was to identify the sex-specific characteristics that predict depression among adult women with diabetes.

METHODS

Data from the 2007-2012 National Health and Nutrition Examination Survey in the United States were used to identify the predictors of depression in a large sample of women ages 20 years and older with diabetes (n = 946).

RESULTS

When extrapolated to almost 9 million women in the United States ≥ 20 years of age with diabetes, 19.0% had depression. Female-specific significant predictors of depression included younger age (< 65 years old), less than high school graduation, self-rated fair or poor health, inactivity due to poor health, and pain that interferes with usual activities. Marital status and diabetes-related factors (years living with diabetes, use of insulin, parent or sibling with diabetes) were not significant predictors of depression in adult women with diabetes.

CONCLUSION

When educating and counseling women with diabetes, diabetes educators should be aware that some of the predictors of depression in women with diabetes differ from those of populations that include both sexes. Depression screening, although important for all women with diabetes, should especially be performed among women with female-specific depression predictors.

Depression in diabetes mellitus-A comprehensive systematic review of literature from an Indian perspective

Diabetes and depression are rapidly growing chronic health conditions that have significant negative impact upon the physical, psychological, social and occupational functioning, quality of life and often leads to socio-economic burden. Presence of both these comorbid diseases results in various short term and long term complications and increases the mortality as compared to those with depression or diabetes alone.

OBJECTIVES

Systematic review of the epidemiological data, risk factors and relationship between depression and glycaemic control among the Indian studies.

METHODS

We searched Pubmed, Pubmed Central, Google Scholar and Directory of Open Access Journal (DOAJ) databases to identify relevant Indian studies.

RESULTS

Substantial variation in the prevalence of depression in people with diabetes was found across the 41 selected studies; according to this review the range is 2% to 84% (T1DM - 2-7%; T2DM - 8%-84%). Correlates of depression in diabetic patients are advancing age, female gender, low literacy rate, burden of being from a lower socioeconomic status, rural domicile, marriage and duration of diabetes of >2years, diabetes related complications and poor glycaemic control. Sedentary life without adequate physical activities, lack of self-care are often the factors that precipitates depression in a T2DM patient and vice versa.

CONCLUSION

According to this review, among Indian population there is a significant association between depression and diabetes.