Association of Depression With Increased Risk of Severe Hypoglycemic Episodes in Patients With Diabetes

Katon, Wayne; Young, Bessie A.; Russo, Joan; Lin, Elizabeth; Ciechanowski, Paul; Ludman, Evette; Korff, Michael R. Von

doi:10.1370/afm.1501

Cited by 74 publications

(63 citation statements)

References 29 publications

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“…For adults with comorbid type 2 diabetes, there are the added concerns that depression relates to poorer self-care, poorer glycemic control, serious negative health outcomes, and higher healthcare costs (7)(8)(9)(10)(11)(12)(13)(14). Depression treatment for diabetic patients can result in improved mental health, but the evidence is less clear that intervention will lead to improved glycemic control or improvement in other diabetesrelated outcomes (32,33), although interventions that integrate both depression and diabetes treatment appear to hold promise (34,35).…”

Section: Discussionmentioning

confidence: 99%

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Depression in Adults in the T1D Exchange Clinic Registry

et al. 2014

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OBJECTIVELittle is known about the frequency of depression in adults with type 1 diabetes (T1D) or its relationship to diabetes outcomes. The T1D Exchange clinic registry allowed us to explore depression in a large, heterogeneous sample. RESEARCH DESIGN AND METHODSParticipants ‡18 years old (N = 6,172; median age 34 years; median diabetes duration 16 years; 55% female; and 89% non-Hispanic white) completed the eight-item Patient Health Questionnaire (PHQ-8), a validated, reliable measure of current depression. Probable major depression was defined in four ways: PHQ-8 ‡10, PHQ-8 ‡12, per diagnostic algorithm, and as a continuous variable. Characteristics and clinical outcomes of those with and without depression were compared using logistic and linear regression models. RESULTSA total of 4.6-10.3% of participants were classified as probable major depression depending on how defined. Participants classified as depressed were more likely female, nonwhite race/ethnicity, to have a lower household income and lower education level, to exercise less often, to miss insulin doses, and to have one or more complications (neuropathy, nephropathy, treatment for retinopathy, or cardiovascular/cerebrovascular disease) (all P < 0.01). HbA 1c was higher in the depressed versus not depressed groups (8.4 6 1.7% [68 6 8.6 mmol/mol] vs. 7.8 6 1.4% [62 6 15.3 mmol/mol]; P < 0.001). Occurrence of one or more diabetic ketoacidosis events (11 vs. 4%; P < 0.001) and one or more severe hypoglycemic events (18 vs. 9%; P < 0.001) in the past 3 months was higher among depressed participants. CONCLUSIONSIn the T1D Exchange clinic registry, adults with probable major depression have worse clinical outcomes than those not depressed. Whether identification and treatment of depression improves diabetes outcomes requires study. Depression is common in T1D, and better identification and treatment of this comorbid condition is needed.The prevalence of depression is almost two times higher in persons with diabetes than it is in the general population (1-3). Not only do persons with diabetes have an increased risk of developing depression (4), but persons with depression have an increased risk of developing diabetes (5), which may relate to their use of antidepressants (6) or other biological or psychosocial factors associated with diabetes. Depression in diabetes is a particular concern because it is associated with poorer glycemic control (7) and regimen adherence (8), greater morbidity and mortality

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Section: Discussionmentioning

confidence: 99%

“…, greater risk of severe hypoglycemia (SH) (12), higher healthcare costs (13,14), and poorer quality of life (15). Most studies and meta-analyses include only people with type 2 diabetes or combine type 1 and type 2 diabetic participants without reporting data separately for each group.…”

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confidence: 99%

Depression in Adults in the T1D Exchange Clinic Registry

et al. 2014

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“…4 T2DM is linked to an increased prevalence of mental health problems, primarily depression and anxiety disorders. [5][6][7][8][9] Individuals with T2DM and a mental health condition are at increased risk for hyperglycemia, 10,11 diabetic complications, 12 coronary heart disease, 13 poor quality of life, 12,14 and increased health care costs 15 when compared to those with diabetes alone.…”

Section: Introduction Disparitiesmentioning

confidence: 99%

Anxiety and diabetes: Innovative approaches to management in primary care

Bickett

Tapp

2016

Exp Biol Med (Maywood)

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Type 2 diabetes mellitus is a chief concern for patients, healthcare providers, and health care systems in America, and around the globe. Individuals with type 2 diabetes mellitus exhibit clinical and subclinical symptoms of anxiety more frequently than people without diabetes. Anxiety is traditionally associated with poor metabolic outcomes and increased medical complications among those with type 2 diabetes mellitus. Collaborative care models have been utilized in the multidisciplinary treatment of mental health problems and chronic disease, and have demonstrated success in managing the pathology of depression which often accompanies diabetes. However, no specific treatment model has been published that links the treatment of anxiety to the treatment of type 2 diabetes mellitus. Given the success of collaborative care models in treating depression associated with diabetes, and anxiety unrelated to chronic disease, it is possible that the collaborative care treatment of primary care patients who suffer from both anxiety and diabetes could be met with the same success. The key issue is determining how to implement and sustain these models in practice. This review summarizes the proposed link between anxiety and diabetes, and offers an innovative and evidence-based collaborative care model for anxiety and diabetes in primary care.

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“…12 Katon and colleagues prospectively examine the association of depression with risk of hypoglycemic episodes requiring either an emergency department visit or hospitalization among a large sample of people with diabetes. 13 The fi ndings call for attention to the conjoint effect of these comorbid conditions on this important outcome.…”

Section: Other Interesting Research In This Issuementioning

confidence: 99%

In This Issue: Practice Change--Context Matters

Stange¹

2013

The Annals of Family Medicine

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Association of Depression With Increased Risk of Severe Hypoglycemic Episodes in Patients With Diabetes

Cited by 74 publications

References 29 publications

Depression in Adults in the T1D Exchange Clinic Registry

Depression in Adults in the T1D Exchange Clinic Registry

Anxiety and diabetes: Innovative approaches to management in primary care

In This Issue: Practice Change--Context Matters

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