Association of Depressive Symptoms and Diabetes Distress With Severe Hypoglycemia in Adults With Type 2 Diabetes

OBJECTIVES

To examine the association of depressive symptoms (DS) and diabetes-related distress (DD) with severe hypoglycemia (SH) in adults with type 2 diabetes.

METHODS

Baseline data from a cohort study of adults with type 2 diabetes (N=2,040) were used. The Patient Health Questionnaire 8-items and Problem Areas in Diabetes 5-items questionnaires were used to assess DS and DD, respectively. SH was defined as a positive report of "calling an ambulance or visiting an emergency department because of hypoglycemia in the past year." Composite dummy variables for the 2 stratification levels of DS and DD were computed and used in multivariable logistic regression analyses.

RESULTS

Participants had a mean (± SD) age of 64±11 years, and 45% were female. The average duration of diabetes was 12±9 years; 3% had moderate to severe DS, 8% had moderate to severe DD and 5% had moderate to severe levels of both symptoms. Only 4.2% of participants reported experiencing SH in the past year. The presence of any level of DD (adjusted OR 2.3; 95% CI 1.3, 3.9) or moderate to severe DD (2.2; 1.1, 4.2) was associated with increased risk for SH. Combinations of any levels of DD and DS (4.3; 2.5, 7.3) and moderate to severe DD and DS (2.3; 1.1, 4.8) were associated with increased risk for SH. The presence of any level of DS alone (1.2; 0.3, 4.9) or moderate to severe DS (1.7; 0.6, 5.1) was not associated with increased risk for SH.

CONCLUSIONS

Patients with type 2 diabetes and symptoms of depression, but not diabetes-related distress alone, were more likely to experience SH than those without either of these symptoms.

Associations Between Depressive Symptoms and Indices of Obesity in Adults With Prediabetes and Normal Blood Glucose Levels: Results From the Emotional Health and Wellbeing Study

OBJECTIVES

This study describes associations between depressive symptoms and indices of obesity in a community sample of adults with prediabetes. The strengths of these associations were compared to those observed in individuals with normal blood glucose levels.

METHODS

Cross-sectional data came from the baseline assessment of the Emotional Health and Wellbeing Study. Participants were classified as meeting the American Diabetes Association criteria for prediabetes (n=1,152) or normal blood glucose levels (n=1,567). Indices of obesity included body mass index, waist circumference and fat mass index.

RESULTS

After adjusting for sociodemographic covariates, greater depressive symptoms were associated with greater body mass index, waist circumference and fat mass index. These associations were stronger in participants with prediabetes compared to participants with normal blood glucose levels. The pattern of results observed for body mass index and waist circumference held after controlling for self-reported fruit and vegetable consumption, physical activity and sedentary time, but the strength of the interaction was attenuated for fat mass index.

CONCLUSIONS

Depressive symptoms were more strongly associated with indices of obesity in people with prediabetes than in people with normal blood glucose levels. Depressive symptoms may be a barrier to weight management in people with prediabetes.