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Aims To examine the factors that are associated with changes in depression in people with type 2 diabetes living in 12 different countries. Methods People with type 2 diabetes treated in out-patient settings aged 18–65 years underwent a psychiatric assessment to diagnose major depressive disorder (MDD) at baseline and follow-up. At both time points, participants completed the Patient Health Questionnaire (PHQ-9), the WHO five-item Well-being scale (WHO-5) and the Problem Areas in Diabetes (PAID) scale which measures diabetes-related distress. A composite stress score (CSS) (the occurrence of stressful life events and their reported degree of ‘upset’) between baseline and follow-up was calculated. Demographic data and medical record information were collected. Separate regression analyses were conducted with MDD and PHQ-9 scores as the dependent variables. Results In total, there were 7.4% (120) incident cases of MDD with 81.5% (1317) continuing to remain free of a diagnosis of MDD. Univariate analyses demonstrated that those with MDD were more likely to be female, less likely to be physically active, more likely to have diabetes complications at baseline and have higher CSS. Mean scores for the WHO-5, PAID and PHQ-9 were poorer in those with incident MDD compared with those who had never had a diagnosis of MDD. Regression analyses demonstrated that higher PHQ-9, lower WHO-5 scores and greater CSS were significant predictors of incident MDD. Significant predictors of PHQ-9 were baseline PHQ-9 score, WHO-5, PAID and CSS. Conclusion This study demonstrates the importance of psychosocial factors in addition to physiological variables in the development of depressive symptoms and incident MDD in people with type 2 diabetes. Stressful life events, depressive symptoms and diabetes-related distress all play a significant role which has implications for practice. A more holistic approach to care, which recognises the interplay of these psychosocial factors, may help to mitigate their impact on diabetes self-management as well as MDD, thus early screening and treatment for symptoms is recommended.

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Background. Retinal microcirculation disorders can be diagnosed at the early stage of complication development while cerebral circulation disorders and cognitive impairment are diagnosed at a rather late stage, when structural changes develop in the brain of the patients. Most authors have investigated the cognitive function by studying memory, information and operation processing speed not taking into consideration the sensitivity of tests in this group of patients. The relationship between diabetic retinopathy and cognitive impairments has not investigated. The purpose of the present study was to investigate the state of cognitive function in type 2 diabetes patients with diabetic retinopathy and to determine the most sensitive cognitive tests. Material and Methods. The study included 93 patients with type 2 diabetes, aged 50 to 80. The patients were divided into two groups: DR-group and non-DR group. Cognitive function was studied using tests as follow: a "five words" test, Minimental State Examination (MMSE); Frontal Assessment Battery (FAB), a clock drawing test, a "fifteen words" test, the Brixton test, the Trail making test (TMT), Digit span forward and backforward (DSFB), the Verbal fluency test, the Тest symbol and the Stroop color test. Results. The TMT test showed significantly better performance in regard of working memory, memory flexibility, and executive functions in the group of patients without DR as compared to those with retinopathy. Statistically significant impairment of the executive function in patients with DR was confirmed by the Brixton test in comparison with that parameter in non-DR-group. According to the TMT and the Brixton test, patients without DR had better performance of working memory and memory flexibility as well as executive functioning compared to DR patients, which indicates lesions of frontal and prefrontal areas of the brain in those patients with DR. The Brixton test seems to be more sensitive and easy to use for screening the cognitive impairments in patients with diabetes mellitus and DR.

Психічні розлади входять до численних ускладнень у хворих на цукровий діабет (ЦД), які значною мірою погіршують його перебіг. У статті наведено дані міжнародного дослідження та результати, отримані серед пацієнтів України. Мета роботи — вивчити частоту депресивних станів у хворих на ЦД 2-го типу (ЦД2), ґрунтуючись на результатах проведеного дослідження. Матеріал і методи. Для проведення даного спостереження було рандомізовано 190 пацієнтів відповідно до протоколу міжнародного проспективного дослідження International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD). Діагностичними інструментами були адаптовані шкали PHQ‑9, PAID, WHO, MINI‑6, Гамільтона; вимірювання рівня HbA1с, ліпідограми; опрацьовані дані з амбулаторних карт пацієнтів за останні 15 років, збирання анамнезу, проведення загального огляду; консультативні висновки психіатра, ендокринолога, хірурга кабінету діабетичної стопи. На підставі отриманих результатів вирішували питання про доцільність тактики лікування за допомогою заспокійливих, антидепресантів, протитривожних засобів і сеансів психотерапії. Результати. Частка чоловіків у дослідженні становила 39,47%, середня тривалість ЦД2 — 9,3±1,2 року. Депресивні розлади діагностовано в 10,7% пацієнтів, за результатами тестування за шкалою PHQ‑9 (Patient Health Questionnaire) у 12,10% випадків відзначено наявність депресивної симптоматики різного ступеня (рівень PHQ>9). Таким пацієнтам було рекомендовано проведення сеансів психотерапії, медикаментозне лікування антидепресантами та прицільне спостереження психіатром протягом подальшого року. Висновки. Визначено частоту депресивних розладів у пацієнтів із ЦД2.