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

Abstract

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.

Longitudinal associations between depression and diabetes complications: a systematic review and meta‐analysis

“…ORs instead of HRs; for full details, see Table ). In terms of macrovascular complications, the results of two studies supported the findings of the meta‐analysis . Another study found a significantly increased risk only for angina (HR = 1.40; 95% CI: 1.06–1.84), but not for the objective, coronary artery disease (no statistics were provided for the latter).…”

“…Three of the 22 studies examined people with Type 1 diabetes, [23,29,30] nine examined people with Type 2 diabetes, [16][17][18][19][31][32][33][34][35] and 6 examined people with either Type 1 or Type 2 diabetes [36][37][38][39][40][41]. Four studies did not specify the type of diabetes [42][43][44][45].…”

“…Twelve studies quantified the results in terms of Cox proportional HRs, [16][17][18][19][31][32][33]36,38,41,42,45] while others used ORs, [29,30,35,40,43,44] RR [37], or provided regression coefficients [39]. Two papers briefly explained that depression did not increase incident diabetes complications but neither provided numerical data [23,34].…”

Association between diabetes distress and all-cause mortality in Japanese individuals with type 2 diabetes: a prospective cohort study (Diabetes Distress and Care Registry in Tenri [DDCRT 18])

“…However, these studies were limited by their cross-sectional design. One recently published study found that diabetes distress (defined by a PAID score of ≥40) was not associated with worsening HbA 1c levels in individuals with type 2 diabetes [21]. This study was limited by a very short follow-up duration of only 2 years, and further evidence is needed to evaluate an association between diabetes distress and glycaemic control.…”

“…One found that general (not diabetes-specific) distress, as measured by the Mental Health Inventory 5, was associated with a 1.8-fold higher risk of mortality and a 1.7-fold higher risk of having a cardiovascular event in 1533 Swedish individuals with type 2 diabetes during a mean follow-up of 5.4 years [22]. The other prospective study evaluated the association between diabetes-specific distress, measured using PAID, and the subsequent risk of diabetic complications among individuals in the UK, and found that a PAID score of ≥40 was not associated with microvascular and macrovascular complications in individuals with type 2 diabetes during the 2-year follow-up [21]. However, we believe that 2 years is too short a period to evaluate the effect of complications, and further studies are needed to examine the prospective association between diabetes distress and diabetes complications.…”