Mediating Role of Depression Between Diabetes Management Self-Efficacy and Diabetes Self-Care Behavior Among Elderly Type 2 Diabetes Mellitus Patients in China

Targeting depression and diabetes comorbidity: A generalization meta-analysis of randomized controlled trials on cognitive-behavioural therapy efficacy

AIMS

This study evaluated the effectiveness of cognitive-behavioural therapy (CBT) in managing comorbid depression and diabetes by examining its influence on psychological and metabolic outcomes, addressing inconsistencies in existing research.

METHODS

A systematic review of 26 randomized controlled trials (RCTs) involving 4220 participants conducted between 2000 and 2024 was performed. Subgroup analyses evaluated geographic location, delivery modes, and intervention characteristics, including session duration and frequency.

METHODS

A systematic review of 26 randomized controlled trials (RCTs) involving 4220 participants from year 2000 to 2024 was conducted…. Sub-group analyses assessed geographic location, delivery modes, and intervention features, such as session duration and frequency.

RESULTS

CBT significantly reduced depressive symptoms (SMD = -1.30, 95 % CI -2.46 to -0.13, p < 0.05), demonstrating substantial psychological benefits. Its effect on glycemic control, measured by HbA1c levels, was modest and not statistically significant (SMD = -0.56, 95 % CI -1.12-0.01, p > 0.05). Subgroup analyses revealed variations based on region and intervention characteristics. High heterogeneity across studies highlighted the need for tailored approaches that consider context-specific factors and delivery methods.

CONCLUSIONS

CBT effectively reduces depressive symptoms in individuals with diabetes, supporting its role in integrated care models. However, its association with glycemic control remains inconclusive. Future research should refine CBT protocols to enhance both psychological and metabolic outcomes while addressing diverse needs.

Psychosocial factors correlating self-care management among Jordanian adolescents with type 1 diabetes

PURPOSE

Few studies were conducted to examine the correlation between the anxiety symptoms, depressive symptoms, self-efficacy, and social support variables and type 1 diabetes in developing countries, including Jordan. Thus, this study was conducted to assess the correlation between these psychosocial factors and self-care management among Jordanian adolescents with type 1 diabetes.

DESIGN & METHODS

A cross-sectional, descriptive correlational design was used to perform a study among adolescents with type 1 diabetes (N = 351) aged 14-18 years who attended primary healthcare centers clinics, and diabetic clinics related to hospitals in Amman Governorate, Jordan. A convenience sampling method was used to recruit participants. The data were collected using self-reported questionnaire during the period from June to December 2023.

FINDINGS

The results revealed that around 61.0 % of the sample were males and 39 % female, and 74.9 % of the participants experienced type 1 diabetes for more than one year. Only, 4.3 % of the participants had the recommended HbA1c (< 7.5 %). The participants had high percentage anxiety and depressive symptoms, poor self-efficacy, moderate social support, and low self-care management. There was a correlation between self-efficacy, social support, and self-care management. Also, social support mediated the relationship between self-efficacy and self-care management. However, no relationship existed between anxiety and depressive symptoms and self-care management.

CONCLUSION

Screening for anxiety and depressive symptoms should be a significant element of care for adolescents with type 1 diabetes in outpatient clinics. Policymakers and healthcare professionals including pediatric nurses should develop strategies and education programs on self-care management to enhance self-care practices and management for adolescents with type 1 diabetes.

An Exploration of Self-Efficacy and Its Associated Factors among Rheumatoid Arthritis Patients in Taiwan

Self-efficacy is an important ingredient in successful disease management, especially in patients with chronic conditions such as rheumatoid arthritis (RA). However, the information on self-efficacy and its influencing factors among RA patients is scarce. This study investigated the level of self-efficacy and its pertinent predictors among RA patients in Taiwan. This cross-sectional study recruited patients with RA from a hospital in Taiwan between January and October 2023. A structured questionnaire was used to collect data on respondents' demographic and job characteristics and included a Chinese version of the Arthritis Self-Efficacy Scale (ASES). Multiple linear stepwise regression analysis was employed to identify predictors of self-efficacy. A total of 284 RA patients were enrolled during the study period. The mean ASES score among enrollees was 1607.1, indicating a moderate level of self-efficacy (score range of 200-2000). The regression model displayed that those with higher disease activity scores, Taiwanese Depression Questionnaire scores, fatigue level, shorter disease duration, swollen upper limb joints, and no regular exercise regimen reported lower ASES scores, accounted for 46% of the total variance. The study findings may be useful for healthcare providers in identifying RA patients with low self-efficacy attitudes, a trait that appears to be linked to several medical indicators, and thus facilitating the provision of future tailored healthcare regimens.

Depression and type 2 diabetes risk: a Mendelian randomization study

Background

Extensive observational evidence has suggested an association between depression and type 2 diabetes (T2D). However, the causal relationships between these two diseases require further investigation. This study aimed to evaluate the bidirectional causal effect between two types of depression and T2D using two-sample Mendelian randomization (MR).

Methods

We applied two-step MR techniques, using single-nucleotide polymorphisms (SNPs) as the genetic instruments for analysis. We utilized summary data from genome-wide association studies (GWASs) for major depression (MD), depressive status (frequency of depressed mood in the last two weeks), T2D, and other known T2D risk factors such as obesity, sedentary behavior (time spent watching television), and blood pressure. The analysis utilized inverse variance weighted (IVW), MR-Egger regression, weighted median, weighted mode, MR pleiotropy residual sum, and outlier methods to determine potential causal relationships.

Results

The study found that MD was positively associated with T2D, with an odds ratio (OR) of 1.26 (95% CI: 1.10-1.43, p = 5.6×10-4) using the IVW method and an OR of 1.21 (95% CI: 1.04-1.41, p = 0.01) using the weighted median method. Depressive status was also positively associated with T2D, with an OR of 2.26 (95% CI: 1.03-4.94, p = 0.04) and an OR of 3.62 (95% CI: 1.33-9.90, p = 0.01) using the IVW and weighted median methods, respectively. No causal effects of MD and depressive status on T2D risk factors were observed, and T2D did not influence these factors.

Conclusion

Our study demonstrates a causal relationship between depression and an increased risk of developing T2D, with both major depression and depressive status being positively associated with T2D.

Association between depression and diabetes mellitus and the impact of their comorbidity on mortality: Evidence from a nationally representative study

BACKGROUND

Depression and diabetes mellitus (DM) are major chronic noncommunicable diseases that impair one's mental and physical well-being and impose substantial burdens on the health system. Depressed individuals have an increased risk of impaired blood glucose, weight gain and dyslipidemia which could induce poorer long-term survival.

METHODS

37,040 individuals from the National Health and Nutrition Examination Survey (NHANES) were included. Depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-9) and classified by the total scores as no (0-4), mild (5-9), moderate (10-14), and severe (15-27). DM was determined based on self-reported medical history, clinical test results, and medication use. Logistic and Cox regression were the main statistical models. All analyses were based on weighted data from complex sampling.

RESULTS

The prevalence of DM was higher in depressed than non-depressed individuals (21.26 % vs. 13.75 %). The adjusted odds ratio (OR) (95 % CI) of comorbid DM increased with depression severity, from 1.00 (reference) for no depression, to 1.22 (1.09,1.36) for mild, 1.62 (1.37,1.92) for moderate, and 1.52(1.28,1.82) for severe depression. Comorbidity of DM and depression significantly associated with a higher risk of all-cause mortality, with a hazard ratio (HR) (95 % CI) = 2.09 (1.64,2.66).

LIMITATIONS

Dynamic demographic and metabolic data were not available.

CONCLUSION

Depression is associated with a higher risk of DM, which may be related to biological, socioeconomic, and medication-related factors. Comorbidity of the two worsens long-term survival. Therefore, blood glucose management and prevention of DM should be emphasized in depressed patients.

A multi-state analysis of disease trajectories and mental health transitions in patients with type 2 diabetes: A population-based retrospective cohort study utilizing health administrative data

AIMS

To investigate the risk of major depression and dementia in patients with type 2 diabetes, including dementia resulting from depression, and their impact on diabetes-related complications and mortality.

METHODS

We conducted a population-based retrospective cohort study including 11,441 incident cases of diabetes in 2015-2017, with follow-up until 2022. A multi-state survival analysis was performed on a seven-state model with 15 transitions to capture disease progression and onset of mental disorders.

RESULTS

Eight-year probabilities of depression, dementia, diabetes-related complications, and death were 9.7% (95% CI 8.7-10.7), 0.9% (95% CI 0.5-1.3), 10.4% (95% CI 9.5-11.4), and 14.8% (95% CI 13.9-15.7), respectively. Depression increased the risk of dementia up to 3.7% (95% CI 2.0-5.4), and up to 10.3% (95% CI 0.3-20.4) if coupled with diabetes complications. Eight-year mortality was 37.5% (95% CI 33.1-42.0) after depression, 74.1% (95% CI 63.7-84.5) after depression plus complications, 76.4% (95% CI 68.8-83.9) after dementia, and 98.6% (95% CI 96.1-100.0) after dementia plus complications.

CONCLUSIONS

The interconnections observed across depression, dementia, complications, and mortality underscore the necessity for comprehensive and integrated approaches in managing diabetes. Early screening for depression, followed by timely and targeted interventions, may mitigate the risk of dementia and improve diabetes prognosis.