Longitudinal Analysis of Depressive Symptoms and Glycemic Control in Type 2 Diabetes

Aikens, James E.; Perkins, Denise White; Lipton, Bonnie; Piette, John D.

doi:10.2337/dc09-0071

Cited by 75 publications

(63 citation statements)

References 20 publications

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“…16,30], and a number of studies support this hypothesis regarding both outcomes, self-management behaviour [31] and glycaemic control [32][33][34].…”

Section: Accepted Manuscriptmentioning

confidence: 92%

Depression is linked to hyperglycaemia via suboptimal diabetes self-management: A cross-sectional mediation analysis

Schmitt

Reimer

Hermanns

et al. 2017

Journal of Psychosomatic Research

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Depression is linked to hyperglycaemia via suboptimal diabetes self-management: A cross-sectional mediation analysis. The address for the corresponding author was captured as affiliation for all authors. Please check if appropriate. Psr(2016Psr( ), doi: 10.1016Psr( / j.jpsychores.2016 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T 1 Abstract ObjectiveTo analyse if the association between depressive symptoms and hyperglycaemia is mediated by diabetes self-management. Methods430 people with diabetes (57.7% type 1, 42.3% type 2) were cross-sectionally assessed using validated self-report scales for depressive symptoms (Center for ResultsThe hypothesised model of depressive symptoms, diabetes self-management and hyperglycaemia fit the data well for both diabetes types (SRMR ≤ 0.04, TLI ≥ 0.99, CFI > 0.99, RMSEA ≤ 0.02 for both models). In both the type 1 and type 2 diabetes group, higher depressive symptoms were associated with lower self-management (P < 0.001), and lower self-management was associated with higher HbA 1c (P < 0.001).Results indicated that the association between depressive symptoms and hyperglycaemia was significantly mediated by suboptimal diabetes self-management in both type 1 and type 2 diabetes patients (P < 0.001). Significant direct associations ACCEPTED MANUSCRIPTA C C E P T E D M A N U S C R I P T 2 between depressive symptoms and hyperglycaemia, not mediated by selfmanagement, could not be observed. ConclusionsThis study provides good evidence supporting that depression is linked to hyperglycaemia via suboptimal diabetes self-management in both major diabetes types.

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“…16,30], and a number of studies support this hypothesis regarding both outcomes, self-management behaviour [31] and glycaemic control [32][33][34].…”

Section: Accepted Manuscriptmentioning

confidence: 92%

Depression is linked to hyperglycaemia via suboptimal diabetes self-management: A cross-sectional mediation analysis

Schmitt

Reimer

Hermanns

et al. 2017

Journal of Psychosomatic Research

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“…However, pooled data from cross-sectional studies of depressive symptoms and glycaemic control have found only a small effect size (d = 0.17) [8]. From the few prospective studies published, the evidence for an association between depressive symptoms and glycaemic control is also weak [9][10][11][12][13]. While treatments for depressive symptoms usually improve depressive symptoms [14,15], they do not always improve glycaemic control, unless integrated with additional support in diabetes management [16].…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of depressive symptoms and diabetes distress are known to increase with diabetes duration [24,25], an important confounder that limits the interpretation of previous studies of the effects of depression and diabetes distress on self-management and glycaemic control [11,26]. Studying these potential effects at the time of diagnosis of type 2 diabetes is a methodologically robust approach, as there is minimal confounding by long duration of type 2 diabetes and it is an important window of opportunity for interventions.…”

Section: Introductionmentioning

confidence: 99%

The association of depressive symptoms and diabetes distress with glycaemic control and diabetes complications over 2 years in newly diagnosed type 2 diabetes: a prospective cohort study

et al. 2017

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Aims/hypothesis We examined the associations between depressive symptoms and diabetes distress with glycaemic control and diabetes complications over 2 years, after diagnosis of type 2 diabetes. Methods In a multi-ethnic, primary care cohort (n = 1735) of adults, all with recent (<6 months) diagnosis of type 2 diabetes, we measured the associations between depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) and diabetes distress (Problem Areas in Diabetes [PAID] score ≥40), with change in 2 year HbA 1c as the primary outcome and with incident rates of diabetes complications as secondary outcomes. Multivariate models were used to account for potential confounders. Results Of the 1651 participants (95.2%) of the total primary care cohort with available baseline PHQ-9 and PAID scores, mean ± SD age was 56.2 ± 11.1 years, 55.1% were men and 49.1% were of non-white ethnicity; 232 (14.1%) and 111 (6.7%) had depressive symptoms and diabetes distress, respectively. After adjustment for confounders, depressive symptoms were not associated with worsening HbA 1c . After adjustment for age, sex, ethnicity, vascular risk factors and diabetes treatments, depressive symptoms were associated with increased risk of incident macrovascular complications (OR 2.78 [95% CI 1.19,6.49], p = 0.018) but not microvascular complications. This was attenuated (p = 0.09) after adjustment for IL-1 receptor antagonist concentration. Diabetes distress was not associated with worsening HbA 1c or incident complications. Conclusions/interpretation In the first 2 years of type 2 diabetes, the effect of depressive symptoms and diabetes distress on glycaemic control is minimal. There was, however, an association between depressive symptoms and incidence of macrovascular complications. Elevated innate inflammation may be common to both depression and macrovascular diabetes complications, but these findings require replication.

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“…Persons with ITDM are more vulnerable to depression and their depression is more severe than persons with NITDM [15]. This interaction of insulin treatment and depression could result in persons on insulin treatment being more likely to be hospitalized and to stay in the hospital longer for the depression treatment [11][12][13]15]. Future research is needed to examine how insulin treatment impacts depression treatment in this population.…”

Section: Discussionmentioning

confidence: 99%

“…These persons need to closely monitor blood glucose and manage insulin use on a daily basis and are, perhaps, more vulnerable to diabetes-related depression [11][12][13][14], and have worsening depressive symptoms (among those with MDD) [15]. Because of the severity of depression, persons with ITDM may be vulnerable to self-monitoring their blood glucose less frequently than they should [16] and to subsequent diabetes complications [11,15]. Thus, excess costs are very likely to be influenced by the interaction between depression and diabetes treatment mode [17].…”

Section: Introductionmentioning

confidence: 99%

Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008

Shrestha

Zhang

et al. 2013

Diabetes Research and Clinical Practice

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Aim-We aimed at estimating excess medical expenditures associated with major depressive disorder (MDD) among working-age adults diagnosed with diabetes, disaggregated by treatment mode: insulin-treated diabetes (ITDM) or non-insulin-treated diabetes (NITDM).Methods-We analyzed data for over 500,000 individuals with diagnosed diabetes from the 2008 U.S. MarketScan claims database. We grouped diabetic patients first by treatment mode (ITDM or NITDM), then by MDD status (with or without MDD), and finally by whether those with MDD used antidepressant medication. We estimated annual mean excess outpatient, inpatient, prescription drug, and total expenditures using regression models, controlling for demographics, types of health coverage, and comorbidities.Results-Among persons having ITDM, the estimated annual total mean expenditure for those with no MDD (the comparison group) was $19,625. For those with MDD, the expenditures were $12,406 (63%) larger if using antidepressant medication and $7322 (37%) larger if not using antidepressant medication. Among persons having NITDM, the corresponding estimated expenditure for the comparison group was $10,746, the excess expenditures were $10,432 (97%) larger if using antidepressant medication and $5579 (52%) larger if not using antidepressant medication, respectively. Inpatient excess expenditures were the largest of total excess expenditure for those with ITDM and MDD treated with antidepressant medication; for all others with diabetes and MDD, outpatient expenditures were the largest excess expenditure.Conclusions-Among working-age adults with diabetes, MDD was associated with substantial excess medical expenditures. Implementing the effective interventions demonstrated in clinical trials and treatment guidelines recommended by professional organizations might reduce the economic burden of MDD in this population.

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Longitudinal Analysis of Depressive Symptoms and Glycemic Control in Type 2 Diabetes

Cited by 75 publications

References 20 publications

Depression is linked to hyperglycaemia via suboptimal diabetes self-management: A cross-sectional mediation analysis

Depression is linked to hyperglycaemia via suboptimal diabetes self-management: A cross-sectional mediation analysis

The association of depressive symptoms and diabetes distress with glycaemic control and diabetes complications over 2 years in newly diagnosed type 2 diabetes: a prospective cohort study

Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008

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