OBJECTIVE -We assessed whether patients with comorbid minor and major depression and type 2 diabetes had a higher mortality rate over a 3-year period compared with patients with diabetes alone.RESEARCH DESIGN AND METHODS -In a large health maintenance organization (HMO), 4,154 patients with type 2 diabetes were surveyed and followed for up to 3 years. Patients initially filled out a written questionnaire, and HMO-automated diagnostic, laboratory, and pharmacy data and Washington State mortality data were collected to assess diabetes complications and deaths. Cox proportional hazards regression models were used to calculate adjusted hazard ratios of death for each group compared with the reference group.RESULTS -There were 275 (8.3%) deaths in 3,303 patients without depression compared with 48 (13.6%) deaths in 354 patients with minor depression and 59 (11.9%) deaths among 497 patients with major depression. A proportional hazards model with adjustment for age, sex, race/ethnicity, and educational attainment found that compared with the nondepressed group, minor depression was associated with a 1.67-fold increase in mortality (P ϭ 0.003), and major depression was associated with a 2.30-fold increase (P Ͻ 0.0001). In a second model that controlled for multiple potential mediators, both minor and major depression remained significant predictors of mortality.CONCLUSIONS -Among patients with diabetes, both minor and major depression are strongly associated with increased mortality. Further research will be necessary to disentangle causal relationships among depression, behavioral risk factors (adherence to medical regimens), diabetes complications, and mortality. Diabetes Care 28:2668 -2672, 2005P atients with type 2 diabetes have a high prevalence of affective illness, with ϳ11-15% meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for major depression (1). Major depression has been found to be a chronic or recurrent illness in most patients with type 2 diabetes (2). As many as two-thirds of patients with diabetes and major depression have been ill with depression for Ն2 years (2). Over a 5-year period, ϳ80% of patients with major depression and diabetes were found to have had one or more relapses (3).Compared with patients with diabetes alone, patients with depression and diabetes have been shown to have poorer self-management (i.e., following diet, exercise regimens, and checking blood glucose) (4,5) and to have significantly more lapses in refilling oral hypoglycemic, lipid-lowering, and antihypertensive medications (4). Depressed patients with diabetes are also significantly more likely to have three or more cardiac risk factors (i.e., smoking, obesity, sedentary lifestyle, HbA 1c [AIC] Ͼ8.0%) compared with those with diabetes alone (6).A meta-analysis of 27 cross-sectional studies showed that patients with depression and diabetes were significantly more likely to have macrovascular and microvascular complications (7). This association between complications and depression ...

OBJECTIVE -To determine the independent risk factors for coronary artery disease (CAD) in type 1 diabetes by type of CAD at first presentation. RESEARCH DESIGN AND METHODS-This is a historical prospective cohort study of 603 patients with type 1 diabetes diagnosed before 18 years of age between 1950 and 1980. The mean age and duration of diabetes at baseline were 28 (range 8 -47) and 19 years (7-37), respectively, and patients were followed for 10 years. Patients with prevalent CAD were excluded from the study. Electrocardiogram (ECG) ischemia was defined by Minnesota Code (MC) 1.3, 4.1-3, 5.1-3, or 7.1; angina was determined by Pittsburgh Epidemiology of Diabetes Complications (EDC) study physician diagnosis; and hard CAD was determined by angiographic stenosis Ն50%, revascularization procedure, Q waves (MC 1.1-1.2), nonfatal myocardial infarction (MI), or CAD death.RESULTS -A total of 108 incident CAD events occurred during the 10-year follow-up: 17 cases of ECG ischemia, 49 cases of angina, and 42 cases of hard CAD (5 CAD deaths, 25 nonfatal MI or major Q waves, and 12 revascularization or Ն50% stenosis). Blood pressure, lipid levels, inflammatory markers, renal disease, and peripheral vascular disease showed a positive gradient across the groups of no CAD, angina, and hard CAD (P Ͻ 0.01, trend analysis, all variables), although estimated glucose disposal rate (eGDR) and physical activity showed inverse associations (P Ͻ 0.01, trend analysis, both variables). In addition, depressive symptomatology predicted angina (P ϭ 0.016), whereas HbA 1 showed no association with subsequent CAD.CONCLUSIONS -These data suggest that although the standard CAD risk factors are still operative in type 1 diabetes, greater glycemia does not seem to predict future CAD events. In addition, depressive symptomatology predicts angina and insulin resistance (eGDR) predicts hard CAD end points. Diabetes Care 26:1374 -1379, 2003B oth type 1 and type 2 diabetes increase the risk of coronary artery disease (CAD) (1). However, the reasons underlying this are largely unknown, although renal disease (2) and the standard CAD risk factors seem important (3). The role of glycemic control is controversial; two studies (3,4) suggest little relationship to CAD, although others report such an association (5).Although it has been an accepted practice to consider all CAD manifestations together, because they are believed to be linked by the same underlying atherosclerosis, important differences have been noted in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of type 1 diabetes. This study suggested somewhat distinct pathophysiologic mechanisms; for example, depressive symptomatology was more related to morbidity than mortality (3).To further address these issues, risk factors, including glycemic control, for angina, ischemic electrocardiogram (ECG), and hard CAD (myocardial infarction [MI], CAD death, or angiographically proven stenosis) were investigated in this prospective study of type 1 diabetes using, for the first time, the ...

The prevalence of the metabolic syndrome is elevated among women with a history of depression. It is important to better understand the role depression may play in the effort to reduce the prevalence of the metabolic syndrome and its health consequences.