Clinical correlates and metabolic indicators of elevated fasting glucose in overweight/obese Chinese Han patients with first-episode and drug-naive major depressive disorder

Abstract

BackgroundOverweight/obese major depressive disorder (MDD) patients have a high probability of developing glucose metabolism disorders; however, the results are inconsistent due to the confounding variables involved in the studies. The purpose of this study was to explore the prevalence and risk factors for elevated fasting glucose in Chinese Han patients with overweight/obese first-episode and drug naïve (FEDN) MDD.MethodsThe study used a cross-sectional design and recruited 1718 FEDN MDD patients between the ages of 18 and 60 years. Socio-demographic information, anthropometric data, and biochemical parameters were collected. The 17-item Hamilton Assessment Scale for Depression (HAMD), the 14-item Hamilton Anxiety Scale (HAMA), and the Positive and Negative Syndrome Scale (PANSS) positive subscale were used to assess symptoms of all patients.ResultsMDD patients with elevated fasting glucose had higher TSH, TPOAb, TC, TG, LDL-C, systolic and diastolic blood pressure levels than those with normal fasting glucose. Logistic regression analysis showed that age, TSH, TgAb, TPOA, and TG were related factors for elevated fasting glucose, while TSH and combination all these five parameters had the potential to differentiate between patients with elevated fasting glucose and those with normal fasting glucose. Multifactorial regression analysis showed that TSH, TG, and LDL-C were independently associated with elevated fasting glucose.ConclusionOur findings suggest a high prevalence of elevated fasting glucose in overweight/obese FEDN MDD patients. Several clinically relevant factors and metabolic parameters are associated with elevated fasting glucose in overweight/obese FEDN MDD patients.LimitationDue to the cross-sectional design, no causal relationship could be derived.

Incidence and Factors Associated with Hyperglycemia in Patients with First Hospitalization for Major Depression Disorder: A Large Cross-Sectional Sample

“…25,[41][42][43][44][45][46][47][48][49] We also found that the hyperglycemic subgroup had a shorter duration of disease and a lower level of education. However, these did not differ significantly in some other studies, 24,34 which may be related to differences in the study population and for the classification of education level.…”

“… 27 Elevated TSH levels and TG levels are consistent with the results of other studies. 34 , 41 Thyroid hormone function is closely related to glycemia, and elevated TSH levels in particular may cause metabolic abnormalities in MDD patients, including elevated blood glucose, obesity, elevated LDL-C, and metabolic syndrome. 25 , 41 , 42 TSH may cause insulin resistance and glucose dysregulation, where mechanisms include hepatic endoplasmic reticulum stress, 42 , 50 endothelial dysfunction, and inhibition of lipid triglyceride lipase leading to increased TG stores, 51 , 52 among others.…”

“…Similar to the results of existing studies, we found that TG levels were also associated with hyperglycemia in patients. 21 , 34 There is a close relationship between hyperglycemia and hyperlipidemia. 43 , 44 On the one hand, hyperglycemia may lead to elevated lipids through conversion to lipids.…”

“… 55 However, other studies have not found significant differences in the course of disease between first-time or first-treatment MDD patients with elevated glucose and MDD patients with normal glucose. 24 , 34 This variability in outcomes may be related to differences between the enrolled samples. In our study, the patients were all first-time hospitalized MDD patients, 64.83% had received medication prior to admission, and the shorter disease course may be related to acute inflammatory or metabolic reactions associated with the administration of antidepressants.…”

“…24,34,35 In animal and clinical trials, it is found that hyperglycemia may affect patients' mood and behavior by affecting the hippocampus and amygdala, 36,37 the hypothalamus and its nucleus accumbens, 38 the HPA axis, 39 and MDD and hyperglycemic co-morbidity genes. 40 We also observed that waist circumference, other metabolic index levels and blood pressure were also higher in the hyperglycemic group than in the non-hyperglycemic subgroup, which is similar to the results of some previous studies, 21,34 suggesting that the overall metabolic level of patients with comorbid hyperglycemic MDD was disturbed, and interactions between different metabolic disorders have been found. 25,[41][42][43][44][45][46][47][48][49] We also found that the hyperglycemic subgroup had a shorter duration of disease and a lower level of education.…”