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Golmohammadi M, Attari VE, Salimi Y, Nachvak SM, Samadi M. The effect of MIND diet on sleep status, anxiety, depression, and cardiometabolic indices in obese diabetic women with insomnia: study protocol for a randomized controlled clinical trial {1}. Trials 2024; 25:660. [PMID: 39370509 PMCID: PMC11457347 DOI: 10.1186/s13063-024-08486-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 09/19/2024] [Indexed: 10/08/2024] Open
Abstract
BACKGROUND The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet is a plant-based and anti-inflammatory diet that has the ability to protect and manage cardiovascular and nervous system diseases. Regarding that insomnia and cardiovascular problems are x`common in type 2 diabetes mellitus (T2DM), the present study will assess the effectiveness of the MIND dietary pattern on sleep quality, cardiometabolic indicators, and other psychological indicators. METHODS Forty-four overweight/obese T2DM women with insomnia, aged 30-65 years, will voluntarily participate in this randomized controlled trial and will be randomized to receive either a MIND low-calorie diet (MLCD) or a low-calorie diet (LCD) over a 3-month period. Before and after the study, sleep quality, some biochemical and cardiometabolic indices, cortisol, brain-derived neurotrophic factor (BDNF), high-sensitivity C-reactive protein (hs-CRP), and oxidative stress indicators will be assessed. DISCUSSION The use of dietary interventions in the management of T2DM complications is practical and safe. This research seeks to investigate the capacity of the MIND diet in the management of insomnia and cardiovascular problems of DM. It is expected that the results of this research will provide new perspectives on using an ideal dietary regimen to treat these health conditions. TRIAL REGISTRATION IRCT20181111041611N8. Registered on August 7, 2023. https://www.irct.ir/trial/71772.
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Affiliation(s)
- Mona Golmohammadi
- Student Research Committee, Department of Nutritional Sciences, School of Nutrition Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vahideh Ebrahimzadeh Attari
- Department of Biochemistry and Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yahya Salimi
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Mostafa Nachvak
- Department of Nutritional Sciences, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Mehnoosh Samadi
- Department of Nutritional Sciences, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Morito K, Yamagata M, Naka F, Kobayashi K, Ueda H, Morimoto H, Yasukawa T, Takayama K, Uozumi Y, Nagasawa K. Sub-chronic and mild social defeat stress exposure to C57BL/6J mice increases visceral fat mass and causes accumulation of cholesterol and bile acids in the liver. Biochem Biophys Res Commun 2024; 702:149631. [PMID: 38335703 DOI: 10.1016/j.bbrc.2024.149631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/10/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
Major depressive disorder is accompanied by a high metabolic illness comorbidity and patients with atypical depression are a subgroup with particularly high risk of obesity, dyslipidemia, and metabolic syndrome; however, the underlying mechanisms have not been fully elucidated. In this study, we examined visceral fat deposition, lipid profiles in the liver, and gut microbiota in sub-chronic and mild social defeat stress (sCSDS)-exposed C57BL/6J mice, which exhibit atypical depression-like phenotypes, i.e., increased body weight and food and water intake. We found that visceral fat mass and levels of hepatic cholesterol and bile acids in sCSDS-exposed mice were significantly increased compared to those in controls. The expression of hepatic small heterodimer partner, a negative regulator of cholesterol metabolism, was significantly elevated in sCSDS-exposed mice. We also found that gut microbial diversity and composition including lower relative abundance of Bacteroides spp. and Bifidobacterium spp. in sCSDS-exposed mice were different from those in controls. In addition, relative abundance of Bacteroides spp. and Bifidobacterium spp. was significantly and negatively correlated with body weight, visceral fat mass, and hepatic cholesterol and bile acids levels. These results indicate that sCSDS-exposure induces dysbiosis, and thereby contributes to metabolic disorder development.
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Affiliation(s)
- Katsuya Morito
- Laboratory of Environmental Biochemistry, Division of Biological Sciences, Kyoto Pharmaceutical University, 5 Misasaginakauchi-cho, Yamashina-ku, Kyoto, 607-8414, Japan
| | - Mayu Yamagata
- Laboratory of Environmental Biochemistry, Division of Biological Sciences, Kyoto Pharmaceutical University, 5 Misasaginakauchi-cho, Yamashina-ku, Kyoto, 607-8414, Japan
| | - Futaba Naka
- Laboratory of Environmental Biochemistry, Division of Biological Sciences, Kyoto Pharmaceutical University, 5 Misasaginakauchi-cho, Yamashina-ku, Kyoto, 607-8414, Japan
| | - Kayo Kobayashi
- Laboratory of Environmental Biochemistry, Division of Biological Sciences, Kyoto Pharmaceutical University, 5 Misasaginakauchi-cho, Yamashina-ku, Kyoto, 607-8414, Japan
| | - Hikari Ueda
- Laboratory of Environmental Biochemistry, Division of Biological Sciences, Kyoto Pharmaceutical University, 5 Misasaginakauchi-cho, Yamashina-ku, Kyoto, 607-8414, Japan
| | - Hirotoshi Morimoto
- Technical Development Division, Ako Kasei, Co., Ltd., 329 Sakoshi, Ako, 678-0193, Japan
| | - Takeshi Yasukawa
- Technical Development Division, Ako Kasei, Co., Ltd., 329 Sakoshi, Ako, 678-0193, Japan
| | - Kentaro Takayama
- Laboratory of Environmental Biochemistry, Division of Biological Sciences, Kyoto Pharmaceutical University, 5 Misasaginakauchi-cho, Yamashina-ku, Kyoto, 607-8414, Japan
| | - Yoshinobu Uozumi
- Technical Development Division, Ako Kasei, Co., Ltd., 329 Sakoshi, Ako, 678-0193, Japan
| | - Kazuki Nagasawa
- Laboratory of Environmental Biochemistry, Division of Biological Sciences, Kyoto Pharmaceutical University, 5 Misasaginakauchi-cho, Yamashina-ku, Kyoto, 607-8414, Japan.
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Shah MK, Gandrakota N, Bullard KM, Siegel KR, Ali MK. Trends in health behaviors of US adults with and without Diabetes: 2007-2018. Diabetes Res Clin Pract 2023; 206:110990. [PMID: 37926116 PMCID: PMC10842838 DOI: 10.1016/j.diabres.2023.110990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
AIMS Understanding health behaviors of people with diabetes can inform strategies to reduce diabetes-related burdens. METHODS We used serial cross-sectional National Health and Nutrition Examination Surveys over 2007-2018 to characterize self-reported health behaviors among non-pregnant adults, with and without self-reported diabetes. We estimated weighted proportions meeting recommended health behaviors overall and by sociodemographic and glycemic levels. RESULTS During 2007-2010, proportions of adults with diabetes meeting recommendations were: 61.9 % for added sugar consumption (<10 % of total calories), 17.2 % for physical activity, 68.2 % for weight management, 14.4 % avoided alcohol, 57.5 % avoided tobacco, 34.1 % got adequate sleep, and 97.5 % saw a healthcare provider (compared with 19.2 %, 33.6 %, 68.8 %, 8.5 %, 44.2 %, 33.0 %, and 82.6 % respectively, among those without diabetes). During 2015-2018, adjusted analyses showed more adults with diabetes met sleep (+16.7 percentage-points[pp]; 95 % CI: 10.6,22.8) and physical activity goals (+8.3 pp; 95 % CI: 3.8,12.8), and fewer met added sugar recommendations (-8.8 pp; 95 % CI -14.7, -2.9). Meeting added sugar, physical activity, and weight management varied by age, education, and glycemic level, but not race and ethnicity. CONCLUSIONS During 2007-2018, there was some improvement in health behaviors. Improving self-management may require targeted interventions for different segments, like age groups or glycemic levels, among those with diabetes.
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Affiliation(s)
- Megha K Shah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, United States.
| | - Nikhila Gandrakota
- Department of Family and Preventive Medicine, Emory University School of Medicine, United States
| | - Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, United States
| | - Karen R Siegel
- Hubert Department of Global Health, Emory Rollins School of Public Health, United States
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, Emory University School of Medicine, United States; Hubert Department of Global Health, Emory Rollins School of Public Health, United States
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Scodari BT, Chacko S, Matsumura R, Jacobson NC. Using machine learning to forecast symptom changes among subclinical depression patients receiving stepped care or usual care. J Affect Disord 2023; 340:213-220. [PMID: 37541599 PMCID: PMC10548339 DOI: 10.1016/j.jad.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 03/08/2023] [Accepted: 08/01/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Subclinical depression (SD) is a mental health disorder characterized by minor depressive symptoms. Most SD patients are treated in the primary practice, but many respond poorly to treatment at the expense of provider resources. Stepped care approaches are appealing for tiering SD care to efficiently allocate scarce resources while jointly optimizing patient outcomes. However, stepped care can be time inefficient, as some persons may respond poorly and be forced to suffer with their symptoms for prolonged periods. Machine learning can offer insight into optimal treatment paths and inform clinical recommendations for incident patients. METHODS As part of the Step-Dep trial, participants with SD were randomized to receive stepped care (N=96) or usual care (N=140). Machine learning was used to predict changes in depressive symptoms every three months over a year for each treatment group. RESULTS Tree-based models were effective in predicting PHQ-9 changes among patients who received stepped care (r=0.35-0.46, MAE=0.14-0.17) and usual care (r=0.34-0.49, MAE=0.15-0.18). Patients who received stepped care were more likely to reduce PHQ-9 scores if they had high PHQ-9 but low HADS-A scores at baseline, a low number of chronic illnesses, and an internal locus of control. LIMITATIONS Models may suffer from potential overfitting due to sample size limitations. CONCLUSION Our findings demonstrate the promise of machine learning for predicting changes in depressive symptoms for SD patients receiving different treatments. Trained models can intake incident patient information and predict outcomes to inform personalized care.
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Affiliation(s)
- Bruno T Scodari
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Sarah Chacko
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Rina Matsumura
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Nicholas C Jacobson
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Computer Science, Dartmouth College, Hanover, NH, USA
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Possidente C, Fanelli G, Serretti A, Fabbri C. Clinical insights into the cross-link between mood disorders and type 2 diabetes: A review of longitudinal studies and Mendelian randomisation analyses. Neurosci Biobehav Rev 2023; 152:105298. [PMID: 37391112 DOI: 10.1016/j.neubiorev.2023.105298] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/15/2023] [Accepted: 06/26/2023] [Indexed: 07/02/2023]
Abstract
Mood disorders and type 2 diabetes mellitus (T2DM) are prevalent conditions that often co-occur. We reviewed the available evidence from longitudinal and Mendelian randomisation (MR) studies on the relationship between major depressive disorder (MDD), bipolar disorder and T2DM. The clinical implications of this comorbidity on the course of either condition and the impact of antidepressants, mood stabilisers, and antidiabetic drugs were examined. Consistent evidence indicates a bidirectional association between mood disorders and T2DM. T2DM leads to more severe depression, whereas depression is associated with more complications and higher mortality in T2DM. MR studies demonstrated a causal effect of MDD on T2DM in Europeans, while a suggestive causal association in the opposite direction was found in East Asians. Antidepressants, but not lithium, were associated with a higher T2DM risk in the long-term, but confounders cannot be excluded. Some oral antidiabetics, such as pioglitazone and liraglutide, may be effective on depressive and cognitive symptoms. Studies in multi-ethnic populations, with a more careful assessment of confounders and appropriate power, would be important.
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Affiliation(s)
- Chiara Possidente
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Fanelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Chiara Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Barker MM, Davies MJ, Zaccardi F, Brady EM, Hall AP, Henson JJ, Khunti K, Lake A, Redman EL, Rowlands AV, Speight J, Yates T, Sargeant JA, Hadjiconstantinou M. Age at Diagnosis of Type 2 Diabetes and Depressive Symptoms, Diabetes-Specific Distress, and Self-Compassion. Diabetes Care 2023; 46:579-586. [PMID: 36630531 PMCID: PMC10020022 DOI: 10.2337/dc22-1237] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate the association between age at diagnosis of type 2 diabetes and depressive symptoms, diabetes-specific distress, and self-compassion among adults with type 2 diabetes. RESEARCH DESIGN AND METHODS This analysis used data from the Chronotype of Patients with Type 2 Diabetes and Effect on Glycemic Control (CODEC) cross-sectional study. Information was collected on depressive symptoms, diabetes-specific distress, and self-compassion, measured using validated self-report questionnaires, in addition to sociodemographic and clinical data. Multivariable regression models, adjusted for diabetes duration, sex, ethnicity, deprivation status, prescription of antidepressants (selective serotonin reuptake inhibitors), and BMI were used to investigate the association between age at diagnosis of type 2 diabetes and each of the three psychological outcomes. RESULTS A total of 706 participants were included; 64 (9.1%) were diagnosed with type 2 diabetes at <40 years, 422 (59.8%) between 40 and 59 years, and 220 (31.2%) at ≥60 years of age. After adjustment for key confounders, including diabetes duration, younger age at diagnosis was significantly associated with higher levels of depressive symptoms (βadj: -0.18 [95% CI -0.25 to -0.10]; P < 0.01) and diabetes-specific distress (βadj: -0.03 [95% CI -0.04 to -0.02]; P < 0.01) and lower levels of self-compassion (βadj: 0.01 [95% CI 0.00 to 0.02]; P < 0.01). CONCLUSIONS Diagnosis of type 2 diabetes at a younger age is associated with lower psychological well-being, suggesting the need for clinical vigilance and the availability of age-appropriate psychosocial support.
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Affiliation(s)
- Mary M. Barker
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, U.K
- Corresponding author: Mary M. Barker,
| | - Melanie J. Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, U.K
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, U.K
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, U.K
| | - Francesco Zaccardi
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, U.K
| | - Emer M. Brady
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, U.K
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, U.K
| | - Andrew P. Hall
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, U.K
- The Hanning Sleep Laboratory, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Joseph J. Henson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, U.K
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, U.K
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, U.K
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, U.K
- National Institute for Health Research Applied Research Collaboration East Midlands, Leicester, U.K
| | - Amelia Lake
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Emma L. Redman
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, U.K
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, U.K
| | - Alex V. Rowlands
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, U.K
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, U.K
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Tom Yates
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, U.K
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, U.K
| | - Jack A. Sargeant
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, U.K
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, U.K
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, U.K
| | - Michelle Hadjiconstantinou
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, U.K
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Yang H, Sun D, Yang Y, Lin R, Xu J, Wu J, Cui X, Li J, Qin G, Han X, Yu Y. Association of depression with all-cause and cardiovascular mortality among US adults with high and low baseline risk of cardiovascular disease. Psychiatry Res 2023; 320:115051. [PMID: 36652845 DOI: 10.1016/j.psychres.2023.115051] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
The intervention of depression was considered a prevention and treatment option for cardiovascular disease (CVD). However, evidence regarding whether association of depression with mortality differed among people at high or low risk of CVD yielded conflicting results. We aimed to investigate associations between depression and all-cause and CVD mortality among 3854 and 3044 US adults at high and low baseline risk of CVD, respectively. Among participants at high risk of CVD, depression and per 5-point increase in PHQ-9 score were associated with 81% (HR=1.81, 95%CI: 1.15-2.86) and 33% (HR=1.33, 95%CI: 1.14-1.55) increased all-cause mortality, respectively. We did not find statistically significant associations between depression (HR=1.40, 95%CI: 0.67-2.95) and PHQ-9 score (HR=1.28, 95%CI: 1.00-1.63) with CVD mortality due to a small number of mortality events. Among people with low risk of CVD, each 5-point increment in PHQ-9 score was associated with all-cause mortality (HR=1.26, 95%CI: 1.02-1.56), while there was no statistically significant association of depression with all-cause mortality (HR=1.69, 95%CI: 0.75-3.81) and CVD mortality (HR=1.99, 95%CI: 0.83-4.81). This study found that depression was associated with all-cause mortality among individuals at a high baseline risk of CVD, but no significant association was observed in people at a low baseline risk of CVD.
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Affiliation(s)
- Hui Yang
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Di Sun
- Department of Cardiology, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Yating Yang
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Ruilang Lin
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Jiaqin Xu
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Jingyi Wu
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xiaorui Cui
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Jiong Li
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China.
| | - Xiaojie Han
- The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China.
| | - Yongfu Yu
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China.
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Abrahamian H, Kautzky-Willer A, Rießland-Seifert A, Lebherz-Eichinger D, Fasching P, Ebenbichler C, Kautzky A, Toplak H. [Mental disorders and diabetes mellitus (Update 2023)]. Wien Klin Wochenschr 2023; 135:225-236. [PMID: 37101044 PMCID: PMC10133031 DOI: 10.1007/s00508-022-02117-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 04/28/2023]
Abstract
Psychiatric disorders and psychological problems are common in patients with diabetes mellitus. There is a twofold increase in depression which is associated with suboptimal glycemic control and increased morbidity and mortality. Other psychiatric disorders with a higher incidence of diabetes are cognitive impairment, dementia, disturbed eating behavior, anxiety disorders, schizophrenia, bipolar disorders and borderline personality disorder. The coincidence of mental disorders and diabetes has unfavorable influences on metabolic control and micro- and macroangiopathic complications. Improvement of therapeutic outcome is a challenge in the modern health care system. The intentions behind this position paper are to rise awareness of this special set of problems, to intensify cooperation between involved health care providers and to reduce incidence of diabetes mellitus as well as morbidity and mortality from diabetes in this patient group.
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Affiliation(s)
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.
| | - Angelika Rießland-Seifert
- 1. Psychiatrische Abteilung mit Zentrum für Psychotherapie und Psychosomatik, Klinik Penzing, Wien, Österreich
| | | | - Peter Fasching
- Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
| | - Christoph Ebenbichler
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Alexander Kautzky
- Klinische Abteilung für Sozialpsychiatrie, Medizinische Universitätsklinik für Psychiatrie und Psychotherapie, Wien, Österreich
| | - Hermann Toplak
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für , Innere Medizin, Medizinische Universität Graz, Graz, Österreich
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Hosokawa R, Ojima T, Myojin T, Kondo K, Kondo N. Geriatric symptoms associated with healthy life expectancy in older people in Japan. Environ Health Prev Med 2023; 28:44. [PMID: 37423739 DOI: 10.1265/ehpm.22-00300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND We investigated the relationship between characteristic geriatric symptoms and healthy life expectancy in older adults in Japan. Additionally, we determined relationship predictors that would help formulate effective approaches toward promoting healthy life expectancy. METHODS The Kihon Checklist was used to identify older people at high risk of requiring nursing care in the near future. We evaluated the association of geriatric symptoms with healthy life expectancy while considering risk factors (frailty, poor motor function, poor nutrition, poor oral function, confinement, poor cognitive function, and depression). Data from the 2013 and 2019 Japan Gerontological Evaluation Studies were used. Healthy life expectancy was assessed using the multistate life table method. RESULTS Overall, 8,956 individuals were included. For both men and women, healthy life expectancy was shorter in the symptomatic group than in the asymptomatic group for several domains of the Kihon Checklist. For men, the difference between individuals with risk factors and those with no risk factors was the maximum for confinement (3.83 years) and the minimum for cognitive function (1.51 years). For women, the difference between individuals with risk factors and those with no risk factors was the maximum for frailty (4.21 years) and the minimum for cognitive function (1.67 years). Healthy life expectancy tended to be shorter when the number of risk factors was higher. Specifically, the difference between individuals with ≥3 risk factors and those with no risk factors was 4.46 years for men and 5.68 years for women. CONCLUSIONS Healthy life expectancy was negatively associated with characteristic geriatric symptoms, with strong associations with frailty, physical functional decline, and depression. Therefore, comprehensive assessment and prevention of geriatric symptoms may increase healthy life expectancy.
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Affiliation(s)
- Rikuya Hosokawa
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University
- Center for Well-being and Society, Nihon Fukushi University
- Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology
| | - Naoki Kondo
- School of Public Health and Graduate School of Medicine, Kyoto University
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Mao Y, Li X, Zhu S, Ma J, Geng Y, Zhao Y. Associations between urea nitrogen and risk of depression among subjects with and without type 2 diabetes: A nationwide population-based study. Front Endocrinol (Lausanne) 2022; 13:985167. [PMID: 36387890 PMCID: PMC9646599 DOI: 10.3389/fendo.2022.985167] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Depression and type 2 diabetes (T2D) are serious public health problems with irreversible health consequences and a significant economic burden on the healthcare system. Previous studies have suggested that blood urea nitrogen (BUN) was inversely longitudinally associated with incidence of diabetes and depression in adults, but few well-designed studies have examined the effects of status of T2D on the full range of relationship between BUN and depression. Methods The analysis sample consisted of adults aged≥20 years from the 2007-2014 National Health and Nutrition Examination Survey (NHANES) who completed the Patient Health Questionnaire-9 (PHQ-9), involving 19,005 participants. By stratifying participants according to T2D status, we further assessed the difference between BUN and risk of depression in participants with and without T2D using multivariate logistic regression (interaction test). Results In this cross-sectional study, the association between BUN and depression prevalence appeared to differ between the T2D and non-T2D groups (OR: 1.00, 95% Cl: 0.95-1.05 vs. OR: 0.89, 95% Cl: 0.85-0.93). In addition, there was evidence of an interaction between BUN levels and T2D status in reducing the risk of depression (P value for interaction = 0.032.) The relationship between BUN and depressive symptoms was significant in non-T2D subjects (P < 0.001), but not in T2D (P = 0.940). Conclusions Our findings suggest that there is a significant relationship between BUN and depression, and T2D status may influence the association between BUN and the risk of depression. Such findings require further prospective studies to provide more evidence.
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Affiliation(s)
- Yafei Mao
- Department of Laboratory Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinyuan Li
- Department of Laboratory Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shumin Zhu
- Department of Laboratory Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jin Ma
- Department of Laboratory Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yulan Geng
- Department of Laboratory Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuanyuan Zhao
- Department of Laboratory Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
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11
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Perez NB, Vorderstrasse AA, Yu G, Melkus GD, Wright F, Ginsberg SD, Crusto CA, Sun YV, Taylor JY. Associations Between DNA Methylation Age Acceleration, Depressive Symptoms, and Cardiometabolic Traits in African American Mothers From the InterGEN Study. Epigenet Insights 2022; 15:25168657221109781. [PMID: 35784386 PMCID: PMC9247996 DOI: 10.1177/25168657221109781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022] Open
Abstract
Background African American women (AAW) have a high risk of both cardiometabolic (CM) illness and depressive symptoms. Depressive symptoms co-occur in individuals with CM illness at higher rates than the general population, and accelerated aging may explain this. In this secondary analysis, we examined associations between age acceleration; depressive symptoms; and CM traits (hypertension, diabetes mellitus [DM], and obesity) in a cohort of AAW. Methods Genomic and clinical data from the InterGEN cohort (n = 227) were used. Age acceleration was based on the Horvath method of DNA methylation (DNAm) age estimation. Accordingly, DNAm age acceleration (DNAm AA) was defined as the residuals from a linear regression of DNAm age on chronological age. Spearman's correlations, linear and logistic regression examined associations between DNAm AA, depressive symptoms, and CM traits. Results DNAm AA did not associate with total depressive symptom scores. DNAm AA correlated with specific symptoms including self-disgust/self-hate (-0.13, 95% CI -0.26, -0.01); difficulty with making decisions (-0.15, 95% CI -0.28, -0.02); and worry over physical health (0.15, 95% CI 0.02, 0.28), but were not statistically significant after multiple comparison correction. DNAm AA associated with obesity (0.08, 95% CI 1.02, 1.16), hypertension (0.08, 95% CI 1.01, 1.17), and DM (0.20, 95% CI 1.09, 1.40), after adjustment for potential confounders. Conclusions Associations between age acceleration and depressive symptoms may be highly nuanced and dependent on study design contexts. Factors other than age acceleration may explain the connection between depressive symptoms and CM traits. AAW with CM traits may be at increased risk of accelerated aging.
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Affiliation(s)
| | | | - Gary Yu
- Rory Meyers College of Nursing, New
York University, New York, NY, USA
| | | | - Fay Wright
- Rory Meyers College of Nursing, New
York University, New York, NY, USA
| | - Stephen D Ginsberg
- Center for Dementia Research, Nathan
Kline Institute, Orangeburg, NY, USA
- NYU Grossman School of Medicine, New
York, NY, USA
| | - Cindy A Crusto
- Yale School of Medicine, Orange, CT,
USA
- Department of Psychology, University of
Pretoria, Pretoria, South Africa
| | - Yan V Sun
- Emory University School of Public
Health, Atlanta, GA, USA
- Atlanta VA Health Care System, Decatur,
GA, USA
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12
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Chandrasekar EK, Ali MK, Wei J, Narayan KV, Owens-Gary MD, Bullard KM. Trends in depression by glycemic status: Serial cross-sectional analyses of the National Health and Nutrition Examination Surveys, 2005-2016. Prim Care Diabetes 2022; 16:404-410. [PMID: 35272962 DOI: 10.1016/j.pcd.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 01/08/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
AIMS We examined changes in the prevalence of elevated depressive symptoms among US adults with diabetes, prediabetes, and normal glycemic status during 2005-2016. METHODS We analyzed data from 32,676 adults in the 2005-2016 National Health and Nutrition Examination Surveys. We defined diabetes as self-reporting a physician diagnosis of diabetes or A1C ≥ 6.5% [48 mmol/mol], and prediabetes as A1C 5.7-6.4% [39-46 mmol/mol]. We used the 9-item Patient Health Questionnaire (PHQ-9) score ≥ 10 or antidepressant use to define 'clinically significant depressive symptoms' (CSDS) and PHQ-9 score ≥ 12 as 'Major Depressive Disorder' (MDD). We calculated prevalence age-standardized to the 2000 US census and used logistic-regression to compute adjusted odds of CSDS and MDD for 2005-2008, 2009-2012, and 2015-2016. We analyzed the prevalence of A1C ≥ 9.0% [75 mmol/mol], systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, non-HDL cholesterol ≥ 130 mg/dL, and current smoking among adults with diagnosed diabetes by depressive status. RESULTS The prevalence of CSDS increased among individuals with normal glycemic status from 15.0% (13.5-16.2) to 17.3% (16.0-18.7) (p = 0.03) over 2005-2016. The prevalence of CSDS and MDD remained stable among adults with prediabetes (~ 16% and 1%, respectively) and diabetes (~ 26% and ~3%). After controlling for glycemic, sociodemographic, economic, and self-rated health variables, we found 2-fold greater odds of CSDS among unemployed individuals and 3-fold greater odds among those with fair/poor self-rated health across all survey periods. Cardiometabolic care targets for adults with diagnosed diabetes were stable from 2005 to 2016 and similar across depressive status. CONCLUSIONS One-fourth of adults with diabetes have comorbid CSDS; this prevalence remained stable over 2005-2016 with no change in diabetes care. At the population level, depression does not appear to impact diabetes care, but further research could explore subgroups that may be more vulnerable and could benefit from integrated care that addresses both conditions.
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Affiliation(s)
- Eeshwar K Chandrasekar
- University of Rochester Medical Center, Rochester, NY 14642, USA; School of Medicine, Emory University, Atlanta, GA 30307, USA; Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Mohammed K Ali
- School of Medicine, Emory University, Atlanta, GA 30307, USA; Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jingkai Wei
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Km Venkat Narayan
- School of Medicine, Emory University, Atlanta, GA 30307, USA; Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Michelle D Owens-Gary
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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Horiba Y, Ishizawa K, Takasaki K, Miura J, Babazono T. Effect of depression on progression to end-stage renal disease or pre-end-stage renal disease death in advanced diabetic nephropathy: A prospective cohort study of the Diabetes Study from the Center of Tokyo Women's Medical University. J Diabetes Investig 2022; 13:94-101. [PMID: 34174034 PMCID: PMC8756320 DOI: 10.1111/jdi.13620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS/INTRODUCTION This study aimed to determine the effect of depression on the progression to end-stage renal disease (ESRD) and pre-ESRD death in patients with advanced diabetic nephropathy. MATERIALS AND METHODS This single-center prospective cohort study enrolled Japanese patients with type 2 diabetes and advanced diabetic nephropathy. The total Patient Health Questionnaire-9 score was used to evaluate depression at baseline and classified patients into: no, mild and severe depression groups. The outcomes were ESRD, defined as initiation of renal replacement therapy, and pre-ESRD death. The relationship between the severity of depression and these outcomes was analyzed using a competing risks model, defining each outcome as the competing risk of the other outcome. RESULTS Of the 486 patients with a mean estimated glomerular filtration rate of 37.1 ± 21.1 mL/min/1.73 m2 , 345 were men. During the median follow up of 4.4 years, 164 patients progressed to ESRD and 50 died. The cumulative incidence function of ESRD was significantly higher in the severe depression group (Gray's test, P = 0.003). The ESRD risk increased by 12.4% and 45.1% in patients with mild and severe depression, respectively, compared with those without depression, although these differences did not reach statistical significance in the multivariate subdistribution hazard model (P = 0.450 and 0.161, respectively). The cumulative incidence of death was similar for the study groups. CONCLUSION Depression potentially has a weak impact on progression to ESRD, however, the presence of comorbidities might have the possibility to reduce the effect of depression on the renal outcome in patients with advanced diabetic nephropathy.
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Affiliation(s)
- Yu Horiba
- Diabetes CenterTokyo Women’s Medical University School of MedicineTokyoJapan
| | - Kaya Ishizawa
- Diabetes CenterTokyo Women’s Medical University School of MedicineTokyoJapan
| | - Keiko Takasaki
- Diabetes CenterTokyo Women’s Medical University School of MedicineTokyoJapan
| | - Junnosuke Miura
- Diabetes CenterTokyo Women’s Medical University School of MedicineTokyoJapan
| | - Tetsuya Babazono
- Diabetes CenterTokyo Women’s Medical University School of MedicineTokyoJapan
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14
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Abstract
PURPOSE OF REVIEW The aim of this study was to examine updated prevalence rates, risk factors and the prognosis, diagnosis and treatments for depression among dialysis patients. RECENT FINDINGS Depression influences prognosis, complications, quality of life (QOL), treatment and costs for dialysis patients worldwide. Reported prevalence of depression is 13.1-76.3%; it is higher for dialysis than transplant and higher post than predialysis. Reported depression rates with peritoneal dialysis (PD) compared with in-centre haemodialysis (HD) are inconsistent. Related medical factors are known, but suspected associated patient characteristics including gender and race remain unexplored. Associations between depression in dialysis and QOL, mortality, pathophysiological mechanisms of increased mortality, infection and pathways of inflammation-mediated and psychosocial factors require clarification. Several depression screening instruments are validated for dialysis patients - the Structured Clinical Interview for DSM disorders (SCID) remains the gold standard - but authors suggest the diagnostic standard should be higher than for the general population. Short-term studies indicate nonpharmacological therapy achieves clinical effects for depression in dialysis patients, but research on long-term effects is needed. SUMMARY Depression management through early screening and continuous care models emphasizing dynamic relationships between healthcare teams, patients and families should be encouraged. Large-scale studies of short-term and long-term benefits of pharmacological and nonpharmacological depression management are warranted.
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Affiliation(s)
- Na Tian
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia
| | - Na Chen
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
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15
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Marzolini S, Banks L, Oh PI. Sex Differences in Predictors of Completion of a 6-month Adapted Cardiac Rehabilitation Program for People with Type 2 Diabetes and No Known Cardiac Disease. Can J Diabetes 2021; 46:277-286.e1. [DOI: 10.1016/j.jcjd.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/19/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022]
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16
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Fu L, Zhou Y, Sun J, Zhu Z, Xing Z, Zhou S, Wang Y, Tai S. Atherogenic index of plasma is associated with major adverse cardiovascular events in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2021; 20:201. [PMID: 34610830 PMCID: PMC8493717 DOI: 10.1186/s12933-021-01393-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/28/2021] [Indexed: 12/29/2022] Open
Abstract
Background Previous studies reported the prognostic value of the atherogenic index of plasma (AIP) in the course of atherosclerosis and other cardiovascular diseases (CVDs). Still, the predictive utility of the AIP is unknown among patients with type 2 diabetes mellitus (T2DM). Methods This was a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, which randomized 10,251 patients with long-lasting T2DM. ROC curve analysis was used to determine an optimal threshold for AIP, and the study population was divided into high and low AIP groups. Univariable and multivariable Cox proportional hazards regression analyses were used to determine the association between AIP and primary (major adverse cardiovascular events [MACEs], including nonfatal myocardial infarction, nonfatal stroke, and/or death from cardiovascular causes) and secondary outcomes (all-cause mortality). Stratified analyses were performed to control for the confounding factors. Results AIP was an independent risk factor for the prognosis of T2DM (HR = 1.309; 95% CI 1.084–1.581; P = 0.005). The threshold for AIP was determined to be 0.34 in the study population. After adjustments for confounding factors, multivariable analysis showed that AIP was associated with the risk of MACEs (Model 1: HR = 1.333, 95% CI 1.205–1.474, P < 0.001; Model 2: HR = 1.171, 95% CI 1.030–1.333, P = 0.016; Model 3: HR = 1.194, 95% CI 1.049–1.360, P = 0.007), all-cause mortality (Model 1: HR = 1.184, 95% CI 1.077–1.303, P < 0.001), cardiovascular death (Model 1: HR = 1.422, 95% CI 1.201–1.683, P < 0.001; Model 3: HR = 1.264, 95% CI 1.015–1.573, P = 0.036), and nonfatal myocardial infarction (Model 1: HR = 1.447, 95% CI 1.255–1.669, P < 0.001; Model 2: HR = 1.252, 95% CI 1.045–1.499, P = 0.015; Model 3: HR = 1.284, 95% CI 1.071–1.539, P = 0.007). Subgroup stratified analyses showed that AIP might interact with sex, a classical risk factor of cardiovascular events. Conclusions This study showed that AIP might be a strong biomarker that could be used to predict the risk of cardiovascular events in patients with T2DM. Trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000620. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01393-5.
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Affiliation(s)
- Liyao Fu
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, No. 139, Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Ying Zhou
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, No. 139, Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Jiaxing Sun
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, No. 139, Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Zhaowei Zhu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, No. 139, Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Zhenhua Xing
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, No. 139, Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, No. 139, Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Yongjun Wang
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi Tai
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, No. 139, Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
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17
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Perez NB, Lanier Y, Squires A. Inequities along the Depression Care Cascade in African American Women: An Integrative Review. Issues Ment Health Nurs 2021; 42:720-729. [PMID: 33306426 DOI: 10.1080/01612840.2020.1853289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Depression represents a growing health problem and African American women (AAW) disproportionally experience increased risk and broad disparities in health care. This integrative review examines what is known about the equity of depression care provided to AAW. PubMed, PsychINFO, and Web of Science were searched through April 2020 for studies in peer-reviewed journals from 2015 to 2020. Across the studies (n = 7), AAW received inequitable care across a depression care cascade including lower rates of screening, treatment initiation, and guideline-concordant care. Here we explore individual-, relational-, and structural-level factors related to these disparities and implications for research, practice, and education.
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Affiliation(s)
| | - Yzette Lanier
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, New York, USA
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18
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Swan BP, Mayorga ME, Ivy JS. The SMART Framework: Selection of Machine learning Algorithms with ReplicaTions - a Case Study on the Microvascular Complications of Diabetes. IEEE J Biomed Health Inform 2021; 26:809-817. [PMID: 34232896 DOI: 10.1109/jbhi.2021.3094777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Over 34 million people in the US have diabetes, a major cause of blindness, renal failure, and amputations. Machine learning (ML) models can predict high-risk patients to help prevent adverse outcomes. Selecting the 'best' prediction model for a given disease, population, and clinical application is challenging due to the hundreds of health-related ML models in the literature and the increasing availability of ML methodologies. To support this decision process, we developed the Selection of Machine-learning Algorithms with ReplicaTions (SMART) Framework that integrates building and selecting ML models with decision theory. We build ML models and estimate performance for multiple plausible future populations with a replicated nested cross-validation technique. We rank ML models by simulating decision-maker priorities, using a range of accuracy measures (e.g., AUC) and robustness metrics from decision theory (e.g., minimax Regret). We present the SMART Framework through a case study on the microvascular complications of diabetes using data from the ACCORD clinical trial. We compare selections made by risk-averse, -neutral, and -seeking decision-makers, finding agreement in 80% of the risk-averse and risk-neutral selections, with the risk-averse selections showing consistency for a given complication. We also found that the models that best predicted outcomes in the validation set were those with low performance variance on the testing set, indicating a risk-averse approach in model selection is ideal when there is a potential for high population feature variability. The SMART Framework is a powerful, interactive tool that incorporates various ML algorithms and stakeholder preferences, generalizable to new data and technological advancements.
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19
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Park S, Lee S, Kim Y, Lee Y, Kang MW, Kim K, Kim YC, Han SS, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK. Causal Effects of Positive Affect, Life Satisfaction, Depressive Symptoms, and Neuroticism on Kidney Function: A Mendelian Randomization Study. J Am Soc Nephrol 2021; 32:1484-1496. [PMID: 33785582 PMCID: PMC8259638 DOI: 10.1681/asn.2020071086] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/12/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Further investigation of the causal effects of psychologic wellbeing on kidney function is warranted. METHODS In this Mendelian randomization (MR) study, genetic instruments for positive affect, life satisfaction, depressive symptoms, and neuroticism were introduced from a previous genome-wide association study meta-analysis of European individuals. Summary-level MR was performed using the CKDGen data of European ancestry (n=567,460), and additional allele score-based MR was performed in the individual-level data of White British UK Biobank participants (n=321,024). RESULTS In summary-level MR with the CKDGen data, depressive symptoms were a significant causative factor for kidney function impairment (CKD OR, 1.45; 95% confidence interval, 1.07 to 1.96; eGFR change [%] beta -2.18; 95% confidence interval, -3.61 to -0.72) and pleiotropy-robust sensitivity analysis results supported the causal estimates. A genetic predisposition for positive affect was significantly associated with better kidney function (CKD OR, 0.69; 95% confidence interval, 0.52 to 0.91), eGFR change [%] beta 1.50; 95% confidence interval, 0.09 to 2.93) and sensitivity MR analysis results supported the finding for CKD outcome, but was nonsignificant for eGFR. Life satisfaction and neuroticism exposures showed nonsignificant causal estimates. In the UK Biobank with covariate-adjusted allele score MR analysis, allele scores for positive affect and life satisfaction were causally associated with reduced risk of CKD and higher eGFR. In contrast, neuroticism allele score was associated with increased risk of CKD and lower eGFR, and depressive symptoms allele score was associated with lower eGFR, but showed nonsignificant association with CKD. CONCLUSIONS Health care providers in the nephrology field should be aware of the causal linkage between psychologic wellbeing and kidney function.
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Affiliation(s)
- Sehoon Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea,Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Gyeonggi-do, Korea
| | - Soojin Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Yeonhee Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Woo Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea,Kidney Research Institute, Seoul National University, Seoul, Korea,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea,Kidney Research Institute, Seoul National University, Seoul, Korea,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea,Kidney Research Institute, Seoul National University, Seoul, Korea
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20
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Fuentes B, Amaro S, Alonso de Leciñana M, Arenillas J, Ayo-Martín O, Castellanos M, Freijo M, García-Pastor, Gomis M, Gómez Choco M, López-Cancio E, Martínez Sánchez P, Morales A, Palacio-Portilla E, Rodríguez-Yáñez M, Roquer J, Segura T, Serena J, Vivancos-Mora J. Stroke prevention in patients with type 2 diabetes mellitus or prediabetes: recommendations of the Spanish Society of Neurology’s Stroke Study Group. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2020.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Rohde C, Knudsen JS, Schmitz N, Østergaard SD, Thomsen RW. The impact of hospital-diagnosed depression or use of antidepressants on treatment initiation, adherence and HbA 1c/LDL target achievement in newly diagnosed type 2 diabetes. Diabetologia 2021; 64:361-374. [PMID: 33073329 DOI: 10.1007/s00125-020-05303-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/02/2020] [Indexed: 11/26/2022]
Abstract
AIMS/HYPOTHESIS We aimed to assess whether current antidepressant therapy or a history of hospital-diagnosed depression affects diabetes treatment initiation, adherence, and HbA1c and LDL-cholesterol target achievement. METHODS In this register-based study, we included all individuals from Central and Northern Denmark with newly diagnosed type 2 diabetes, defined as a first-ever HbA1c measurement of ≥48 mmol/mol (6.5%), between 2000 and 2016. Individuals either diagnosed with depression at a psychiatric hospital in the 2 years prior to their diabetes diagnosis or currently receiving treatment with an antidepressant were compared with individuals with type 2 diabetes, but without depression treatment or previous history of depression. Outcome measures included initiation of glucose-lowering drugs and lipid-modifying agents, adherence to these medications (medication possession ratio >80%), and HbA1c (<53 mmol/mol [7%]) and LDL-cholesterol (<2.6 mmol/l) target achievement. The assessment of association between depression or antidepressant treatment and these outcomes was conducted using regression analyses with adjustment for potential confounders. RESULTS We included a total of 87,650 individuals with first-ever HbA1c-diagnosed type 2 diabetes, of whom 0.9% (n = 784) had hospital-diagnosed depression and 11.4% (n = 9963) currently received antidepressant treatment. Compared with those without depression treatment, treatment with an antidepressant was associated with increased likelihood of glucose-lowering drug initiation (HR 1.39 [95% CI 1.34, 1.44]) and adherence (OR 1.27 [95% CI 1.18, 1.36]), lipid-modifying agent initiation (HR 1.17 [95% CI 1.11, 1.23]) and adherence (OR 1.25 [95% CI 1.09, 1.43]), and achievement of LDL (OR 1.08 [95% CI 1.03, 1.14]) but not HbA1c target (OR 0.99 [95% CI 0.93, 1.06]). The findings were similar for individuals who had hospital-diagnosed depression. CONCLUSIONS/INTERPRETATION In individuals with newly diagnosed type 2 diabetes, antidepressant treatment and depression were associated with improved diabetes treatment quality. Graphical abstract.
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Affiliation(s)
- Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Jakob S Knudsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Norbert Schmitz
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Søren Dinesen Østergaard
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Reimar W Thomsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Shafiee M, Vatanparast H, Janzen B, Serahati S, Keshavarz P, Jandaghi P, Pahwa P. Household food insecurity is associated with depressive symptoms in the Canadian adult population. J Affect Disord 2021; 279:563-571. [PMID: 33152560 DOI: 10.1016/j.jad.2020.10.057] [Citation(s) in RCA: 6] [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: 08/26/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is essential to identify factors associated with depression as it is a highly prevalent and disabling mental disorder. The aim of this study was to examine the association between depressive symptoms and household food security status among the Canadian adult population. METHODS This is a cross-sectional study of the adult population in the five provinces and one territory (Northwest Territories) of Canada using data from the 2015-2016 Canadian Community Health Survey-Annual Component (n=19,118). Depressive symptoms were assessed using the 9-item Patient Health Questionnaire. Household food insecurity was measured using the Household Food Security Survey Module. A weighted logistic regression analysis with robust variance estimation technique was performed. RESULTS Approximately 22% of the Canadian adult population reported mild-to-severe depressive symptoms, and 8.3% were from households classified as food insecure. Household food insecurity remained a predictor of mild-to-severe depressive symptoms after adjustment for other known risk factors (ORajd: 2.87, 95% CI: 2.33-3.55, p<0.001). In the multivariable model, significant associations were also found with multimorbidity, lower household income, a history of illicit drug use, being a current smoker, being a widowed/divorced/separated, obesity, and being a non-drinker. Significant interactions also emerged between employment status and age (p=0.03), employment status and gender (p<0.001), and physical activity level and gender (p<0.001). LIMITATIONS The cross-sectional nature of the study does not allow inferring causality. CONCLUSIONS Household food insecurity is associated with depressive symptoms in Canadian adults. Additional longitudinal research is required to further elucidate the nature of this relationship.
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Affiliation(s)
- Mojtaba Shafiee
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Hassan Vatanparast
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada; School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Bonnie Janzen
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Sara Serahati
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Pardis Keshavarz
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Parisa Jandaghi
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Punam Pahwa
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada; Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada.
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Inoue K, Beekley J, Goto A, Jeon CY, Ritz BR. Depression and cardiovascular disease events among patients with type 2 diabetes: A systematic review and meta-analysis with bias analysis. J Diabetes Complications 2020; 34:107710. [PMID: 32921574 PMCID: PMC7467011 DOI: 10.1016/j.jdiacomp.2020.107710] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/22/2020] [Accepted: 08/18/2020] [Indexed: 12/31/2022]
Abstract
AIMS To provide updated systematic and quantitative summary of the association between depression and the risk of CVD events among individuals with type 2 diabetes. We also aimed to examine the sensitivity of the association to uncontrolled confounding. METHODS Data sources included Medline, Embase, and PsycInfo through September 2019. Two independent reviewers selected cohort studies that evaluated the association between depression and fatal or non-fatal CVD events among individuals with type 2 diabetes. Bias analysis was performed using the bias formula approach. RESULTS Of 2527 citations screened, 17 eligible studies with a total of 1,033,131 participants were identified. Based on random-effects meta-analysis, depression was associated with higher risks of non-fatal CVD events (relative risk 1.35, 95% confidence interval [CI] 1.20 to 1.53) and fatal CVD event (relative risk 1.47, 95% CI 1.21 to 1.77). Bias analysis indicated that unmeasured confounders alone may not explain the observed association between depression and CVD events among individuals with type 2 diabetes. CONCLUSIONS Depression was associated with a higher risk of non-fatal and fatal CVD events among individuals with type 2 diabetes. Our findings provide updated and robust evidence about the association between depression and CVD events among individuals with type 2 diabetes.
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Affiliation(s)
- Kosuke Inoue
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, United States; Division of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan..
| | - James Beekley
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Atsushi Goto
- Metabolic Epidemiology Section, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Christie Y Jeon
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Beate R Ritz
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, United States; Department of Environmental Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States; Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
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Kulzer B, Priesterroth L. [Depressive disorders: An often underestimated comorbidity in diabetes]. Dtsch Med Wochenschr 2020; 145:1614-1623. [PMID: 33142328 DOI: 10.1055/a-1038-0408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
People with diabetes often have a depressive disorder in addition to diabetes, which makes therapy more difficult and worsens the prognosis of the disease. Depression is an often underestimated risk factor in the context of diabetes. The aim of this article is to illustrate the significance of depression in diabetes for the course of the disease and to provide an overview of the most important diagnostic and therapeutic recommendations for practice.
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Stroke prevention in patients with type 2 diabetes or prediabetes. Recommendations from the Cerebrovascular Diseases Study Group, Spanish Society of Neurology. Neurologia 2020; 36:305-323. [PMID: 32981775 DOI: 10.1016/j.nrl.2020.04.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/15/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To update the Spanish Society of Neurology's guidelines for stroke prevention in patients with type 2 diabetes or prediabetes, analysing the available evidence on the effect of metabolic control and the potential benefit of antidiabetic drugs with known vascular benefits in addition to conventional antidiabetic treatments in stroke prevention. DEVELOPMENT PICO-type questions (Patient, Intervention, Comparison, Outcome) were developed to identify practical issues in the management of stroke patients and to establish specific recommendations for each of them. Subsequently, we conducted systematic reviews of the PubMed database and selected those randomised clinical trials evaluating stroke as an independent variable (primary or secondary). Finally, for each of the PICO questions we developed a meta-analysis to support the final recommendations. CONCLUSIONS While there is no evidence that metabolic control reduces the risk of stroke, some families of antidiabetic drugs with vascular benefits have been shown to reduce these effects when added to conventional treatments, both in the field of primary prevention in patients presenting type 2 diabetes and high vascular risk or established atherosclerosis (GLP-1 agonists) and in secondary stroke prevention in patients with type 2 diabetes or prediabetes (pioglitazone).
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26
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Ali MK, Chwastiak L, Poongothai S, Emmert-Fees KMF, Patel SA, Anjana RM, Sagar R, Shankar R, Sridhar GR, Kosuri M, Sosale AR, Sosale B, Rao D, Tandon N, Narayan KMV, Mohan V. Effect of a Collaborative Care Model on Depressive Symptoms and Glycated Hemoglobin, Blood Pressure, and Serum Cholesterol Among Patients With Depression and Diabetes in India: The INDEPENDENT Randomized Clinical Trial. JAMA 2020; 324:651-662. [PMID: 32809002 PMCID: PMC7435347 DOI: 10.1001/jama.2020.11747] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Mental health comorbidities are increasing worldwide and worsen outcomes for people with diabetes, especially when care is fragmented. OBJECTIVE To assess whether collaborative care vs usual care lowers depressive symptoms and improves cardiometabolic indices among adults with diabetes and depression. DESIGN, SETTING, AND PARTICIPANTS Parallel, open-label, pragmatic randomized clinical trial conducted at 4 socioeconomically diverse clinics in India that recruited patients with type 2 diabetes; a Patient Health Questionnaire-9 score of at least 10 (range, 0-27); and hemoglobin A1c (HbA1c) of at least 8%, systolic blood pressure (SBP) of at least 140 mm Hg, or low-density lipoprotein (LDL) cholesterol of at least 130 mg/dL. The first patient was enrolled on March 9, 2015, and the last was enrolled on May 31, 2016; the final follow-up visit was July 14, 2018. INTERVENTIONS Patients randomized to the intervention group (n = 196) received 12 months of self-management support from nonphysician care coordinators, decision support electronic health records facilitating physician treatment adjustments, and specialist case reviews; they were followed up for an additional 12 months without intervention. Patients in the control group (n = 208) received usual care over 24 months. MAIN OUTCOMES AND MEASURES The primary outcome was the between-group difference in the percentage of patients at 24 months who had at least a 50% reduction in Symptom Checklist Depression Scale (SCL-20) scores (range, 0-4; higher scores indicate worse symptoms) and a reduction of at least 0.5 percentage points in HbA1c, 5 mm Hg in SBP, or 10 mg/dL in LDL cholesterol. Prespecified secondary outcomes were percentage of patients at 12 and 24 months who met treatment targets (HbA1c <7.0%, SBP <130 mm Hg, LDL cholesterol <100 mg/dL [<70 mg/dL if prior cardiovascular disease]) or had improvements in individual outcomes (≥50% reduction in SCL-20 score, ≥0.5-percentage point reduction in HbA1c, ≥5-mm Hg reduction in SBP, ≥10-mg/dL reduction in LDL cholesterol); percentage of patients who met all HbA1c, SBP, and LDL cholesterol targets; and mean reductions in SCL-20 score, Patient Health Questionnaire-9 score, HbA1c, SBP, and LDL cholesterol. RESULTS Among 404 patients randomized (mean [SD] age, 53 [8.6] years; 165 [40.8%] men), 378 (93.5%) completed the trial. A significantly greater percentage of patients in the intervention group vs the usual care group met the primary outcome (71.6% vs 57.4%; risk difference, 16.9% [95% CI, 8.5%-25.2%]). Of 16 prespecified secondary outcomes, there were no statistically significant between-group differences in improvements in 10 outcomes at 12 months and in 13 outcomes at 24 months. Serious adverse events in the intervention and usual care groups included cardiovascular events or hospitalizations (4 [2.0%] vs 7 [3.4%]), stroke (0 vs 3 [1.4%]), death (2 [1.0%] vs 7 [3.4%]), and severe hypoglycemia (8 [4.1%] vs 0). CONCLUSIONS AND RELEVANCE Among patients with diabetes and depression in India, a 12-month collaborative care intervention, compared with usual care, resulted in statistically significant improvements in a composite measure of depressive symptoms and cardiometabolic indices at 24 months. Further research is needed to understand the generalizability of the findings to other low- and middle-income health care settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02022111.
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Affiliation(s)
- Mohammed K. Ali
- Hubert Department of Global Health, Emory University, Atlanta, Georgia
- Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
| | | | - Karl M. F. Emmert-Fees
- Hubert Department of Global Health, Emory University, Atlanta, Georgia
- Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany
| | - Shivani A. Patel
- Hubert Department of Global Health, Emory University, Atlanta, Georgia
| | | | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | | | | | - Madhu Kosuri
- Department of Psychology, Andhra University, Visakhapatnam, India
| | - Aravind R. Sosale
- Diacon Hospital, Diabetes Care and Research Center, Bangalore, India
| | - Bhavana Sosale
- Diacon Hospital, Diabetes Care and Research Center, Bangalore, India
| | - Deepa Rao
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
| | - Nikhil Tandon
- Endocrinology & Metabolism, All India Institute of Medical Sciences, Delhi, India
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Jannat-Khah DP, Khodneva Y, Bryant K, Ye S, Richman J, Shah R, Safford M, Moise N. Depressive symptoms do not discriminate: racial and economic influences between time-varying depressive symptoms and mortality among REGARDS participants. Ann Epidemiol 2020; 46:31-40.e2. [PMID: 32451197 DOI: 10.1016/j.annepidem.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/30/2020] [Accepted: 04/25/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Depressive symptoms relapse and remit over time, perhaps differentially by race and income. Few studies have examined whether time-varying depressive symptoms (TVDS) differentially predict mortality. We sought to determine whether race (white/black) and income (</≥$35,000) moderate the association between TVDS and mortality in a large cohort. METHODS The REGARDS study is a prospective cohort study among community-dwelling U.S. adults aged 45 years or older. Cox proportional hazard models were constructed to separately analyze the association between mortality (all cause, cardiovascular death, noncardiovascular death, and cancer death) and TVDS in race and income stratified models. RESULTS Point estimates were similar and statistically significant for white (aHR = 1.24 [95% CI: 1.10, 1.41]), black (aHR = 1.26 [95% CI: 1.11, 1.42]), and low-income participants (aHR = 1.28 [95% CI: 1.16, 1.43]) for the association between TVDS and mortality. High-income participants had a lower hazard (aHR = 1.19 [95% CI: 1.02, 1.38]). Baseline depressive symptoms predicted mortality in blacks only (aHR = 1.17, 95% CI: [1.00, 1.35]). CONCLUSIONS We found that TVDS significantly increased the immediate hazard of mortality similarly across race and income strata. TVDS may provide more robust evaluations of depression impact compared with the baseline measures, making apparent racial disparities cited in the extant literature a reflection of the imperfection of using baseline measures.
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Affiliation(s)
- Deanna P Jannat-Khah
- Department of Medicine, Weill Cornell Medicine, New York, NY; Division of Rheumatology, Hospital for Special Surgery, New York, NY; Division of General Internal Medicine, Weill Cornell Medicine, New York, NY
| | - Yulia Khodneva
- Division of Preventative Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL
| | | | - Siqin Ye
- Columbia University Medical Center, Center for Behavioral Cardiovascular Health, New York, NY
| | - Joshua Richman
- Division of Preventative Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL
| | - Ravi Shah
- Columbia University Medical Center, Psychiatry Faculty Practice Organization, New York, NY
| | - Monika Safford
- Department of Medicine, Weill Cornell Medicine, New York, NY; Division of General Internal Medicine, Weill Cornell Medicine, New York, NY
| | - Nathalie Moise
- Columbia University Medical Center, New York, NY; Columbia University Medical Center, Center for Behavioral Cardiovascular Health, New York, NY.
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TELCİ ÇAKLILI Ö, ALKAYA FEYİZOĞLU G, TÜLÜ S, DİZMAN N, BOZKURT İS, OĞUZ A. Reliability and validity of the Turkish version of the Diabetes Distress Scale for type 2 diabetes and distress levels of the participants. Turk J Med Sci 2020; 50:464-470. [PMID: 31655535 PMCID: PMC7165243 DOI: 10.3906/sag-1903-121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/30/2019] [Indexed: 11/16/2022] Open
Abstract
Background/aim Studies have shown an increased depression rate in patients with type 2 diabetes mellitus (T2DM) compared to the normal population. It is now acknowledged that patients suffer from distress rather than depression. Our aim was to validate the Turkish version of the Diabetes Distress Scale (DDS) and to show distress levels of the participants. Materials and methods The scale was translated from English to Turkish by the authors and translated back to English. Between August 2015 and January 2016 all the patients who were referred to the T2DM Clinic of İstanbul Medeniyet University were screened, and eligible patients were recruited. For calculating internal consistency Cronbach’s alpha coefficient was used. Results A total of 205 patients [120 females (58.5%), 85 males (41.5%)] were included. Cronbach’s alpha coefficient was 0.874, showing internal consistency. The Spearman Brown correlation coefficient was calculated between the first 9 and second 8 questions as 0.884. Thetotal variances were explained at a level of 66.2% with 4 factors. Sixty-three patients (30%) had a score of ≥3, indicating diabetic distress. Correlation analysis showed a significant correlation between total score and HbA1c levels (r = 0.152 and P = 0.038). Conclusion The Turkish version of the DDS for type 2 diabetes is a reliable tool for assessment of distress levels.
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Affiliation(s)
| | | | - Selcan TÜLÜ
- Department of Internal Medicine, Faculty of Medicine, İstanbul Medeniyet University, İstanbulTurkey
| | - Nazlı DİZMAN
- Department of Internal Medicine, Faculty of Medicine, İstanbul Medeniyet University, İstanbulTurkey
| | - İrem Sıdıka BOZKURT
- Department of Internal Medicine, Faculty of Medicine, İstanbul Medeniyet University, İstanbulTurkey
| | - Aytekin OĞUZ
- Department of Internal Medicine, Faculty of Medicine, İstanbul Medeniyet University, İstanbulTurkey
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Xing Z, Peng Z, Wang X, Zhu Z, Pei J, Hu X, Chai X. Waist circumference is associated with major adverse cardiovascular events in male but not female patients with type-2 diabetes mellitus. Cardiovasc Diabetol 2020; 19:39. [PMID: 32213183 PMCID: PMC7093979 DOI: 10.1186/s12933-020-01007-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although studies have shown that waist circumference (WC) is positively associated with an increased risk of cardiovascular diseases among the normal population, few studies have investigated WC in patients with type-2 diabetes mellitus (T2DM). METHODS This was a post hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. The Cox proportional hazards models was used to investigate the relationship between WC and major adverse cardiovascular events (MACEs) in T2DM patients with cardiovascular disease (CVD) or high risk factors of CVD. RESULTS A total of 10,251 T2DM patients (6299 men [61.4%], 3952 women [38.6%]) were included in our analysis. The mean age was 64.0 ± 7.53 years. After a mean follow-up at 9.2 ± 2.4 years later, 1804 patients (event rate of 23 per 1000 person-years) had developed MACEs. MACEs rates in men and women were 18.0 and 26.0 events per 1000 person-years, respectively. After multivariable adjustment, each increase in WC of 1 SD increased the risk of MACEs (HR: 1.10, 95% CI 1.04-1.17; P < 0.01) in men, with a non-significant increase in MACEs (HR: 1.04, 95% CI 0.95-1.13; P = 0.40) in women. Compared with those in the first quartile of WC, male patients in the fourth quartile of WC had a hazard ratio (HR) of 1.24 (95% CI 1.05-1.46) for MACEs; female patients in the fourth quartile of WC had an HR of 1.22 (95% CI 0.96-1.56) for MACEs. CONCLUSIONS Higher WC is associated with increased risks of MACEs in male but not female T2DM patients. Trial registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000620).
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Affiliation(s)
- Zhenhua Xing
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, 410011, China.,Emergency Medicine and Difficult Diseases Institute,Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Zhenyu Peng
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, 410011, China.,Emergency Medicine and Difficult Diseases Institute,Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Xiaopu Wang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Zhaowei Zhu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Junyu Pei
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xinqun Hu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xiangping Chai
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, 410011, China. .,Emergency Medicine and Difficult Diseases Institute,Second Xiangya Hospital, Central South University, Changsha, 410011, China.
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30
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Breyer MK, Ofenheimer A, Altziebler J, Hartl S, Burghuber OC, Studnicka M, Purin D, Heinzle C, Drexel H, Franssen FME, Wouters EFM, Harreiter J, Kautzky-Willer A, Breyer-Kohansal R. Marked differences in prediabetes- and diabetes-associated comorbidities between men and women-Epidemiological results from a general population-based cohort aged 6-80 years-The LEAD (Lung, hEart, sociAl, boDy) study. Eur J Clin Invest 2020; 50:e13207. [PMID: 31997311 DOI: 10.1111/eci.13207] [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: 04/10/2019] [Revised: 12/29/2019] [Accepted: 01/25/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Based on biological and behavioural diversity sex and gender may affect comorbidities associated with prediabetes and diabetes. Besides evaluating the prevalence of prediabetes and diabetes (using fasting plasma glucose and HbA1c levels), the primary aim of the study is to investigate sex and gender differences in the prevalence of comorbidities in subjects with prediabetes and diabetes and to identify possible risk factors associated with prediabetes and diabetes. DESIGN This observational, population-based cohort study included 11.014 subjects aged 6-80 years. Examinations included blood samples, ankle-brachial index, ECG, dual-energy X-ray absorptiometry scan and an interviewer-administered questionnaire. RESULTS Across all ages, prevalence of prediabetes was 20.2% (male 23.6%; female 17.1%), and 5.4% for diabetes (male 7.3%; female 3.7%). The prevalence of prediabetes ranged from 4.4% (6-<10 years) up to 40.4% (70+ years) in men and from 4.8% up to 42.3% in women. Comorbidity profile was markedly different between male and female, particularly in those with prediabetes: women more often suffered from arrhythmia, noncoronary artery disease, osteoporosis, increased systemic inflammatory biomarkers and depression, while men with prediabetes more often showed angina pectoris, myocardial infarction and media sclerosis. CONCLUSIONS The unexpected 4.6% prevalence of prediabetes in children aged 6-10 underscores the need for population-based studies across all ages and the onset of prevention of diabetes at a young age. Marked differences have been found in comorbidities as men with prediabetes and diabetes more often suffer from cardiovascular disease, while women more often show arrhythmia, noncoronary artery disease, increased systemic inflammatory biomarkers and depression.
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Affiliation(s)
- Marie-Kathrin Breyer
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Alina Ofenheimer
- Sigmund Freud University, Medical School and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Julia Altziebler
- Karl Landsteiner University, Human Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Sylvia Hartl
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria.,Sigmund Freud University, Medical School and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Otto C Burghuber
- Sigmund Freud University, Medical School and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Michael Studnicka
- Department of Respiratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Daniela Purin
- Vivit-Institute, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Christine Heinzle
- Vivit-Institute, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Heinz Drexel
- Vivit-Institute, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Frits M E Franssen
- Department of Respiratory Medicine+, MUMC+, Maastricht University, Maastricht, The Netherlands
| | - Emiel F M Wouters
- Department of Respiratory Medicine+, MUMC+, Maastricht University, Maastricht, The Netherlands
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Robab Breyer-Kohansal
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
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Abstract
AIMS Several studies suggested that depression might worsen the clinical outcome of diabetes mellitus; however, such association was confounded by duration of illness and baseline complications. This study aimed to assess whether depression increases the risk of diabetes complications and mortality among incident patients with diabetes. METHODS This was a population-based matched cohort study using Taiwan's National Health Insurance Research Database. A total of 38 537 incident patients with diabetes who had depressive disorders and 154 148 incident diabetes patients without depression who were matched by age, sex and cohort entry year were randomly selected. The study endpoint was the development of macrovascular and microvascular complications, all-cause mortality and cause-specific mortality. RESULTS Among participants, the mean (±SD) age was 52.61 (±12.45) years, and 39.63% were male. The average duration of follow-up for mortality was 5.5 years, ranging from 0 to 14 years. The adjusted hazard ratios were 1.35 (95% confidence interval [CI], 1.32-1.37) for macrovascular complications and 1.08 (95% CI, 1.04-1.12) for all-cause mortality. However, there was no association of depression with microvascular complications, mortality due to cardiovascular diseases or mortality due to diabetes mellitus. The effect of depression on diabetes complications and mortality was more prominent among young adults than among middle-aged and older adults. CONCLUSIONS Depression was associated with macrovascular complications and all-cause mortality in our patient cohort. However, the magnitude of association was less than that in previous studies. Further research should focus on the benefits and risks of treatment for depression on diabetes outcome.
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Hasanovic E, Trifunovic N, Dzambo I, Erkocevic H, Cemerlic A, Jatic Z, Kulenovic AD. The Association among Glycemic Control and Depression Symptoms in Patients with Type 2 Diabetes. Mater Sociomed 2020; 32:177-182. [PMID: 33424445 PMCID: PMC7780785 DOI: 10.5455/msm.2020.32.177-182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction Diabetes and depression are two common and major non-communicable diseases with significant disease burdens worldwide. Aim The aim of this study is to obtain the association among A1C levels and symptoms of depression in patients with type 2 diabetes in family medicine offices. Methods This cross-sectional study was carried out between June 2016 and July 2017. We recruited 150 adults with type 2 diabetes from various family medicine offices. The study questionnaire had two parts; the first one for participants and the second one for family medicine physicians. Participants completed the part of the questionnaire with the PHQ-9 scale and questions regarding demographic data. Family medicine physicians completed the part of the questionnaire with questions concerning clinical data. A univariate and multivariate linear regression analysis was conducted to identify significant predictors of depressive symptoms revealed by the PHQ-9 score. Results Multiple linear regression showed that the level of A1C was a significant predictor of the PHQ-9 score in all three models. Increases in the A1C level were followed by increases in depressive symptoms. Other significant predictors of a positive PHQ-9 score were smoking, level of education and income. Conclusion The level of A1C as an indicator of glycemic control has been shown to have a significant association with the scores of the PHQ-9 questionnaire, which identifies the intensity of symptoms of depression. An increase in the level of A1C is followed by an increase in the intensity of symptoms of depression.
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Affiliation(s)
| | - Natasa Trifunovic
- Public Institution Health Centre of Canton Sarajevo.,Faculty of Medicine University of Sarajevo
| | - Irma Dzambo
- Public Institution Health Centre of Canton Sarajevo
| | - Hasiba Erkocevic
- Public Institution Health Centre of Canton Sarajevo.,Faculty of Medicine University of Sarajevo
| | | | - Zaim Jatic
- Public Institution Health Centre of Canton Sarajevo.,Faculty of Medicine University of Sarajevo
| | - Alma Dzubur Kulenovic
- Faculty of Medicine University of Sarajevo.,Clinical Centre of the University of Sarajevo
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33
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Xing Z, Pei J, Huang J, Peng X, Chen P, Hu X. Relationship of Obesity to Adverse Events Among Patients With Mean 10-Year History of Type 2 Diabetes Mellitus: Results of the ACCORD Study. J Am Heart Assoc 2019; 7:e010512. [PMID: 30554548 PMCID: PMC6404442 DOI: 10.1161/jaha.118.010512] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Recent evidence from cohort studies and meta‐analyses suggests that the obesity paradox phenomenon may exist in patients with diabetes mellitus. The goal of this study was to assess the association between adverse events and obesity by using 2 different measures of obesity, body mass index (BMI; kg/m2) and waist circumference, in patients with a mean 10‐year history of type 2 diabetes mellitus. Methods and Results We used data from the ACCORD (the Action to Control Cardiovascular Risk in Diabetes) study to evaluate the relationship between obesity and adverse events in patients with a mean 10‐year history of type 2 diabetes mellitus. The primary outcome of this study was all‐cause mortality. Secondary outcomes were cardiac death, nonfatal myocardial infarction, and stroke. Patients who were class III obese with BMI ≥40 had the highest risk of all‐cause mortality, followed by patients with class II obesity, whereas overweight patients had the lowest risk. We found significant correlations between BMI and waist circumference (r=0.802). We observed that the relationships between waist circumference and primary and second end points were much like the relationships between BMI and primary and second end points (J‐shaped relationship for all‐cause mortality, V‐shaped relationship for cardiac death, U‐shaped relationship for nonfatal myocardial infarction, and reverse linear relationship for noncardiac death). Conclusions No evidence of the obesity paradox was observed in patients with a 10‐year history of diabetes mellitus. Class III obese patients showed the highest risk of adverse events (all‐cause mortality, cardiac death, nonfatal myocardial infarction, and noncardiac death). BMI and waist circumference showed similar relationships with adverse events. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000620.
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Affiliation(s)
- Zhenhua Xing
- 1 Department of Cardiovascular Medicine The Second Xiangya Hospital Central South University Changsha China
| | - Junyu Pei
- 1 Department of Cardiovascular Medicine The Second Xiangya Hospital Central South University Changsha China
| | - Jiabing Huang
- 1 Department of Cardiovascular Medicine The Second Xiangya Hospital Central South University Changsha China
| | - Xiaofan Peng
- 1 Department of Cardiovascular Medicine The Second Xiangya Hospital Central South University Changsha China
| | - Pengfei Chen
- 1 Department of Cardiovascular Medicine The Second Xiangya Hospital Central South University Changsha China
| | - Xinqun Hu
- 1 Department of Cardiovascular Medicine The Second Xiangya Hospital Central South University Changsha China
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34
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Nouwen A, Adriaanse MC, van Dam K, Iversen MM, Viechtbauer W, Peyrot M, Caramlau I, Kokoszka A, Kanc K, de Groot M, Nefs G, Pouwer F. Longitudinal associations between depression and diabetes complications: a systematic review and meta-analysis. Diabet Med 2019; 36:1562-1572. [PMID: 31215077 DOI: 10.1111/dme.14054] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 01/10/2023]
Abstract
To conduct a systematic review and meta-analysis of longitudinal studies assessing the bi-directional association between depression and diabetes macrovascular and microvascular complications. Embase, Medline and PsycINFO databases were searched from inception through 27 November 2017. A total of 4592 abstracts were screened for eligibility. Meta-analyses used multilevel random/mixed-effects models. Quality was assessed using the Newcastle-Ottawa scale. Twenty-two studies were included in the systematic review. Sixteen studies examined the relationship between baseline depression and incident diabetes complications, of which nine studies involving over one million participants were suitable for meta-analysis. Depression was associated with an increased risk of incident macrovascular (HR = 1.38; 95% CI: 1.30-1.47) and microvascular disease (HR = 1.33; 95% CI: 1.25-1.41). Six studies examined the association between baseline diabetes complications and subsequent depression, of which two studies involving over 230 000 participants were suitable for meta-analysis. The results showed that diabetes complications increased the risk of incident depressive disorder (HR = 1.14; 95% CI: 1.07-1.21). The quality analysis showed increased risk of bias notably in the representativeness of selected cohorts and ascertainment of exposure and outcome. Depression in people with diabetes is associated with an increased risk of incident macrovascular and microvascular complications. The relationship between depression and diabetes complications appears bi-directional. However, the risk of developing diabetes complications in depressed people is higher than the risk of developing depression in people with diabetes complications. The underlying mechanisms warrant further research.
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Affiliation(s)
- A Nouwen
- Middlesex University, London, UK
| | | | | | - M M Iversen
- Western Norway University of Applied Sciences, Bergen, Norway
| | | | - M Peyrot
- Western Norway University of Applied Sciences, Bergen, Norway
- Loyola University Maryland, Baltimore, USA
| | | | | | - K Kanc
- Jazindiabetes (Diabetes & Me), Private Diabetes Centre, Ljubljana, Slovenia
| | - M de Groot
- Indiana University School of Medicine, Indianapolis, USA
| | - G Nefs
- Tilburg University, The Netherlands
- Radboud University Medical Center, Nijmegen, The Netherlands
- Diabeter, Rotterdam, The Netherlands
| | - F Pouwer
- University of Southern Denmark, Odense, Denmark
- STENO Diabetes Center Odense, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
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35
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Farooqi A, Khunti K, Abner S, Gillies C, Morriss R, Seidu S. Comorbid depression and risk of cardiac events and cardiac mortality in people with diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract 2019; 156:107816. [PMID: 31421139 DOI: 10.1016/j.diabres.2019.107816] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/23/2019] [Accepted: 08/12/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the association of comorbid occurrence of diabetes and depression with risk of cardiovascular endpoints including cardiovascular mortality, coronary heart disease and stroke. RESEARCH DESIGN AND METHODS A systematic review and metaanalysis. We searched PUBMED/MEDLINE, Medscape, Cochrane Library, CINAHL, EMBASE and Scopus databases assessing cardiac events and mortality associated with depression in diabetes up until 1 December 2018. Pooled hazard ratios were calculated using random- effects models. RESULTS Nine studies met the inclusion criteria. The combined pooled hazard ratios showed a significant association of cardiac events in people with depression and type 2 diabetes, compared to those with type 2 diabetes alone. For cardiovascular mortality the pooled hazard ratio was 1.48 (95% CI: 1.185, 1.845), p = 0.001, for coronary heart disease 1.37 (1.165, 1.605), p < 0.001 and for stroke 1.33 (1.291, 1.369), p < 0.001. Heterogeneity was high in the meta-analysis for stroke events (I-squared = 84.7%) but was lower for coronary heart disease and cardiovascular mortality (15% and 43.4% respectively). Meta-regression analyses showed that depression was not significantly associated with the study level covariates mean age, duration of diabetes, length of follow-up, BMI, sex and ethnicity (p < 0.05 for all models). Only three studies were found that examined the association of depression in type 1 diabetes, there was a high degree of heterogeneity and data synthesis was not conducted for these studies. CONCLUSIONS We have demonstrated a 47.9% increase in cardiovascular mortality, 36.8% increase in coronary heart disease and 32.9% increase in stroke in people with diabetes and comorbid depression. The presence of depression in a person with diabetes should trigger the consideration of evidence-based therapies for cardiovascular disease prevention irrespective of the baseline risk of cardiovascular disease or duration of diabetes.
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Affiliation(s)
- A Farooqi
- Birmingham City University, Faculty of Business, Law and Social Sciences, Birmingham B4 7BD, UK.
| | - K Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
| | - S Abner
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
| | - C Gillies
- Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
| | - R Morriss
- University of Nottingham, Institute of Mental Health, Nottingham NG8 1BB, UK.
| | - S Seidu
- Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
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36
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Abrahamian H, Kautzky-Willer A, Rießland-Seifert A, Fasching P, Ebenbichler C, Kautzky A, Hofmann P, Toplak H. [Mental disorders and diabetes mellitus (Update 2019)]. Wien Klin Wochenschr 2019; 131:186-195. [PMID: 30980168 DOI: 10.1007/s00508-019-1458-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Psychiatric disorders and psychological problems are common in patients with diabetes mellitus. There is a twofold increase in depression which is associated with suboptimal glycemic control and increased morbidity and mortality. Other psychiatric disorders with a higher incidence of diabetes mellitus are cognitive impairment, dementia, disturbed eating behavior, anxiety disorders, schizophrenia, bipolar disorders and borderline personality disorder. The coincidence of mental disorders and diabetes mellitus has unfavorable influences on metabolic control and micro- and macroangiopathic complications. Improvement of therapeutic outcome is a challenge in the modern health care system. The intentions behind this position paper are to rise awareness of this special set of problems, to intensify cooperation between involved health care providers and to reduce incidence of diabetes mellitus as well as morbidity and mortality from diabetes in this patient group.
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Affiliation(s)
- Heidemarie Abrahamian
- Internistisches Zentrum, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto-Wagner-Spital, 1140, Wien, Österreich.
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Klinische, Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Angelika Rießland-Seifert
- 1. Psychiatrische Abteilung mit Zentrum für Psychotherapie und Psychosomatik, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto-Wagner-Spital, Wien, Österreich
| | - Peter Fasching
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
| | - Christoph Ebenbichler
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Alexander Kautzky
- Klinische Abteilung für Sozialpsychiatrie, Medizinische Universitätsklinik für Psychiatrie und Psychotherapie, Wien, Österreich
| | - Peter Hofmann
- Universitätsklinik für Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Hermann Toplak
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
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37
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Li HQ, Chi S, Dong Q, Yu JT. Pharmacotherapeutic strategies for managing comorbid depression and diabetes. Expert Opin Pharmacother 2019; 20:1589-1599. [PMID: 31149850 DOI: 10.1080/14656566.2019.1622090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: The increasing prevalence of comorbid depression and diabetes exerts a heavy burden on global health. Co-occurrence of depression and diabetes is common, affecting 14% to 35.8% of patients with diabetes, leading to a higher mortality and morbidity rate, more micro- and macro-vascular diseases and more cognitive decline. Areas covered: In this paper, the authors address various areas from epidemiology, the association between depression and diabetes, treatment strategies and future directions based on the currently available literature to provide novel insight into the pharmacotherapeutic management of comorbid depression and diabetes. Expert opinion: Pharmacotherapy can help patients with comorbid depression and diabetes by relieving depressive symptoms and improving glycemic control. When combined with psychological therapy, as a collaborative care effort, pharmacological therapy based on selective serotonin reuptake inhibitors (SSRIs) is recommended for comorbid depression with diabetes. Furthermore, studies with larger sample sizes that can help to define different subtypes of diabetes and severity of depression are needed so that clinicians can draw up a precise and applicable management guidelines for the personalized therapy of these diseases.
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Affiliation(s)
- Hong-Qi Li
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University , Shanghai , China
| | - Song Chi
- Department of Neurology, The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University , Shanghai , China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University , Shanghai , China
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38
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Stewart J, Garrido S, Hense C, McFerran K. Music Use for Mood Regulation: Self-Awareness and Conscious Listening Choices in Young People With Tendencies to Depression. Front Psychol 2019; 10:1199. [PMID: 31178806 PMCID: PMC6542982 DOI: 10.3389/fpsyg.2019.01199] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/07/2019] [Indexed: 11/29/2022] Open
Abstract
The current study explored the circumstances in which seven young people with a tendency to depression chose different styles of music to listen to, and their level of awareness of the impact of their music listening habits on mood and wellbeing. A model of various pathways through music use was developed that may explain why music listening intentions in young people do not always align with their wellbeing outcomes. We suggest that the relationship between intentions and outcomes are mediated by differing levels of self-awareness and insight into the mood regulation processes occurring during music listening.
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Affiliation(s)
- Joanna Stewart
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Penrith, NSW, Australia
| | - Sandra Garrido
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Penrith, NSW, Australia
| | - Cherry Hense
- Department of Music Therapy, Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, VIC, Australia
| | - Katrina McFerran
- Department of Music Therapy, Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, VIC, Australia
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39
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Joseph LM, Berry DC, Jessup A, Davison J, J. Schneider B, I. Twersky J. Implementing and feasibility testing depression screening using the electronic medical record for patients with type 2 diabetes admitted to the hospital. Nurs Open 2019; 6:30-38. [PMID: 30534392 PMCID: PMC6279719 DOI: 10.1002/nop2.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/05/2018] [Indexed: 11/11/2022] Open
Abstract
AIM Is it feasible to implement a programme to screen for depression in patients admitted to the hospital for diabetes complications and use the electronic medical record to notify providers of their patient's depression score and give suggestions for medication and counselling? DESIGN A feasibility study was conducted with patients hospitalized with diabetes and depression in the Durham Veterans Affairs Medical Center, Durham, North Carolina, United States. METHODS Patients with type 2 diabetes were screened for depression. The healthcare provider was notified via the electronic medical record about the patients' depression scores. The provider discussed options for management of depression with the patient and initiated treatment. RESULTS The process of screening for depression at admission, notifying the provider by way of electronic medical record that the patient screened positive for depression with suggestions for medication and counseling was feasible and acceptable to providers and patients.
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Affiliation(s)
| | - Diane C. Berry
- The University of North Carolina at Chapel Hill School of NursingChapel HillNorth Carolina
| | - Ann Jessup
- The University of North Carolina at Chapel Hill School of NursingChapel HillNorth Carolina
| | - Jean Davison
- The University of North Carolina at Chapel Hill School of NursingChapel HillNorth Carolina
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40
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Pols AD, Schipper K, Overkamp D, van Marwijk HWJ, van Tulder MW, Adriaanse MC. Patients' and practice nurses' perceptions of depression in patients with type 2 diabetes and/or coronary heart disease screened for subthreshold depression. BMC FAMILY PRACTICE 2018; 19:202. [PMID: 30579329 PMCID: PMC6304236 DOI: 10.1186/s12875-018-0870-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/14/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Comorbid depression is common in patients with type 2 diabetes (DM2) and/or coronary heart disease (CHD) and is associated with poor quality of life and adverse health outcomes. However, little is known about patients' and practice nurses' (PNs) perceptions of depression. Tailoring care to these perceptions may affect depression detection and patient engagement with treatment and prevention programs. This study aimed to explore patients' and PNs' perceptions of depression in patients with DM2/CHD screened for subthreshold depression. METHODS A qualitative study was conducted as part of a Dutch stepped-care prevention project. Using a purposive sampling strategy, data were collected through semi-structured interviews with 15 patients and 9 PNs. After consent, all interviews were recorded, transcribed verbatim and analyzed independently by two researchers with Atlas.ti.5.7.1 software. The patient and PN datasets were inspected for commonalities using a constant comparative method, from which a final thematic framework was generated. RESULTS Main themes were: illness perception, need for care and causes of depression. Patients generally considered themselves at least mildly depressed, but perceived severity levels were not always congruent with Patient Health Questionnaire 9 scores at inclusion. Initially recognizing or naming their mental state as a (subthreshold) depression was difficult for some. Having trouble sleeping was frequently experienced as the most burdensome symptom. Most experienced a need for care; psycho-educational advice and talking therapy were preferred. Perceived symptom severity corresponded with perceived need for care, but did not necessarily match help-seeking behaviour. Main named barriers to help-seeking were experienced stigma and lack of awareness of depression and mental health care possibilities. PNs frequently perceived patients as not depressed and with minimal need for specific care except for attention. Participants pointed to a mix of causes of depression, most related to negative life events and circumstances and perceived indirect links with DM2/CHD. CONCLUSION Data of the interviewed patients and PNs suggest that they have different perceptions about (subthreshold) depressive illness and the need for care, although views on its causes seem to overlap more.
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Affiliation(s)
- Alide D Pols
- Department of Health Sciences, Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Department of General Practice & Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Karen Schipper
- Amsterdam Public Health Research Institute, Department of Medical Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Debbie Overkamp
- Amsterdam Public Health Research Institute, Department of General Practice & Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Harm W J van Marwijk
- Amsterdam Public Health Research Institute, Department of General Practice & Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Mayfield House, University of Brighton, Brighton, UK
| | - Maurits W van Tulder
- Department of Health Sciences, Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marcel C Adriaanse
- Department of Health Sciences, Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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41
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Lee J, Brazeal M, Choi H, Rehner TA, McLeod ST, Jacobs CM. Physical and psychosocial factors associated with depression among adults with type 2 diabetes mellitus at a Federally Qualified Healthcare Center. SOCIAL WORK IN HEALTH CARE 2018; 57:834-850. [PMID: 30136904 DOI: 10.1080/00981389.2018.1508113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of this study is to examine the prevalence of depression and physical and psychosocial factors associated with depression among adults with Type 2 Diabetes Mellitus (T2DM). METHODS The sample included 421 patients with T2DM at a Federally Qualified Healthcare Center in a southern state. The Patient Health Questionnaire (PHQ-9) was used to measure the severity of depression. RESULTS The multiple logistic regression analyses revealed that the likelihood of depression increased as the level of pain increased and as the level of ambulation difficulties increased. The likelihood of depression increased as the number of traumatic events increased and as the number of SES-related stressors increased. Expectedly, the likelihood of depression decreased as levels of self-esteem increased. CONCLUSIONS The findings support that health care providers developing care plans for individuals with diabetes need to include assessments and interventions that address both the physical and psychosocial needs of patients.
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Affiliation(s)
- Joohee Lee
- a School of Social Work , University of Southern Mississippi , Hattiesburg , MS , USA
| | - Michelle Brazeal
- b School of Social Work, Mississippi Integrated Health and Disaster Program , University of Southern Mississippi , Hattiesburg , MS , USA
| | - Hwanseok Choi
- c Department of Public Health , University of Southern Mississippi , Hattiesburg , MS , USA
| | - Tim A Rehner
- a School of Social Work , University of Southern Mississippi , Hattiesburg , MS , USA
| | - Stephanie T McLeod
- b School of Social Work, Mississippi Integrated Health and Disaster Program , University of Southern Mississippi , Hattiesburg , MS , USA
| | - Christina M Jacobs
- a School of Social Work , University of Southern Mississippi , Hattiesburg , MS , USA
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42
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Pols AD, Adriaanse MC, van Tulder MW, Heymans MW, Bosmans JE, van Dijk SE, van Marwijk HWJ. Two-year effectiveness of a stepped-care depression prevention intervention and predictors of incident depression in primary care patients with diabetes type 2 and/or coronary heart disease and subthreshold depression: data from the Step-Dep cluster randomised controlled trial. BMJ Open 2018; 8:e020412. [PMID: 30373778 PMCID: PMC6224718 DOI: 10.1136/bmjopen-2017-020412] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Major depressive disorders (MDD), diabetes mellitus type 2 (DM2) and coronary heart disease (CHD) are leading contributors to the global burden of disease and often co-occur. OBJECTIVES To evaluate the 2-year effectiveness of a stepped-care intervention to prevent MDD compared with usual care and to develop a prediction model for incident depression in patients with DM2 and/or CHD with subthreshold depression. METHODS Data of 236 Dutch primary care patients with DM2/CHD with subthreshold depression (Patient Health Questionnaire 9 (PHQ-9) score ≥6, no current MDD according to the Mini International Neuropsychiatric Interview (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria)) who participated in the Step-Dep trial were used. A PHQ-9 score of ≥10 at minimally one measurement during follow-up (at 3, 6, 9, 12 and 24 months) was used to determine the cumulative incidence of MDD. Potential demographic and psychological predictors were measured at baseline via web-based self-reported questionnaires and evaluated using a multivariable logistic regression model. Model performance was assessed with the Hosmer-Lemeshow test, Nagelkerke's R2 explained variance and area under the receiver operating characteristic curve (AUC). Bootstrapping techniques were used to internally validate our model. RESULTS 192 patients (81%) were available at 2-year follow-up. The cumulative incidence of MDD was 97/192 (51%). There was no statistically significant overall treatment effect over 24 months of the intervention (OR 1.37; 95% CI 0.52 to 3.55). Baseline levels of anxiety, depression, the presence of >3 chronic diseases and stressful life events predicted the incidence of MDD (AUC 0.80, IQR 0.79-0.80; Nagelkerke's R2 0.34, IQR 0.33-0.36). CONCLUSION A model with 4 factors predicted depression incidence during 2-year follow-up in patients with DM2/CHD accurately, based on the AUC. The Step-Dep intervention did not influence the incidence of MDD. Future depression prevention programmes should target patients with these 4 predictors present, and aim to reduce both anxiety and depressive symptoms. TRIAL REGISTRATION NUMBER NTR3715.
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Affiliation(s)
- Alide Danielle Pols
- Department of Health Sciences, Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - Marcel C Adriaanse
- Department of Health Sciences, Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences, Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
| | - Susan E van Dijk
- Department of Health Sciences, Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
| | - Harm W J van Marwijk
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Mayfield House, University of Brighton, Brighton, United Kingdom
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Time-dependent depressive symptoms and risk of cardiovascular and all-cause mortality among the Chinese elderly: The Beijing Longitudinal Study of Aging. J Cardiol 2018; 72:356-362. [DOI: 10.1016/j.jjcc.2018.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/08/2018] [Accepted: 02/16/2018] [Indexed: 12/14/2022]
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Lo C, Toyama T, Wang Y, Lin J, Hirakawa Y, Jun M, Cass A, Hawley CM, Pilmore H, Badve SV, Perkovic V, Zoungas S. Insulin and glucose-lowering agents for treating people with diabetes and chronic kidney disease. Cochrane Database Syst Rev 2018; 9:CD011798. [PMID: 30246878 PMCID: PMC6513625 DOI: 10.1002/14651858.cd011798.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diabetes is the commonest cause of chronic kidney disease (CKD). Both conditions commonly co-exist. Glucometabolic changes and concurrent dialysis in diabetes and CKD make glucose-lowering challenging, increasing the risk of hypoglycaemia. Glucose-lowering agents have been mainly studied in people with near-normal kidney function. It is important to characterise existing knowledge of glucose-lowering agents in CKD to guide treatment. OBJECTIVES To examine the efficacy and safety of insulin and other pharmacological interventions for lowering glucose levels in people with diabetes and CKD. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 12 February 2018 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA All randomised controlled trials (RCTs) and quasi-RCTs looking at head-to-head comparisons of active regimens of glucose-lowering therapy or active regimen compared with placebo/standard care in people with diabetes and CKD (estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2) were eligible. DATA COLLECTION AND ANALYSIS Four authors independently assessed study eligibility, risk of bias, and quality of data and performed data extraction. Continuous outcomes were expressed as post-treatment mean differences (MD). Adverse events were expressed as post-treatment absolute risk differences (RD). Dichotomous clinical outcomes were presented as risk ratios (RR) with 95% confidence intervals (CI). MAIN RESULTS Forty-four studies (128 records, 13,036 participants) were included. Nine studies compared sodium glucose co-transporter-2 (SGLT2) inhibitors to placebo; 13 studies compared dipeptidyl peptidase-4 (DPP-4) inhibitors to placebo; 2 studies compared glucagon-like peptide-1 (GLP-1) agonists to placebo; 8 studies compared glitazones to no glitazone treatment; 1 study compared glinide to no glinide treatment; and 4 studies compared different types, doses or modes of administration of insulin. In addition, 2 studies compared sitagliptin to glipizide; and 1 study compared each of sitagliptin to insulin, glitazars to pioglitazone, vildagliptin to sitagliptin, linagliptin to voglibose, and albiglutide to sitagliptin. Most studies had a high risk of bias due to funding and attrition bias, and an unclear risk of detection bias.Compared to placebo, SGLT2 inhibitors probably reduce HbA1c (7 studies, 1092 participants: MD -0.29%, -0.38 to -0.19 (-3.2 mmol/mol, -4.2 to -2.2); I2 = 0%), fasting blood glucose (FBG) (5 studies, 855 participants: MD -0.48 mmol/L, -0.78 to -0.19; I2 = 0%), systolic blood pressure (BP) (7 studies, 1198 participants: MD -4.68 mmHg, -6.69 to -2.68; I2 = 40%), diastolic BP (6 studies, 1142 participants: MD -1.72 mmHg, -2.77 to -0.66; I2 = 0%), heart failure (3 studies, 2519 participants: RR 0.59, 0.41 to 0.87; I2 = 0%), and hyperkalaemia (4 studies, 2788 participants: RR 0.58, 0.42 to 0.81; I2 = 0%); but probably increase genital infections (7 studies, 3086 participants: RR 2.50, 1.52 to 4.11; I2 = 0%), and creatinine (4 studies, 848 participants: MD 3.82 μmol/L, 1.45 to 6.19; I2 = 16%) (all effects of moderate certainty evidence). SGLT2 inhibitors may reduce weight (5 studies, 1029 participants: MD -1.41 kg, -1.8 to -1.02; I2 = 28%) and albuminuria (MD -8.14 mg/mmol creatinine, -14.51 to -1.77; I2 = 11%; low certainty evidence). SGLT2 inhibitors may have little or no effect on the risk of cardiovascular death, hypoglycaemia, acute kidney injury (AKI), and urinary tract infection (low certainty evidence). It is uncertain whether SGLT2 inhibitors have any effect on death, end-stage kidney disease (ESKD), hypovolaemia, fractures, diabetic ketoacidosis, or discontinuation due to adverse effects (very low certainty evidence).Compared to placebo, DPP-4 inhibitors may reduce HbA1c (7 studies, 867 participants: MD -0.62%, -0.85 to -0.39 (-6.8 mmol/mol, -9.3 to -4.3); I2 = 59%) but may have little or no effect on FBG (low certainty evidence). DPP-4 inhibitors probably have little or no effect on cardiovascular death (2 studies, 5897 participants: RR 0.93, 0.77 to 1.11; I2 = 0%) and weight (2 studies, 210 participants: MD 0.16 kg, -0.58 to 0.90; I2 = 29%; moderate certainty evidence). Compared to placebo, DPP-4 inhibitors may have little or no effect on heart failure, upper respiratory tract infections, and liver impairment (low certainty evidence). Compared to placebo, it is uncertain whether DPP-4 inhibitors have any effect on eGFR, hypoglycaemia, pancreatitis, pancreatic cancer, or discontinuation due to adverse effects (very low certainty evidence).Compared to placebo, GLP-1 agonists probably reduce HbA1c (7 studies, 867 participants: MD -0.53%, -1.01 to -0.06 (-5.8 mmol/mol, -11.0 to -0.7); I2 = 41%; moderate certainty evidence) and may reduce weight (low certainty evidence). GLP-1 agonists may have little or no effect on eGFR, hypoglycaemia, or discontinuation due to adverse effects (low certainty evidence). It is uncertain whether GLP-1 agonists reduce FBG, increase gastrointestinal symptoms, or affect the risk of pancreatitis (very low certainty evidence).Compared to placebo, it is uncertain whether glitazones have any effect on HbA1c, FBG, death, weight, and risk of hypoglycaemia (very low certainty evidence).Compared to glipizide, sitagliptin probably reduces hypoglycaemia (2 studies, 551 participants: RR 0.40, 0.23 to 0.69; I2 = 0%; moderate certainty evidence). Compared to glipizide, sitagliptin may have had little or no effect on HbA1c, FBG, weight, and eGFR (low certainty evidence). Compared to glipizide, it is uncertain if sitagliptin has any effect on death or discontinuation due to adverse effects (very low certainty).For types, dosages or modes of administration of insulin and other head-to-head comparisons only individual studies were available so no conclusions could be made. AUTHORS' CONCLUSIONS Evidence concerning the efficacy and safety of glucose-lowering agents in diabetes and CKD is limited. SGLT2 inhibitors and GLP-1 agonists are probably efficacious for glucose-lowering and DPP-4 inhibitors may be efficacious for glucose-lowering. Additionally, SGLT2 inhibitors probably reduce BP, heart failure, and hyperkalaemia but increase genital infections, and slightly increase creatinine. The safety profile for GLP-1 agonists is uncertain. No further conclusions could be made for the other classes of glucose-lowering agents including insulin. More high quality studies are required to help guide therapeutic choice for glucose-lowering in diabetes and CKD.
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Affiliation(s)
- Clement Lo
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive MedicineClaytonVICAustralia
- Monash HealthDiabetes and Vascular Medicine UnitClaytonVICAustralia
- Monash UniversityDivision of Metabolism, Ageing and Genomics, School of Public Health and Preventive MedicinePrahanVICAustralia
| | - Tadashi Toyama
- The George Institute for Global Health, UNSW SydneyRenal and Metabolic DivisionNewtownNSWAustralia2050
- Kanazawa University HospitalDivision of NephrologyKanazawaJapan
| | - Ying Wang
- The George Institute for Global Health, UNSW SydneyRenal and Metabolic DivisionNewtownNSWAustralia2050
| | - Jin Lin
- Beijing Friendship Hospital, Capital Medical UniversityDepartment of Critical Care Medicine95 Yong‐An Road, Xuan Wu DistrictBeijingChina100050
| | - Yoichiro Hirakawa
- The George Institute for Global Health, UNSW SydneyProfessorial UnitNewtownNSWAustralia
| | - Min Jun
- The George Institute for Global Health, UNSW SydneyRenal and Metabolic DivisionNewtownNSWAustralia2050
| | - Alan Cass
- Menzies School of Health ResearchPO Box 41096CasuarinaNTAustralia0811
| | - Carmel M Hawley
- Princess Alexandra HospitalDepartment of NephrologyIpswich RoadWoolloongabbaQLDAustralia4102
| | - Helen Pilmore
- Auckland HospitalDepartment of Renal MedicinePark RoadGraftonAucklandNew Zealand
- University of AucklandDepartment of MedicineGraftonNew Zealand
| | - Sunil V Badve
- St George HospitalDepartment of Renal MedicineKogarahNSWAustralia
| | - Vlado Perkovic
- The George Institute for Global Health, UNSW SydneyRenal and Metabolic DivisionNewtownNSWAustralia2050
| | - Sophia Zoungas
- Monash HealthDiabetes and Vascular Medicine UnitClaytonVICAustralia
- Monash UniversityDivision of Metabolism, Ageing and Genomics, School of Public Health and Preventive MedicinePrahanVICAustralia
- The George Institute for Global Health, UNSW SydneyProfessorial UnitNewtownNSWAustralia
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Sex differences and the prognosis of depressive and nondepressive patients with cardiovascular risk factors: the Japan Morning Surge-Home Blood Pressure (J-HOP) study. Hypertens Res 2018; 41:965-972. [PMID: 30218049 DOI: 10.1038/s41440-018-0103-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/04/2018] [Accepted: 04/13/2018] [Indexed: 11/09/2022]
Abstract
Depression is associated with mortality in patients with cardiovascular risk factors. The frequency and severity of depression and the association between depression and cardiovascular events have sex-specific and ethnic differences. We conducted this study to evaluate the sex-specific difference in the association between depression and cardiovascular prognosis in patients with cardiovascular risk factors. We enrolled 4025 patients (64.7 ± 10.9 years, 53% women, 47% men) with cardiovascular risk factors in the Japan Morning Surge-Home Blood Pressure study. Depressive symptoms were assessed using the Beck Depression Inventory (BDI). The follow-up period was 47 ± 24 months. The primary end points were all-cause mortality and nonfatal cardiovascular events. The BDI scores and the prevalence of depression were significantly higher in women than in men. When a BDI score of 16 was the cutoff, the primary end points in the depression group (n = 217) were significantly higher than those in the nondepression group (n = 1677) among men (adjusted hazard ratio 1.76, 95% confidence interval: 1.17, 2.64; P = 0.007). In women, the primary end points in the depression and nondepression groups were similar when BDI scores of 16, 14, and 10 were the cutoffs. In conclusion, depression defined by a BDI score ≥16 was associated with cardiovascular events in men with cardiovascular risk factors.
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Ida S, Murata K, Nakai M, Ito S, Malmstrom TK, Ishihara Y, Imataka K, Uchida A, Monguchi K, Kaneko R, Fujiwara R, Takahashi H. Relationship between sarcopenia and depression in older patients with diabetes: An investigation using the Japanese version of SARC-F. Geriatr Gerontol Int 2018; 18:1318-1322. [DOI: 10.1111/ggi.13461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 04/17/2018] [Accepted: 05/27/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Satoshi Ida
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Kazuya Murata
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Mari Nakai
- Department of Clinical Psychology Team; Ise Red Cross Hospital; Ise Japan
| | - Sho Ito
- Department of Clinical Psychology Team; Ise Red Cross Hospital; Ise Japan
| | - Theodore K. Malmstrom
- Departments of Psychiatry & Behavioral Neuroscience and Internal Medicine, School of Medicine; Saint Louis University; Saint Louis Missouri USA
| | - Yuki Ishihara
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Kanako Imataka
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Akihiro Uchida
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Kou Monguchi
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Ryutaro Kaneko
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Ryoko Fujiwara
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
| | - Hiroka Takahashi
- Department of Diabetes and Metabolism; Ise Red Cross Hospital; Ise Japan
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Hartzler ML, Shenk M, Williams J, Schoen J, Dunn T, Anderson D. Impact of Collaborative Shared Medical Appointments on Diabetes Outcomes in a Family Medicine Clinic. DIABETES EDUCATOR 2018; 44:361-372. [DOI: 10.1177/0145721718776597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study is to evaluate the impact of a collaborative diabetes shared medical appointment on patient outcomes in an urban family medicine practice. Methods Fifty-nine patients were enrolled to participate in multiple shared medical appointments (SMAs) over 12 months. Baseline data included hemoglobin (A1C), lipids, systolic blood pressure (SBP), weight, adherence to American Diabetes Association (ADA) guidelines, and surveys, including the Problem Areas in Diabetes (PAID-2) scale and the Spoken Knowledge in Low Literacy in Diabetes Scale (SKILLD). A1C and SBP were evaluated at each visit. Lipid control was assessed at baseline and at 6 and 12 months. Adherence to ADA guidelines, SKILLD and PAID-2 survey scores, and number of antihyperglycemic and antihypertensive medications were also evaluated at 12 months. Results Thirty-eight patients completed the study. Compared with baseline, A1C and low-density lipoprotein cholesterol (LDL-C) levels decreased significantly over 12 months ( P < .001 and P = .004, respectively). More patients became compliant with the ADA guidelines throughout the course of the study. Specifically, more patients achieved the LDL-C goal of ≤100 mg/dL (2.59 mmol/L; P < .001), were prescribed appropriate antihypertensive medications ( P < .001) and aspirin ( P < .001), and received the pneumonia vaccine ( P < .001). PAID-2 and SKILLD survey scores also significantly improved over the course of the study ( P ≤ .001 and P = .003, respectively). Conclusion Short-term interdisciplinary SMAs decreased A1C and LDL-C, improved patient adherence to ADA guidelines, improved emotional distress related to diabetes, and increased knowledge of diabetes.
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Affiliation(s)
| | - McKenzie Shenk
- Cedarville University School of Pharmacy, Cedarville, Ohio
| | - Julie Williams
- Wright State University, School of Professional Psychology, Dayton, Ohio
| | - James Schoen
- Grandview Medical Center, Family Medicine, Dayton, Ohio
| | - Thomas Dunn
- Kettering Physicians Network, Family Medicine, Dayton, Ohio
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Affective and cognitive rather than somatic symptoms of depression predict 3-year mortality in patients on chronic hemodialysis. Sci Rep 2018; 8:5868. [PMID: 29651018 PMCID: PMC5897563 DOI: 10.1038/s41598-018-24267-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 03/27/2018] [Indexed: 12/16/2022] Open
Abstract
Depression is more common in many medical conditions than among the general population and is associated with an increased risk of mortality. We aimed to determine whether somatic symptoms of depression were more predictive of mortality than affective and cognitive symptoms in hemodialysis patients. We conducted a prospective cohort study in which the survival outcomes of 151 subjects were followed for more than 3 years. Depression was assessed with the Taiwanese Depression Questionnaire (TDQ). Subjects with TDQ scores 19–54 (correlated with clinically significant depressive symptoms) and those with scores 15–18 had higher 3-year mortality rates than the two groups with lower scores (40.0%, 46.7%, 16.0% and 19.6%, p = 0.021, ANOVA). Affective and cognitive symptoms, including sadness, tenseness, indecisiveness and low self-confidence, and one somatic item (bodily discomfort) were associated with mortality. Affective and cognitive symptoms affected quality of life more than somatic symptoms. The somatic subscale was associated with female gender, low income and education, dialysis vintage, and low serum creatinine and albumin levels, whereas the affective and cognitive subscale was associated with less education and a low serum albumin level. In conclusion, affective and cognitive symptoms of depression may better predict long-term mortality in patients undergoing chronic hemodialysis than somatic symptoms.
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Association between pro- and anti-inflammatory cytokines and depressive symptoms in patients with diabetes-potential differences by diabetes type and depression scores. Transl Psychiatry 2018; 7:1. [PMID: 29520075 PMCID: PMC5843637 DOI: 10.1038/s41398-017-0009-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Subclinical inflammation has been implicated in the development of depression, a common comorbidity of type 1 diabetes (T1D) and type 2 diabetes (T2D). This study aimed to characterise the relationships between biomarkers of inflammation and depressive symptoms in T1D and T2D. Biomarkers of inflammation were measured in serum of participants with elevated depressive symptoms and T1D (n = 389, mean age 38 years, diabetes duration 15 ± 11 years) or T2D (n = 204, mean age 56 years, diabetes duration 13 ± 8 years). Subclinical depression was examined using three questionnaires (Center for Epidemiologic Studies Depression [CES-D], Patient Health Questionnaire-9 [PHQ-9], 5-item World Health Organization Well-Being Index [WHO-5]). In T1D, levels of interleukin-1 receptor antagonist (IL-1RA) were positively associated with two depression scores (CES-D, PHQ-9), and high-sensitivity C-reactive protein (hsCRP) was positively associated with depression for one score (WHO-5) after adjustment for age, sex, body mass index, diabetes duration, metabolic variables, medication and comorbidities (P = 0.008-0.042). In T2D, IL-18 and IL-1RA were positively associated with depression for two scores (IL-18: PHQ-9, WHO-5; IL-1RA: CES-D, WHO-5), hsCRP was associated with one depression score (PHQ-9), and adiponectin showed an inverse association with one depression score (PHQ-9) after adjustment (P = 0.006-0.048). No associations were found for IL-6 and CC-chemokine ligand 2 (CCL2). In conclusion, we observed associations between hsCRP, IL-1RA and depressive symptoms in patients with diabetes. In T2D, there was additional evidence for associations of IL-18 and (inversely) adiponectin with depressive symptoms. The strength of the associations appeared to depend on diabetes type and the method used to asssess depressive symptoms.
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50
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Yeung RO, Cai JH, Zhang Y, Luk AO, Pan JH, Yin J, Ozaki R, Kong APS, Ma R, So WY, Tsang CC, Lau KP, Fisher E, Goggins W, Oldenburg B, Chan J. Determinants of hospitalization in Chinese patients with type 2 diabetes receiving a peer support intervention and JADE integrated care: the PEARL randomised controlled trial. Clin Diabetes Endocrinol 2018. [PMID: 29541481 PMCID: PMC5842642 DOI: 10.1186/s40842-018-0055-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background In a randomized controlled trial of 628 Chinese patients with type 2 diabetes receiving multidisciplinary care in the Joint Asia Diabetes Evaluation (JADE) Progam, 372 were randomized to receive additional telephone-based peer support (Peer Empowerment And Remote communication Linked by information technology, PEARL) intervention. After 12 months, all-cause hospitalization was reduced by half in the PEARL group especially in those with high Depression Anxiety and Stress Scale (DASS) scores. Methods We used stratified analyses, negative binomial regression, and structural equation modelling (SEM) to examine the inter-relationships between emotions, self-management, cardiometabolic risk factors, and hospitalization. Results Hospitalized patients were older, more likely to have heart or kidney disease, and negative emotions than those without hospitalization. Patients with high DASS score who did not receive peer support had the highest hospitalization rates. After adjustment for confounders, peer support reduced the frequency of hospitalizations by 48% with a relative risk of 0.52 (95% CI 0·35-0·79;p = 0·0018). Using SEM, improvement of negative emotions reduced treatment nonadherence (Est = 0.240, p = 0.034) and hospitalizations (Est=-0.218, p = 0.001). The latter was also reduced by an interactive term of peer support and chronic kidney disease (Est = 0.833, p = < 0.001) and that of peer support and heart disease (Est = 0.455, p = 0.001). Conclusions In type 2 diabetes, improvement of negative emotions and peer support reduced hospitalizations, especially in those with comorbidities, in part mediated through improving treatment nonadherence. Integrating peer support is feasible and adds value to multidisciplinary care, augmented by information technology, especially in patients with comorbidities. Trial registration NCT00950716 Registered July 31, 2009.
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Affiliation(s)
- Roseanne O Yeung
- 1Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, 9-111K Clinical Science Building, 11350 83 Avenue, Edmonton, AB T6G 2G3 Canada.,3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
| | | | - Yuying Zhang
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
| | - Andrea O Luk
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Junmei Yin
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
| | - Risa Ozaki
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
| | - Alice P S Kong
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
| | - Ronald Ma
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
| | - Wing-Yee So
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
| | - Chiu Chi Tsang
- 4Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong
| | - K P Lau
- North District Hospital, Sheung Shui, Hong Kong
| | - Edwin Fisher
- 6University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | | | - Julianna Chan
- 3Chinese University of Hong Kong, Hong Kong, Hong Kong.,Asia Diabetes Foundation, Hong Kong, Hong Kong
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