Association of depression and anxiety with diabetes mellitus type 2 concerning some sociological factors

The modulatory effects of tyrosol and nano-tyrosol on anxiety-like behavior and emotional memory in streptozotocin-induced diabetic rats

The effects of tyrosol and nano-tyrosol on the modulation of anxiety-like behavior and memory processes were evaluated in streptozotocin-induced diabetic rats. Male diabetic rats were orally treated with 1 ml of saline, nano-niosome, tyrosol, and nano-tyrosol (20 mg/dl) for 30 days. Anxiety-like behavior and memory process were evaluated by an elevated plus-maze (EPM) test-retest paradigm. The results showed that a single intraperitoneal (i.p.) administration of streptozotocin (50 mg/kg) raised blood glucose. While daily intragastric administration of tyrosol and nano-tyrosol reduced blood glucose. Induction of type II diabetes produced a distorted cellular arrangement whereas treatment with tyrosol and nano-tyrosol showed a typical cellular arrangement in the liver. Furthermore, induction of type II diabetes decreased %OAT (%open-arm time) but daily intragastric application of tyrosol (20 mg/dl) and nano-tyrosol (20 mg/dl) enhanced %OAT and %OAE (%open-arm entry) in the EPM when compared to the saline groups, showing anxiogenic- and anxiolytic-like effects, respectively. Also, induction of type II diabetes increased %OAT while daily intragastric administration of tyrosol (20 mg/dl) and nano-tyrosol (20 mg/dl) decreased %OAT and %OAE in the EPM in comparison to the saline groups, displaying impairment and improvement of emotional memory, respectively. Interestingly, nano-tyrosol exhibited the highest significant effect rather than tyrosol. Upon these results, we proposed the beneficial effects of tyrosol and nano-tyrosol on the modulation of anxiety-like behavior and memory processes in streptozotocin-induced diabetic rats.

Depression literacy, mental health literacy, and their relationship with psychological status and quality of life in patients with type 2 diabetes mellitus

Background

This study was conducted to measure depression literacy (D-Lit) and mental health literacy (MHL) and to investigate their relationship with psychological status and quality of life among Iranian patients with type 2 diabetes mellitus (T2DM).

Methods

This cross-sectional study was conducted in 2021 among 400 patients with T2DM in Iran. Samples were selected using proportional stratified sampling. Data collection tools comprised a demographic questionnaire, measures of MHL and D-Lit, the diabetes quality of life (DQOL) scale, and the DASS-21. After confirming the normality of the data using the Kolmogorov-Smirnov test, parametric statistical tests (such as one-way ANOVA, independent samples t-test, and Chi-Square) were used to investigate the relationship between the variables using SPSS v22 software. The results of continuous quantitative data are reported in the form of means and standard deviations, and qualitative data are reported in the form of absolute and relative frequencies.

Results

In this study, 10.25% of the participants (n = 41) had severe depression, while 36.75% (n = 147) experienced severe anxiety. The mean (standard deviation) of MHL was 80.92 (9.16) from 130 points. Of the participants, only 1.7% (n = 7) did not answer any questions correctly on the D-lit scale, and only 5.8% (n = 23) were able to answer 15 questions or more correctly on the D-lit. MHL had a significant negative correlation with depression (r = -0.236), anxiety (r = -0.243), and stress (r = -0.155) (P < 0.001). There was a positive and significant correlation between MHL and D-Lit (r = 0.186) (P < 0.001). D-Lit had a significant negative correlation with depression (r = -0.192), anxiety (r = -0.238), and stress (r = -0.156) (P < 0.001). There was a positive and significant correlation between the ability to recognize disorders (r = 0.163), knowledge of self-treatment (r = 0.154), and DQOL (P < 0.001). Depression (r = -0.251), anxiety (r = -0.257), and stress (r = -0.203) had a significant negative correlation with DQOL (P < 0.001).

Conclusion

MHL and D-Lit levels were found to be inadequate in patients with T2DM. These low levels of MHL and D-Lit among patients with T2DM were associated with higher levels of anxiety, depression, and stress, as well as a lower quality of life. Therefore, designing and implementing preventive programs to improve the mental health of patients with T2DM can help prevent mental disorders and ultimately improve their quality of life.

Determinants of anxiety and depression among type 2 diabetes mellitus patients: A hospital-based study in Bangladesh amid the COVID-19 pandemic

Anxiety and depression are common psychological disorders in patients with type 2 diabetes mellitus (T2DM), which was upsurging worldwide amid the COVID-19 pandemic. This study aimed to explore factors associated with anxiety and depression among T2DM patients in Bangladesh during the COVID-19 pandemic. A cross-sectional study was conducted among T2DM patients using face-to-face interviews. Anxiety and depressive symptoms were measured using the CAS and PHQ-9 scales. Outcomes were assessed including sociodemographic, lifestyle, anthropometric, and challenges of getting routine medical and healthcare access-related questions. The prevalence of anxiety and depressive symptoms were 29.8% and 22.7%, respectively. Regression analysis reported that males older than 50 years, illiterate, unemployed or retired, urban residents, below the recommended level of moderate to vigorous physical activity (MVPA), low dietary diversity score (DDS) and obese respondents were associated with higher odds of anxiety and depressive symptoms. Moreover, respondents with transport difficulties, unaffordable medicine, medicine shortages, close friends or family members diagnosed with COVID-19 and financial problems during COVID-19 had higher odds of anxiety and depressive symptoms than their counterparts, respectively. Our study suggests providing psychological support, such as home-based psychological interventions, and highlighting policy implications to ensure the well-being of T2DM patients in Bangladesh during the pandemic.

Key Nutrients for Optimal Blood Glucose Control and Mental Health in Individuals with Diabetes: A Review of the Evidence

Diabetes is associated with an increased risk of mental disorders, including depression, anxiety, and cognitive decline. Mental disorders can also contribute to the development of diabetes through various mechanisms including increased stress, poor self-care behaviors, and adverse effects on glucose metabolism. Consequently, individuals suffering from either of these conditions frequently experience comorbidity with the other. Nutrition plays an important role in both diabetes and mental health disorders including depression and anxiety. Deficiencies in specific nutrients such as omega-3 fatty acids, vitamin D, B vitamins, zinc, chromium, magnesium, and selenium have been implicated in the pathogenesis of both diabetes and mental disorders. While the impact of nutrition on the progression and control of diabetes and mental disorders is broadly acknowledged, there is a notable knowledge gap concerning the implications of distinct nutrients in preventing and mitigating symptoms of both conditions when they coexist. The aim of this study was to examine the role of nutrition in improving glucose homeostasis and promoting mental well-being among individuals with diabetes. Further, we evaluated the preventive or delaying effects of key nutrients on the simultaneous manifestation of these conditions when one of them is present. Our findings indicated that the use of personalized dietary interventions and targeted nutrient supplementation can improve metabolic and mental health outcomes in patients with type 2 diabetes.

Intra-gastrically administration of Stevia and particularly Nano-Stevia reversed the hyperglycemia, anxiety, and memory impairment in streptozotocin-induced diabetic rats

Type II diabetes mellitus is a group of metabolic disorders considered chronic hyperglycemia resulting from deficits in insulin secretion or insulin function. This disease usually links with various psychological problems such as anxiety and cognitive dysfunctions. Stevia (Stevia rebaudiana Bertoni) is a natural and healthy substitute sweetener for sugar and artificial sweeteners. It has become essential for human diets and food manufacturers. The aim of this research was to investigate the effects of Stevia and Nano-stevia on the regulation of anxiety and memory processes in male diabetic rats. The elevated plus-maze (EPM) test-retest procedure was used to assess anxiety and memory in male diabetic rats. The findings exhibited that induction of diabetes caused a distorted cellular arrangement in the liver tissue of male rats. On the other hand, intra-gastrically administration of Stevia (1 ml/kg) and nano-Stevia (1 ml/kg) indicated a normal appearance in the liver tissue of male diabetic rats. Moreover, induction of diabetes caused the augmentation of blood glucose, reduction in time spent in%open-arm time (%OAT) on the test day, and enhancement of%OAT on the retest day. Therefore, induction of diabetes in rats produced hyperglycemia, anxiogenic effect, and memory impairment and these responses were reversed by drug treatment. Furthermore, intra-gastrically application of Stevia (1 ml/kg) and nano-Stevia (1 ml/kg) reversed the hyperglycemia, anxiogenic effect, and memory impairment in male diabetic rats. Interestingly, Nano-Stevia exhibited the highest significant response rather than Stevia. In conclusion, the results of this research suggested the beneficial properties of Stevia and particularly Nano-Stevia on inducing anti-diabetic effects, anxiolytic behavior, as well as memory improvement in male diabetic rats.

Efficacy of Internet-Based Cognitive Behavioral Therapy for Depression and Anxiety among Global Population during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis of a Randomized Controlled Trial Study

Background: Depression and anxiety have become the most common mental health disorders worldwide during the COVID-19 pandemic, and increasing interest in telemedicine has led to the innovation of using internet-based cognitive behavioral therapy (iCBT). Objective: This systematic review and meta-analysis aimed to evaluate the efficacy of iCBT for depression and anxiety among the global population during the COVID-19 pandemic. Methods: A literature search was conducted on PubMed, Scopus, Cochrane, ProQuest, Wiley, and Web of Science using the PRISMA framework, and only randomized controlled trials (RCTs) were included in the study. A critical appraisal was also performed using Cochrane’s Risk of Bias (RoB) 2. The meta-analysis used random-effects models to analyze pooled mean difference (MD) and its p-value. Results: Twelve RCTs were included for qualitative analysis and nine RCTs, which yielded 6778 patients with depression and 6556 patients with anxiety during the COVID-19 pandemic, were included for quantitative analysis. Despite high heterogeneity, all studies had a low risk of bias. Pre- and post-iCBT intervention in the depression forest plot depicts a significant effect (p < 0.00001) with a pooled MD of 4.73 (95% CI: 4.55−4.90), while the pre- and post-iCBT intervention depicts a significant effect (p < 0.00001) with a pooled MD of 4.50 (95% CI: 4.34−4.67). This demonstrates that iCBT was found to significantly decrease depression and anxiety scores in patients during the COVID-19 pandemic. However, substantial heterogeneity was also found (I2 = 93%; p < 0.00001 and I2 = 90%) for the pre-/post-depression and anxiety forest plots, respectively. Conclusions: This meta-analysis comprises an evidence-based result for iCBT to treat depression and anxiety in the COVID-19 population, as indicated by the significantly lower assessment scores. Delivering iCBT in this situation needs to be considered more extensively, as it has promising results and yields the benefits of technological advancement in psychotherapy.

Assessing the Prevalence of Diabetes Distress and Determining Its Psychosocial Predictors Among Saudi Adults With Type 2 Diabetes: A Cross-Sectional Study

In recent years, the global burden of diabetes distress has increased significantly worldwide, imposing mental health issues on patients and the healthcare system. Hence, this study aimed to estimate the prevalence of diabetes distress and determine its psychosocial predictors among Saudi adults with type 2 diabetes mellitus (T2DM). This cross-sectional, observational study was conducted at Diabetes Clinics, Tertiary Care Academic Medical Center, King Saud University Medical City, Riyadh, Saudi Arabia. The survey questionnaire was distributed to 423 participants. The sample size was 384, where the prevalence of diabetes distress was 48.5%. Based on 5% precision and a confidence interval of 95%, the response rate was 78.25% (334 respondents), among which 61.4% of respondents were females, the remaining 38.6% were males, and the mean age was 56.39 years. The mean scores for the Saudi Arabian Diabetes Distress Scale-17 (SADDS-17) subdomains including emotional burden, physician-related distress, regimen-related distress, and interpersonal distress were 2.63 ± 1.29, 2.31 ± 1.44, 2.48 ± 1.16, and 2.23 ± 1.24, respectively. Based on the World Health Organization Quality of Life Assessment Instrument, Short Version (WHOQOL-BREF) transformed scores, the quality of life was recorded as 62.7%. There was a statistically significant positive correlation between the Hospital Anxiety and Depression Scale (HADS) score (r = 0.287, p < 0.01) and the total SADDS-17 scores. The Patient Health Questionaire (PHQ) 15 scores showed significant positive correlations with the total SADDS-17 scores (r = 0.288, p < 0.01) and each of the four subdomains. Our present study revealed that diabetes distress prevalence is alarmingly high among patients in Saudi Arabia, Riyadh. Our findings provide evidence that physical symptoms, quality of life, depression, and anxiety are the notable predictors of diabetes distress.

Clarification the optimal cut-off values for Persian-language versions of depression screening tools in Iranian patients with type 2 diabetes

INTRODUCTION

Depression is the most common psychiatric disorder in patients with type 2 diabetes. There are many questionnaires to measure depression symptoms. These tools are generally used with the same cut-off points in different medical diseases. The present study investigates the optimal cut-off points of these tools in patients with type 2 diabetes in the Iranian diabetic population. The original version of this tool is prepared in Persian.

METHOD

Two-hundred and forty four patients with a diagnosis of diabetes were selected to participate in the study. The gold standard for diagnosing depression was the Structured Mini-International Neuropsychiatric Interview. We applied the cut-off points of the Persian versions of the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Depression in Diabetes Self-Rating Scale (DDS-RS), Problematic Areas in Diabetes Survey (PAID), Hamilton Depression Rating Scale (HDRS) and Depression in Diabetes Self-Rating Scale (DDS-RS).

RESULTS

23.8% of patients were diagnosed with depression. Depressed patients had higher levels of HbA1c and physical complaints than non-depressed patients. In all tools, the sum of Sensitivity and Specificity of our proposed cut-off points was better than the conventional cut-off points. In HADS, the results showed that this questionnaire performed better and more efficiently than other tools.

CONCLUSION

In patients with type 2 diabetes, it is better to use the proposed cut-off point's specific to this disorder in the Iranian population. These cut-off points have a higher ability to identify depressed and non-depressed cases.

Health-related quality of life and its predictors among the type 2 diabetes population of Bangladesh: A nation-wide cross-sectional study

AIMS/INTRODUCTION

We aimed to assess the health-related quality of life (HRQoL) and identify its predictors among type 2 diabetes patients of Bangladesh.

MATERIALS AND METHODS

This nationwide cross-sectional study assessed HRQoL among 1,806 type 2 diabetes patients using the EuroQol-5 Dimensions Questionnaire (EQ-5D-5L), and the responses were further translated into a single summary crosswalk index score using the UK time trade-off value set. The predictors were determined using multinomial logistic regression analysis.

RESULTS

The mean EQ-5D-5L index score was 0.62 (standard deviation 0.25), and men scored better than women. More than half of the study participants (53.4%) were ranked as "average" HRQoL. Overall, 64% of respondents had a "problem" at least in one of the dimensions of the EQ-5D-5L, and the burden of reported "problems" was higher among women (70%). Among the five dimensions, the highest reported "problem" was 79.8% for anxiety/depression, 77.7% for pain/discomfort and 60.1% for mobility. However, younger participants (aged <30 years) showed a higher burden of anxiety/depression (95%) compared with the rest of the population. The specific predictors of average/good HRQoL (odds ratio >1) were being men, living in a rural area, married, literate, a monthly income >19,488 BDT, absence of comorbidity and had a duration of diabetes ≤5 years.

CONCLUSIONS

The majority of Bangladesh's type 2 diabetes patients had an "average" HRQoL based on the EQ-5D-5L index score. In broad terms, the identified predictors were sex, place of residence, marital status, literacy, monthly income, comorbidity and duration of diabetes.

Induction of anxiolytic, antidepressant and analgesic effects by Shiff base of (E)-3-(1H-imidazol-4-yl)-2-((2-oxoindolin-3-ylidene)amino)propanoic acid derivatives in diabetic rats

Diabetes mellitus is a metabolic disorder with several psychological problems such as anxiety, depression, and pain sense. This study aimed to evaluate the effect of Schiff base on the modulation of anxiety, depression, and pain behaviors in diabetic rats. Anxiety, depression, and pain behaviors were evaluated by elevated plus maze (EPM), forced swim test (FST), and hot-plate test, respectively. The results indicated that induction of diabetes decreased time spent in open arms (OAT) in the EPM whereas injection of insulin (1 ml/kg), glibenclamide (5 mg/kg), and Schiff base II (100 mg/kg) increased OAT in the EPM. So, induction of diabetes in rats caused an anxiogenic effect that this effect reversed by drug treatment. Interestingly, co-treatment of insulin and glibenclamide along with an ineffective dose of Schiff base II potentiated anxiolytic behavior in diabetic rats. Furthermore, induction of diabetes increased immobility time in the FST but administration of insulin (1 ml/kg), glibenclamide (5 mg/kg), and Schiff base II (25, 50, and 100 mg/kg) decreased immobility time in the FST which indicated depressant effect in diabetic rats without drug-treatment and antidepressant effect in diabetic rats with drug-treatment. Additionally, induction of diabetes decreased latency in the hot-plate test while injection of insulin (1 ml/kg), glibenclamide (5 mg/kg), Schiff base I (50 mg/kg), and Schiff base II (25, 50, and 100 mg/kg) enhanced latency in the hot-plate test which revealed hyperalgesic effect in diabetic rats without drug-treatment and analgesic effect in diabetic rats with drug-treatment. Consequently, induction of diabetes-induced anxiogenic, depressant, and hyperalgesia effects that administration of insulin, glibenclamide, Schiff bases I, and II reversed these effects.

The prevalence of comorbid depression in patients with diabetes: A meta-analysis of observational studies

Depression is one of the most common psychiatric disorders in patients with diabetes, which can exacerbate and accelerate adverse diabetes complaints by reducing self-care behaviors and medication adherence. The purpose of this study is to estimate the prevalence of depression in Iranian patients with diabetes. The search was conducted in the databases of Scientific Information Database (SID), MagIran, PubMed, Scopus, Web of Science, and Google Scholar. The following keywords and their possible combinations were used: depressive disorder, major depressive disorder, dysthymic disorder, diabetes mellitus and Iran. Heterogeneity between studies was examined with I². The data were analyzed using the meta-analysis method and random-effects model with Stata version 11.0. The analysis of 37 selected articles with a total sample size of 7849 indicated that the overall prevalence of depression in Iranian patients with diabetes was 54% (95% CI: 47.32-60.70). In addition, the prevalence of depression in women (56.25%; 95% CI: 48.83-63.68) was higher than that of men (41.05%; 95% CI: 32.74-49.36). The results showed that there was no relationship between the prevalence of depression and publication year (0.249), sample size (p = 0.529), and mean age of the subjects (p = 0.330). More than half of the patients with diabetes suffer from depression. Identification and treatment of these patients can be an important step in controlling and delaying the diabetes complication.

Sucrose and saccharin differentially modulate depression and anxiety-like behavior in diabetic mice: exposures and withdrawal effects

RATIONALE

Sugar has addictive potential owing to increase in monoaminergic-transmission at pleasure and reward centers of brain. Insulin dysfunction triggered synaptic monoamine deficit is associated with sugar overeating and craving-related psychological changes in diabetic patients. Sugar-substitute (saccharin) is non-caloric artificial sweetener that may alleviate brain disorders in diabetes.

OBJECTIVES

In present study, effects of sucrose and sugar-substitute (saccharin) exposures and withdrawal on depression and anxiety-like behavior in type 2 diabetic mice were assessed.

METHODS

Swiss albino mice were injected with streptozotocin (135 mg/kg). After induction of diabetes, mice were exposed to a two-bottle water-water, 10% sucrose-water, or 10% saccharin-water choice paradigm for 28 days. Separate groups were employed to assess withdrawal effect of sucrose or saccharin in diabetic mice. Monoamine oxidase (MAO), corticosterone, thiobarbituric acid reactive substances (TBARS), and reduced glutathione (GSH) were quantified after behavioral tests.

RESULTS

Diabetic mice manifested preference towards 10% sucrose or saccharin over water. Sucrose-overeating by diabetic mice amplified symptoms of depression and anxiety; however, withdrawal further exaggerated these behavioral abnormalities. Substitution of sucrose by 10% saccharin attenuated the depressive and anxiety-like behavior in comparison to diabetic mice that were exposed separately to water-water or sucrose-water alone, and with respect to normal mice. Although withdrawal from saccharin resurfaced behavioral anomalies in diabetic mice, however, these were significantly low in comparison with withdrawal from sucrose or normal group. Reinstatement of exposure to saccharin mitigated symptoms of depression and anxiety in diabetic mice.

CONCLUSION

Preference of sucrose overeating augments while saccharin mitigates depressive and anxiety behavior during diabetes.

The prevalence of depression and anxiety in Iranian patients with diabetes mellitus: A systematic review and meta-analysis

INTRODUCTION

This study aims to estimate the prevalence of depression and anxiety among Iranian patients with diabetes mellitus (DM) through meta-analysis.

METHODS

This is a systematic review article based on MOOSE and PRISMA guidelines. Review of the literature was done using databases including Magiran, Barakat Knowledge Network System, SID, RICST, IranDoc, PubMed/Medline, Science Direct, Embase, Scopus, Cochrane Library, Web of Science and the Google Scholar search engine without time limit until December, 2018. Heterogeneity between studies was assessed using Cochran's Q test and I² index. Data were analyzed using Comprehensive Meta-Analysis (CMA) software version 2 according to a random-effects model. P-values less than 0.05 were considered as the significance level.

RESULTS

The analysis consisted of 44 studies including 10,349 Iranian patients with DM. The prevalence of depression was estimated to be 61.8% (95% confidence interval [CI]: 56.6-66.7). The lowest and highest prevalence of depression based on regions was in the North (56.7% [95%CI: 44.9-67.8]) and the East (64.2% [95%CI: 30.7-87.9]), respectively. The depression prevalence in females and males was 63.9% (95%CI: 54.0-72.8) and 46.3% (95%CI: 36.4-56.4), respectively, The prevalence of mild, moderate, severe and highly severe depression was estimated to be 24.4% (95%CI: 21.0-28.2), 19.1% (95%CI: 15.2-23.9), 11.4% (95%CI: 8.6-14.9), and 4.6% (95%CI: 3.4-6.1), respectively. In eight studies, the prevalence of anxiety in Iranian patients with DM was estimated to be 64.5% (95%CI: 42.0-82.1).

CONCLUSIONS

Depression and anxiety are more prevalent among Iranian patients with DM compared with developed countries. Therefore, regular psychiatric consultation is required for the early diagnosis and treatment of depression and anxiety in these patients.

The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies

AIMS

Depression is a common co-morbidity in patients with type 2 diabetes mellitus (T2DM). Untreated depression in these patients adversely affects self-care activities and other diabetes complications. The aim of this study is to estimate the prevalence of depression among patients with T2DM by conducting a meta-analysis of observational studies.

METHODS

MEDLINE, Web of Science, Science Direct, and Google Scholar databases were searched for all observational studies that assessed depression in T2DM. Relevant articles were searched using the combination of Medical Subject Heading (MeSH) terms of "depression", "depressive disorder", and "diabetes mellitus" published between January 2007 and July 2018. Random effects model was used to estimate the weighted prevalence rates and 95% CI using "metaprop program in STATA 11".

RESULTS

In total, the 248 included studies (with 273 reported prevalence) identified 83,020,812 participants; of them, 23,245,827 (28%; 95% CI 27, 29) suffered from different severity levels of depressive disorders. The prevalence of depression was separately reported in 137,372 males and 134,332 females. Of them, 31,396 males (23%, 95% CI: 20, 26) and 45,673 females (34%, 95% CI: 31, 38) were depressed. Compared with global estimate, depression prevalence was lower in Europe (24%) and Africa (27%), but higher in Australia (29%) and Asia (32%). The prevalence in America was equal to the estimated prevalence in the world (28%). Depression was more common in subjects younger than 65 compared with elderlies (31% vs. 21%).

CONCLUSION

Our findings demonstrated that almost one in four adults with T2DM experienced depression. Given the high prevalence of depressive disorders in diabetic patients, screening these patients for co-morbid depression and its relevant risk factors is highly recommended.

Quality of life in patients with type 2 diabetes mellitus: a cross-sectional study

Purpose

The purpose of this paper is to investigate certain social and psychological parameters and to compare them with basic demographic information, such as the gender and the education, of patients suffering from Type 2 diabetes mellitus (T2DM).

Design/methodology/approach

A cross-sectional study of Type 2 diabetic patients was conducted. In total, 200 patients with T2DM were enrolled in the study. Psychological factors were assessed with questionnaires, including the Symptom Checklist 90-R (SCL-90-R), the Short-Form Health Survey (SF-36), the Life Orientation Test-Revised (LOT-R) and the Cardiac Anxiety Questionnaire (CAQ). The associations of psychological with socio-demographic factors were assessed through logistic regression analyses.

Findings

Women patients had higher levels of heart-focused anxiety psychopathology than men, and therefore, women tend to avoid activities that burden the heart. Men patients had a significantly higher index of physical functionality than women. No differences were recorded by the SCL-90R questionnaire between men and women. For the patients with elementary education, lower levels of mental health (SF-36-MCS) were observed.

Originality/value

The chronicity of the disease aggravates the psychopathology of the patients thereby creating adverse impact not only on health but also on efforts for compliance. A personalized approach by the health professionals could contribute in addressing the psychological factors that accompany T2DM.

Physical and psychosocial factors associated with depression among adults with type 2 diabetes mellitus at a Federally Qualified Healthcare Center

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.

The effect of diabetes self-management education on psychological status and blood glucose in newly diagnosed patients with diabetes type 2

OBJECTIVE

The purpose of this study was to evaluate the efficacy of self-management education on psychological outcomes and glycemic control in type 2 diabetes mellitus.

METHODS

Patients were randomly assigned to education group and control group. Education group received professional education and control group received routine outpatient education.

RESULTS

A total of 118 patients were randomly assigned to two groups (education group, n = 63; control group, n = 55). Compared with control group, the anxiety score (36.00 vs. 42.50, P < 0.05) and depression score (35.50 vs. 44.00, P < 0.05) significantly decreased at the sixth month in education group, respectively. Compared with control group, fasting blood glucose (6.78 mmol/L vs. 7.70 mmol/L, P < 0.00), postprandial blood glucose (7.90 mmol/L vs. 10.58 mmol/L, P < 0.00) and glycosylated haemoglobin A1_C level [6.20 (5.80, 6.60)% vs. 6.70 (6.40, 7.30)%, P < 0.01] significantly decreased after the sixth month in education group.

CONCLUSION

The psychological status and blood glucose of patients with diabetes receiving self-management education were significantly improved.

PRACTICE IMPLICATIONS

Type 2 diabetes mellitus has been usually linked to increased prevalence and risk of depression and anxiety, which can affect blood glucose levels. Through education, the mood of newly diagnosed patients with diabetes improved, resulting in better blood glucose control.

The Effect of Religious Belief and Forgiveness on Coping with Diabetes

We aimed to investigate the relationship of religious beliefs and forgiveness in diabetic patients with various sociodemographic characteristics, emotional problems and glycaemic control. The study comprises 100 patients diagnosed with type 2 DM. We used a data collection form, the Scale of Forgiveness and Religiosity (SFR), Problem Areas in Diabetes Scale (PAID), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and the Audit of Diabetes-Dependent Quality of Life (ADDQoL). We also recorded blood glucose and HbA1c test results. A statistically significant relationship was determined only between the scores of the STAI-I and the religious belief scales (r = 0.198, p = 0.049). A statistically significant negative relationship was determined between the forgiveness scale points and the BDI (r = 0.326, p = 0.001), the STAI-II (r = 0.308, p = 0.002) and PAID (r = 0.313, p = 0.001) and a positive correlation with ADDQoL (r = 0.284, p = 0.004). To conclude, forgiveness by patient himself or others reduced the emotional problems which were experienced related to diabetes by reducing stress levels and could increase quality of life.

Adherence to Basal Insulin Therapy Among People with Type 2 Diabetes: A Retrospective Cohort Study of Costs and Patient Outcomes

INTRODUCTION

This research compares costs, resource utilization, and complications between adherent and nonadherent patients over the 3-year period post initiation on basal insulin therapy.

METHODS

The study utilized the US-based Truven Health MarketScan^® Research Databases from 2011 through 2015. Adults aged 18 years or older and identified with type 2 diabetes (T2D) who initiated therapy on basal insulin in 2012 were included. Patients were excluded if they were pregnant, filled their index basal insulin prescription via mail order, or were not continuously insured from 1 year before through 3 years following initiation of treatment with basal insulin. Instrumental variables were used to control for selection bias, and multivariable analyses were used to examine the associations between adherence to basal insulin therapy and costs, resource utilization, and acute complications.

RESULTS

A total of 21,363 individuals were included in the study. Three years after initiating therapy on basal insulin, patients who were adherent over time to basal insulin treatment therapy (33.8% of patients) had significantly higher diabetes-related drug costs. However, patients' adherence was associated with significantly lower diabetes-related outpatient, acute care, and total costs. Results for all-cause costs were similar. Adherent patients also had significantly fewer all-cause and diabetes-related hospitalizations and emergency room visits and were significantly less likely to be diagnosed with an acute complication.

CONCLUSIONS

Results of this study illustrate that despite higher drug costs, there are disease-specific and all-cause cost offsets and improved patient outcomes associated with adherence to basal insulin therapy for people with T2D.

FUNDING

Eli Lilly and Company.

A randomized controlled trial on the efficacy of resistant dextrin, as functional food, in women with type 2 diabetes: Targeting the hypothalamic-pituitary-adrenal axis and immune system

OBJECTIVE

The aim of this trial was to determine the efficacy of a resistant dextrin on immune-mediated inflammation and hypothalamic-pituitary-adrenal axis in women with type 2 diabetes mellitus (T2DM).

METHODS

Females (n = 55) with T2DM were randomly allocated into intervention group (n = 30) and control group (n = 25), in which they received 10 g/d of Nutriose^®06 (a resistant dextrin) or maltodextrin for 8 weeks, respectively. Fasting blood samples were taken to measure immune system related parameters like white blood cell count, CD4, CD8, interferon-γ (IFNγ), interleukins (IL12, IL4, IL10), cortisol, tryptophan (TRP), ACTH (Adrenocorticotropic hormone), Kynurenine (KYN) and plasma lipopolysaccharide (LPS) at the beginning and end of trial. Mental health was assessed using general health questionnaire (GHQ) and depression, anxiety and stress scale (DASS).

RESULTS

Resistant dextrin caused a significant decrease in levels of cortisol, KYN, KYN/TRP ratio, IFNγ, IL12, IFNγ/IL10 ratio, LPS, and a significant increase in the monocyte, GHQ, DASS, CD8, IL10, IL4 in the intervention group as compared with baseline. A significant decrease in the level of LPS (-6.20 EU/mL, -17.8%), IFNγ (-0.6 pg/ml, -26.8%), cortisol (-2.6 μg/dl, -20.9%), IFNγ/IL10 ratio (0.01, 10%), GHQ (-5.1, -12.5%), DASS (-10.4, -38.4%), KYN/TRP ratio (6.8, 29.1%), and a significant increase in levels of CD8 (6.4%, 6.1%) and IL10 (2.6 pg/ml, 21.6%) in the intervention group as compared with the control group (P < 0.05). No significant changes were observed in white blood cell count, CD4, CD4/CD8 ratio, ACTH, KYN, TRP, IL4 and IL12 in the intervention group as compared with the control group (P > 0.05).

CONCLUSION

Supplementation of Nutriose^®06 may have beneficial effects on mental health and the immune system response in women with T2DM.

Investigating Factors Associated with Depressive Symptoms of Chronic Kidney Diseases in China with Type 2 Diabetes

Aim. To assess the depressive symptoms status of chronic kidney diseases in Nantong, China, with type 2 diabetes and to identify factors associated with depressive symptoms. Methods. In this cross-sectional analytic study, 210 type 2 diabetic patients were recruited from the Second Affiliated Hospital of Nantong University. Depressive symptoms were assessed with the depression subscale of the Hospital Anxiety and Depression Scale (HAD-D). The quality of life was measured with the RAND 36-Item Health Survey (SF-36). And the independent risk factors of depressive symptoms were assessed by using a stepwise forward model of logistic regression analysis. Results. The mean age of the study subjects was 57.66 years (SD: 11.68). Approximately 21.4% of subjects reported depressive symptoms (n = 45). Forward stepwise logistic regression analysis showed that female gender (P = 0.010), hypertension (P = 0.022), Stage IV (P = 0.003), and Stage V (P < 0.001) were significant risk factors for depressive symptoms. The quality of life of individuals with HAD-D score <11 was significantly better compared with individuals with HAD-D score ≥ 11. Conclusions. These results indicate that clinicians should be aware that female patients with chronic kidney diseases with T2DM in their late stage with hypertension are at a marked increased risk of depressive symptoms. Providing optimal care for the psychological health of this population is vital.

Investigating Factors Associated with Depression of Type 2 Diabetic Retinopathy Patients in China

Aims and objectives

To assess the depression status of type 2 diabetic retinopathy patients in Nantong China and to identify factors associated with depression.

Methods

Two hundred and ninety-four patients with type 2 diabetic retinopathy were recruited from the Affiliated Hospital of Nantong University. The severity of DR was measured in the worse eye. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CES-D); the quality of life was measured with the Medical Outcomes Study Short Form 36 (SF-36). The logistic regression analyses were used to identify the independent factors of depression.

Results

The mean age of the study subjects was 57.77 years (SD: 9.64). Approximately 35.7% of subjects reported depressive symptoms (n = 105).Multiple logistic regression analyses showed that female gender (p = 0.014), low monthly income (p = 0.01), poor vision in the better eye (P = 0.002), laser treatment history (p = 0.01) were significant risk factors for depression. The quality of life of individuals with CES-D score<16 was significantly better compared with individuals with CES-D score≥16.

Conclusion

The reported depressive symptoms among type 2 diabetic retinopathy population is higher in Nantong China. Gender, salary, vision acuity and treatment history were important risk factors linked to this disorder in the Chinese type 2 diabetic retinopathy population from Nantong. More attention by medical care personnel needs to be paid to the psychological health of this population.

An application of association rule mining to extract risk pattern for type 2 diabetes using tehran lipid and glucose study database

BACKGROUND

Type 2 diabetes, common and serious global health concern, had an estimated worldwide prevalence of 366 million in 2011, which is expected to rise to 552 million people, by 2030, unless urgent action is taken.

OBJECTIVES

The aim of this study was to identify risk patterns for type 2 diabetes incidence using association rule mining (ARM).

PATIENTS AND METHODS

A population of 6647 individuals without diabetes, aged ≥ 20 years at inclusion, was followed for 10-12 years, to analyze risk patterns for diabetes occurrence. Study variables included demographic and anthropometric characteristics, smoking status, medical and drug history and laboratory measures.

RESULTS

In the case of women, the results showed that impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), in combination with body mass index (BMI) ≥ 30 kg/m(2), family history of diabetes, wrist circumference > 16.5 cm and waist to height ≥ 0.5 can increase the risk for developing diabetes. For men, a combination of IGT, IFG, length of stay in the city (> 40 years), central obesity, total cholesterol to high density lipoprotein ratio ≥ 5.3, low physical activity, chronic kidney disease and wrist circumference > 18.5 cm were identified as risk patterns for diabetes occurrence.

CONCLUSIONS

Our study showed that ARM is a useful approach in determining which combinations of variables or predictors occur together frequently, in people who will develop diabetes. The ARM focuses on joint exposure to different combinations of risk factors, and not the predictors alone.

The bidirectional effects of hypothyroidism and hyperthyroidism on anxiety- and depression-like behaviors in rats

Thyroid hormone disorders have long been linked to depression, but the causal relationship between them remains controversial. To address this question, we established rat models of hypothyroidism using (131)iodine ((131)I) and hyperthyroidism using levothyroxine (LT4). Serum free thyroxine (FT4) and triiodothyronine (FT3) significantly decreased in the hypothyroid of rats with single injections of (131)I (5mCi/kg). These rats exhibited decreased depression-like behaviors in forced swimming test and sucrose preference tests, as well as decreased anxiety-like behaviors in an elevated plus maze. Diminished levels of brain serotonin (5-HT) and increased levels of hippocampal brain-derived neurotrophic factor (BDNF) were found in the hypothyroid rats compared to the control saline-vehicle administered rats. LT4 treatment reversed the decrease in thyroid hormones and depression-like behaviors. In contrast, hyperthyroidism induced by weekly injections of LT4 (15μg/kg) caused a greater than 10-fold increase in serum FT4 and FT3 levels. The hyperthyroid rats exhibited higher anxiety- and depression-like behaviors, higher brain 5-HT level, and lower hippocampal BDNF levels than the controls. Treatment with the antidepressant imipramine (15mg/kg) diminished serum FT4 levels as well as anxiety- and depression-like behaviors in the hyperthyroid rats but led to a further increase in brain 5-HT levels, compared with the controls or the hypothyroid rats. Together, our results suggest that hypothyroidism and hyperthyroidism have bidirectional effects on anxiety- and depression-like behaviors in rats, possibly by modulating hippocampal BDNF levels.

Anxiety, depression, coronary artery disease and diabetes mellitus; an association study in ghaem hospital, iran

BACKGROUND

There is an increasing trend in the prevalence of coronary artery disease (CAD) in Iran.

OBJECTIVES

The present study aimed to investigate the relationship of anxiety, depression, diabetes and coronary artery disease among patients undergoing angiography in Ghaem Hospital, Mashhad, Iran.

PATIENTS AND METHODS

This case-control study was conducted between September 2011 and August 2012 among 200 patients undergoing coronary angiography for symptoms of coronary disease at Ghaem Hospital, Mashhad, Iran. The control group consisted of 697 healthy adults recruited from the individuals who attended the clinic for routine medical checkups or pre-employment examinations. The Beck anxiety and depression inventory scores and fasting blood glucose results were assessed in all the subjects. Data were analyzed using SPSS version 16. P < 0.05 was regarded as statistically significant.

RESULTS

The mean age of patients was 57.52 ± 9.33 years old and for the control group it was 55.35 ± 8.45 years; there was no significant difference between the subjects (P = 0.647) regarding age. There was also no significant difference in gender distribution between the patients and control groups (P = 0.205). There was however a significant difference in anxiety and depression scores between the patients and healthy controls (P < 0.001). There was a significant positive correlation between anxiety score and depression score in both groups when data were analyzed by Pearson test. (P < 0.001, r = 0.604 and r = 0.521). Moreover, there was a significant positive linear correlation between the depression/anxiety scores and fasting blood glucose concentrations in the patients group (r = 0.3, P < 0.001) and a weak negative correlation in the healthy controls (r = -0.096, P < 0.05).

CONCLUSIONS

Depression and anxiety are potentially important factors among patients with angiographically-defined CAD. There appear to be significant associations between glucose tolerance and anxiety and depression in these patients.

Factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia: a descriptive cross-sectional single-centre study

OBJECTIVE

To determine the prevalence and factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia.

DESIGN

Descriptive, cross-sectional single-centre study with universal sampling of all patients with type 2 diabetes.

SETTING

Endocrinology clinic of medical outpatient department in a Malaysian public hospital.

PARTICIPANTS

All 169 patients with type 2 diabetes (men, n=99; women, n=70) aged between 18 and 90 years who acquired follow-up treatment from the endocrinology clinic in the month of September 2013.

MAIN OUTCOME MEASURES

The validated Hospital Anxiety and Depression Scale (HADS), sociodemographic characteristics and clinical health information from patient records.

RESULTS

Of the total 169 patients surveyed, anxiety and depression were found in 53 (31.4%) and 68 (40.3%), respectively. In multivariate analysis, age, ethnicity and ischaemic heart disease were significantly associated with anxiety, while age, ethnicity and monthly household income were significantly associated with depression.

CONCLUSIONS

Sociodemographics and clinical health factors were important correlates of anxiety and depression among patients with diabetes. Integrated psychological and medical care to boost self-determination and confidence in the management of diabetes would catalyse optimal health outcomes among patients with diabetes.