Longitudinale Assoziationen zwischen depressiven Symptomen und Typ-2-Diabetes sowie deren Auswirkung auf die Mortalität von Hausarztpatienten

Abstract

It is unclear whether depressive symptoms are a risk factor for incident diabetes or diabetes is a risk factor for depressive conditions. Therefore, we examined the longitudinal bidirectional associations between depressive symptoms and type 2 diabetes (T2D) as well as the impact of both diseases on (all cause) mortality in a sample of primary care patients over a 3.5-years follow-up period on average. Depressive symptomatology, defined by the Depression Screening Questionnaire (DSQ), was examined both categorically and dimensionally. Patients were categorized as normal fasting glucose (NFG), impaired fasting glucose (IFG), and T2D (untreated, oral antidiabetics, insulin/combined treatment) according to physician ratings and baseline lab values. Incidence rates of T2D were 25.6 and 20.9 per 1000 person-years for those with and without depressive symptoms, respectively. The unadjusted risk of incident type 2 diabetes was 1.03 times higher (CI(95%): 1.01-1.06) for each 1-point increment in DSQ score. The incidence rates of elevated depressive symptoms per 1000 person-years were 30.5 for NFG, 34.2 for IFG, 36.4 for untreated T2D, 32.3 for oral treated T2D, and 47.8 for insulin/combined-treated T2D patients. Compared to NFG patients, insulin-treated patients had a higher risk of incident depressive symptoms (HR: 1.71; CI(95%): 1.03-2.83) and oral-treated patients had a lower risk (HR: 0.58; CI(95%): 0.36-0.96). Higher mortality rates were associated with both diseases compared to patients without T2D or depressive symptoms at baseline (HR: 2.49; CI(95%):1.45-4.28). Results indicate that especially insulin treatment in T2D patients is associated with incident depressive symptoms.

Depression and risk of mortality in individuals with diabetes: a meta-analysis and systematic review

“…Lack of self-care and the psychobiologic changes associated with comorbid depression may explain why individuals with comorbid depression experience increased risk of macro- and micro-vascular complications and dementia. Two publications allowed examination of whether clinical characteristics (such as severity of diabetes and other medical comorbidity) or health risk behaviors potentially mediated the risk of depression on mortality: Lin et al (33) and Pieper et al (37). When clinical characteristics (such as number of diabetes complications) were added to the models that initially only adjusted for demographic characteristics, there was a decrease in point estimates of the HRs.…”

Depression and Risk of Mortality in People with Diabetes Mellitus: A Systematic Review and Meta-Analysis

“…Five studies [11], [18], [19], [20], [21] used the no diabetes, non-depressed group as the reference category, while we were interested in the comparison of the two diabetes groups only (depressed versus non-depressed). Two of these studies [18], [21] performed post hoc analyses in people with diabetes only, producing the desired estimate.…”

The association of hyperglycaemia and insulin resistance with incident depressive symptoms over 4 years of follow-up: The Maastricht Study

“…A recent meta-analysis of prospective studies found an association between prevalent diabetes and incident depression but not between impaired glucose metabolism (IGM) or newly diagnosed type 2 diabetes and incident depression, compared with normal glucose metabolism (NGM) [8]. However, numbers for incident depression with IGM [9][10][11] or newly diagnosed type 2 diabetes were relatively small [10][11][12][13] and thus confidence intervals were large, and all studies used categorical instead of continuous values of glucose metabolism.…”