Depression, anxiety, and diabetes-related distress in type 2 diabetes in primary care in Greece: Different roles for glycemic control and self-care

Abstract

Objectives: The psychological distress of people living with diabetes is increased and associated with poorer glycemic outcomes and self-care. We aimed to examine the frequency of depression, anxiety, and diabetes-related distress (DRD) of individuals with type 2 diabetes (T2D) in primary care (PC) and their comparative associations with clinical, self-care, and socio-demographic characteristics, testing for possible different roles on glycemic control and self-care. Methods: This is a cross-sectional study of 182 adults with a T2D diagnosis of at least six months, recruited between August 2019-March 2020 and May-October 2020, from an urban PC unit. Participants were screened for symptoms of depression (Patient Health Questionnaire-9 (PHQ-9)), anxiety (Generalized Anxiety Disorder-7 (GAD-7)), and DRD (Diabetes Distress Scale (DDS)). Clinical, self-care, and socio-demographic parameters were recorded. Results: The frequency of clinically significant symptoms of depression was 16.6%, (PHQ-9 score ⩾10), anxiety 17.7% (GAD-7 score ⩾10), and DRD 22.6% (DDS score ⩾2). All PHQ-9, GAD-7, and DDS scores intercorrelated, and higher scores were found to be associated with female gender, lower income, and prior diagnosis of depression. Higher PHQ-9 and GAD-7 scores were found to be associated with lower education, more hypoglycemia episodes, more blood glucose self-tests and antidepressant or benzodiazepine use. The retired/housewives scored significantly lower in GAD-7 and DDS compared to the unemployed participants. Higher DDS scores were associated with higher glycated hemoglobin, higher fasting plasma glucose, and insulin use. It was also noted that higher PHQ-9 scores were associated with lower uric acid levels and were significantly higher in the sedentary lifestyle group. Conclusion: DRD was associated with poorer glycemic outcomes while depressive symptoms were associated with lower physical activity perhaps sharing different roles for glycemic control and self-care. The psychological burden of individuals with T2D may be considered in PC.

The use of nomogram for detecting mild cognitive impairment in patients with type 2 diabetes mellitus

“…Therefore, special attention should be paid to those with diabetic retinopathy in the clinical practice. Anxiety and depression are two of the most common mental health concerns among T2DM patients, [59][60][61] and prior studies have linked these conditions to worse cognitive function. 25,62 For example, a recent systematic review and meta-analysis involving 10 eligible studies showed that depression was associated with worse cognitive function and greater dementia risk.…”

A cukorbetegség szövődményeinek összefüggése a depressziós és szorongásos tünetekkel

“…Többváltozós lineáris regressziós analízist végeztünk a BDI és a HAM-A függő változók és a diabeteses szövődmények kapcsolatának vizsgálatára [20]. A diabeteses szövődmények mellett a nemet és az életkort, illetve a BDI-re és a HAM-A-ra ismerten hatással bíró változókat használtuk kovariánsként (BMI, lakóhely, végzettség, inzulinkezelés) [21][22][23][24][25][26][27].…”

“…Többváltozós analízis alapján a női nem, a lakóhely, a végzettség és a szövődmények jelenléte bizonyult a HAM-A-pontszám független meghatározójának. Hasonló eredményre jutott egy nemrég megjelent görög keresztmetszeti vizsgálat, amely a női nem, az alacsony végzettség és a szorongásos tünetek között talált szignifikáns összefüggést 2-es típusú cukorbetegek körében [24]. A lakóhely és a szorongás közti összefüggést támasztotta alá egy másik keresztmetszeti vizsgálat, amelyben a szorongásos zavarok alacsony prevalenciája volt jellemző a városi területeken [25].…”

Differences and similarities in the experience of living with diabetes distress: A qualitative study of adults with type 1 and type 2 diabetes

“…1 DD is not a psychiatric disorder, and it is not a proxy for depression or anxiety, 1 although it is correlated with both depression and anxiety. 2,3 The prevalence of DD varies by population and geography, but two meta-analyses estimate that 22% 4 to 36% 5 of people with diabetes report high levels of DD. Clinically, high levels of DD are associated with fewer selfcare behaviours, 6 higher glycated haemoglobin (HbA1c) levels, 6 increased complications, 7 and lower quality of life (QOL).…”

“…It encompasses a person's worries, concerns, and fears about living with a demanding, progressive chronic illness 1 . DD is not a psychiatric disorder, and it is not a proxy for depression or anxiety, 1 although it is correlated with both depression and anxiety 2,3 . The prevalence of DD varies by population and geography, but two meta‐analyses estimate that 22% 4 to 36% 5 of people with diabetes report high levels of DD.…”