Diabetes, depressive symptoms, and mortality risk in old age: The role of inflammation

Abstract

Background Both diabetes and depression increase the mortality risk in the elderly. In this study, we evaluated mortality risk associated with the comorbidity between depression and diabetes. We also assessed the moderating role of inflammation in the mortality risk in this population. Methods We included a total of 1,183 community‐dwelling older adults, divided into four groups: “neither diabetes nor depression”; “diabetes only”; “depression only,” and “both diabetes and depression,” and followed‐up for a median of 13.5 years. We evaluated the inflammatory status by the high‐sensitivity C‐reactive protein (hs‐CRP) levels. Date of death was computed by reviewing death certificates. We used Cox's proportional hazards models and additive interactions to evaluate the risk of mortality in the subject groups and the moderating effect of hs‐CRP. Results Participants with both diabetes and depression had higher death risk (hazard ratio [HR]: 2.33; 95% confidence interval [CI]: 1.59–3.42) than those with each condition alone (HR diabetes: 2.08 95% CI: 1.56–2.76 HR depression: 1.26; 95% CI: 1.03–1.54). High level of hs‐CRP, indicative of high inflammatory status, significantly moderated the risk of mortality in subjects with both diabetes and depression (Bonferroni‐adjusted p = 0.0116). Conclusions The coexistence of diabetes and depression symptoms is associated with the highest death risk in this population. This risk is moderated by inflammatory status.

Relationships Between Depressive Symptoms, Dietary Inflammatory Potential, and Sarcopenia: Mediation Analyses

“…Additionally, depressive symptoms were significantly associated with sarcopenia in the subgroup with a higher level of DII score in the stratified analyses. Previous studies suggested the moderating effect of inflammation on the association between depression and adverse health outcomes (40), such as all-cause mortality (41), to some certain degree supporting our findings. Due to the relatively small number of participants with sarcopenia affecting the statistical power, stratified analyses did not demonstrate significant association in individuals with the highest tertile of DII.…”

Biomarkers intersection between depression, diabetes, and cognitive impairment

“…Overall, these findings are in line with previous studies from Hispanic and non-Hispanic populations where both depression and diabetes are associated with increased inflammatory and metabolic markers (Diniz et al, 2010(Diniz et al, , 2016Smagula et al, 2016). They also expand recent findings suggesting that insulin resistance is associated with higher depressive symptoms in a predominantly first generation of Mexican American older adults, that higher inflammatory status can significantly increase mortality risk in older adults with depression and diabetes, and that abnormalities in the insulin signaling cascade are related to cognitive impairment in older adults with late-life depression (Castro-Costa et al, 2019;Diniz et al, 2011Diniz et al, , 2018.…”

Increased Levels of Serum Glycosylated Hemoglobin are Associated with Depressive Symptoms in a Population with Cancer (≥49 Years): An Antidepressant-Stratified Analysis

“…Mental health comorbidities including depression are also increasing worldwide and worsen outcomes for population with diabetes. 8,9 As one of the important indexes to evaluate blood glucose levels, the association of glycosylated hemoglobin (GHb) levels with depression is still unclear. GHb is a product of the combination of carbohydrates in serum and hemoglobin in red blood cells.…”