diabetestalk.net

Depression And Diabetes A Potentially Lethal Combination

Factors Affecting Clinical Depression In Diabetic Geriatric Population

Factors Affecting Clinical Depression In Diabetic Geriatric Population

Introduction: Diabetes mellitus is a common metabolic disorder affecting about 10% - 25% of the elderly population. The mechanisms, linking diabetes and major depressive disorders are unknown. Obesity is the risk factor for both diabetes mellitus and depression. The goal of this study was to explore if BMI of elderly diabetic patients with depression differed from BMI of the diabetic individuals without depression. Further, we aimed to explore the association of age, gender, health insurance status, ethnicity influence and systolic blood pressure (SBP) and diastolic blood pressure (DBP) with clinical depression in geriatric diabetics. Methods: Nursing home residents were recruited from an outpatient internal medicine clinic in a teaching university setting. After given written consent, patients received Public Health Questionnaire-9 (PHQ-9) in either English or Spanish language. Results: While the clinically depressed diabetic participants did not differ from that of the non-depressed diabetic participants with respect to age (70.6 ± 6.1 vs. 72.1 ± 4.8; p = 0.111), gender (47.2% of males vs. 57.1% of females; p = 0.754), or ethnicity (69% explain vs. 71%, p = 1.000), race did appear to differ in depression status: Caucasian, African-American, and others were respectively 37%, 48%, and 15% vs. 32%, 16%, 52%, p = 0.0003). Neither the BMI (p > 0.499) nor Hemoglobin A1c (p > 0.839) differed between the clinically depressed and non-depressed participants when controlled for these race differences. Conclusion: In our sample, diabetic African Americans are three times more likely to be depressed. Diabetic Caucasians also experience higher rates of clinical depression. However, diabetics with depression did not differ from diabetics without depression with regard to their age Continue reading >>

Input Of Stakeholders On Reducing Depressive Symptoms And Improving Diabetes Outcomes In India: Formative Work For The Integrated Depression And Diabetes Treatment Study

Input Of Stakeholders On Reducing Depressive Symptoms And Improving Diabetes Outcomes In India: Formative Work For The Integrated Depression And Diabetes Treatment Study

Context: Depression and diabetes are highly comorbid, adversely affecting treatment adherence, and resulting in poor outcomes. To improve treatment and outcomes for people dually affected by diabetes and depression in India, we aimed to develop and test an integrated care model. Aims: In the formative phase of this INtegrated DEPrEssioN and Diabetes TreatmENT (INDEPENDENT) study, we sought stakeholder perspectives to inform culturally-sensitive adaptations of the intervention. Settings and Design: At our Delhi, Chennai, and Visakhapatnam sites, we conducted focus groups for patients with diabetes and depression and interviewed health-care workers, family members, and patients. Subjects and Methods: Key informants were asked about experiences with diabetes and depression and for feedback on intervention materials. Analysis: Qualitative data were analyzed using a grounded theory approach. Results: Three major themes emerged that have bearing on adaptation of the proposed intervention: importance of family assistance, concerns regarding patient/family understanding of diabetes, and feedback regarding the proposed intervention (e.g., adequate time needed for implementation; training program, and intervention should address stigma). Conclusions: Based on our findings, the following components would add value when incorporated into the intervention: (1) engaging families in the treatment process, (2) clear/simple written information, (3) clear nonjargon verbal explanations, and (4) coaching to help patients cope with stigma. Continue reading >>

Prevalence Of Diabetes And Depressive Symptomatology And Their Effect On Mortality Risk In Elderly Italians: The Italian Longitudinal Study On Aging

Prevalence Of Diabetes And Depressive Symptomatology And Their Effect On Mortality Risk In Elderly Italians: The Italian Longitudinal Study On Aging

This study assessed the prevalence of depressive symptomatology (DS) in older individuals with diabetes to determine whether diabetes and DS are independent predictors of mortality, and if their coexistence is associated with an increased mortality risk. Analyses were based on data from the Italian Longitudinal Study on Aging (ILSA), a prospective community-based cohort study in which 5632 individuals aged 65–84years were enrolled. The role of diabetes and DS in all-cause mortality was evaluated using the Cox model, adjusted for possible confounders, for four groups: 1) those with neither diabetes nor DS (reference group); 2) those with DS but without diabetes; 3) those with diabetes but no DS; and 4) those with both diabetes and DS. Type 2 diabetes mellitus (T2DM) was present in 13.8% of the participants; they presented with higher baseline rates of DS compared with the non-diabetic controls. During the first follow-up period, participants with DS but not diabetes had a 42% higher risk of all-cause mortality compared with the reference control group (HR=1.42; 95% CI: 1.02–1.96), while participants with diabetes but not DS had an 83% higher risk of death than the reference group (HR=1.83; 95% CI: 1.19–2.80). The risk of death for those with both disorders was more than twice that for the reference group (HR=2.58; 95% CI: 1.55–4.29). Analyses of deaths from baseline to the second follow-up substantially confirmed these results. The prevalence rate of DS is higher in elderly people with diabetes and their coexistence is associated with an increased mortality risk. The full text of this article is available in PDF format. Keywords : Diabetes mellitus, Depressive symptomatology, Elderly, Prevalence, Mortality risk Continue reading >>

The Effect Of Problem Solving And Decision Making Skills On Tendency To Depression And Anxiety In Patients With Type 2 Diabetes

The Effect Of Problem Solving And Decision Making Skills On Tendency To Depression And Anxiety In Patients With Type 2 Diabetes

Background: Diabetes is the most prevalent disease that has involved 177 million people all over the world and, due to this, these patients suffer from depression and anxiety and they should use special methods for controlling the same. The aim of this research is the study of the effect of problem solving and decision making skill on the rate of the tendency to depression and anxiety. Materials and Methods: This research is a quasi-experimental (case-control) study. Statistically, the population of the present study was all diabetic patients of Qaemshahr who were controlled by physicians in 2011-2012. Thirty files were selected randomly from them and divided into two 15 patients' groups (control and subject group) randomly. The measurement tools were Back depression inventory (21 items) and Zank anxiety questionnaire that were distributed among two groups. Then, the subject group participated in eight sessions of teaching problem solving and decision making courses separately, and the second group (control group) did not receive any instruction. Results: Finally, both groups had passed post-test and the data obtained from the questionnaires were studied by variance analysis statistical methods. Conclusion: The results showed that teaching problem solving and decision making skills was very effective in reducing diabetic patients' depression and anxiety and resulted in reducing their depression and anxiety. Table 2: Comparing the changes of variables after the study Continue reading >>

Increased Mortality Risk In Women With Depression And Diabetes Mellitus

Increased Mortality Risk In Women With Depression And Diabetes Mellitus

Context Depression and diabetes mellitus have been associated with an increased risk of all-cause and cardiovascular disease (CVD) mortality. However, data evaluating the joint effects of these 2 conditions on mortality are sparse. Objectives To evaluate the individual and joint effects of depression and diabetes on all-cause and CVD mortality rate. Design Prospective cohort study. Setting The 11 states of the Nurses' Health Study. Participants A total of 78 282 women who participated in the Nurses' Health Study aged 54 to 79 years at baseline in 2000 were followed up until 2006. Depression was defined as having self-reported diagnosed depression, treatment with antidepressant medications, or a score indicating severe depressive symptoms (ie, a 5-item Mental Health Index score ≤52). Self-reported type 2 diabetes was confirmed using a supplementary questionnaire. Main Outcome Measures All-cause and CVD-specific mortality rate. Results During 6 years of follow-up (433 066 person-years), 4654 deaths were documented, including 979 deaths from CVD. Compared with participants without either condition, the age-adjusted relative risks (RRs) (95% confidence interval) for all-cause mortality were 1.76 (1.64-1.89) for women with depression only, 1.71 (1.54-1.89) for individuals with diabetes only, and 3.11 (2.70-3.58) for women with both conditions. The corresponding age-adjusted RRs of CVD mortality were 1.81 (1.54-2.13), 2.67 (2.20-3.23), and 5.38 (4.19-6.91), respectively. These associations were attenuated after multivariate adjustment for other demographic variables, body mass index, smoking status, alcohol intake, physical activity, and major comorbidities (including hypertension, hypercholesterolemia, heart diseases, stroke, and cancer) but remained significant, with the Continue reading >>

Diabetes, Depression And Stress

Diabetes, Depression And Stress

Depression is not generally listed as a complication of diabetes. However, it can be one of the most common and dangerous complications. The rate of depression in diabetics is much higher than in the general population. Diabetics with major depression have a very high rate of recurrent depressive episodes within the following five years. (Lustman et al 1977) A depressed person may not have the energy or motivation to maintain good diabetic management. Depression is frequently associated with unhealthy appetite changes. The suicidal diabetic adolescent has constant access to potentially lethal doses of insulin. At this point in time, it is well accepted that psychological factors and psychiatric conditions can affect the course of medical illnesses. There is some suggestion that the stress of depression itself may lead to hyperglycemia in diabetics. The interaction between cardiovascular disorders (such as heart attack and high blood pressure) and depression has been extensively studied. Anxiety and depression can also affect other conditions including irritable bowel syndrome, headache and skin diseases. Treatment of anxiety and depression may lead to a better medical prognosis and well as a better quality of life. For over three hundred years, physicians have suspected an interaction between the emotions and the course of diabetes mellitus. Studies have examined whether stressful events or psychiatric illness might precipitate either Type I (insulin-dependent) or Type II (Non-insulin dependent) diabetes. So far, study results are not conclusive. Now that we have more accurate methods of measuring glucose control, it has become easier to measure both short-term and long-term effects of emotional factors on blood glucose level. One study found that children judged to hav Continue reading >>

Constructs Of Depression And Distress In Diabetes: Time For An Appraisal

Constructs Of Depression And Distress In Diabetes: Time For An Appraisal

Depression is at least twice as common in people with diabetes as in the general population, but this common comorbidity is frequently underdiagnosed and undertreated. As chronic depression can reduce treatment adherence and worsen glycaemic control, there is a pressing need to improve clinical diagnosis and management of depression in patients with diabetes to minimise the risk of long-term diabetes complications and improve quality of life. This Series of three papers in The Lancet Diabetes & Endocrinology covers definitions of depression in diabetes, bidirectional pathophysiological mechanisms, and challenges to health-care delivery. Read more Continue reading >>

A Novel Herbal Treatment Reduces Depressive-like Behaviors And Increases Brain-derived Neurotrophic Factor Levels In The Brain Of Type 2 Diabetic Rats

A Novel Herbal Treatment Reduces Depressive-like Behaviors And Increases Brain-derived Neurotrophic Factor Levels In The Brain Of Type 2 Diabetic Rats

1Runliang Diabetes Laboratory, Diabetes Research Center, Ningbo University, 2Department of Gynaecology and Obstetrics, Ningbo Medical Center, Li Huili Eastern Hospital, Ningbo, Zhejiang, People’s Republic of China *These authors contributed equally to this work Background: Radix Puerariae and hawthorn fruit have been demonstrated to treat diabetes. They offer potential benefits for preventing depression in diabetes. Objective: The aim of this study was to investigate whether the combination of Radix Puerariae and hawthorn fruit (CRPHF) could prevent depression in a diabetic rat model generated by feeding the rats with a high-fat diet and a low-dose streptozotocin (STZ). Methods: The CRPHF was provided by the Shanghai Chinese Traditional Medical University. Twenty-four rats were randomly divided into four groups: normal control, normal-given-CRPHF (NC), diabetic control, and diabetic-given-CRPHF (DC) groups. The type 2 diabetic model was created by feeding the rats with a high-fat diet for 4 weeks followed by injection of 25 mg/kg STZ. CRPHF was given at 2 g/kg/d to the rats of NC and DC groups by intragastric gavage daily for 4 weeks after the type 2 diabetic model was successfully created. Body weight, random blood glucose (RBG), oral glucose tolerance test, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured during the study. Depressive-like behavior was evaluated at the end of the treatment by using the open field test (OFT), the elevated plus-maze test (EPMT), locomotor activity test (LAT), and forced swimming test (FST). Levels of extracellular signal-regulated protein kinase (ERK) and brain-derived neurotrophic factor (BDNF) in the prefrontal cortex were evaluated Continue reading >>

Psychosocial Intervention For Patients With Type 2 Diabetes Mellitus And Comorbid Depression: A Meta-analysis Of Randomized Controlled Trials

Psychosocial Intervention For Patients With Type 2 Diabetes Mellitus And Comorbid Depression: A Meta-analysis Of Randomized Controlled Trials

Department of Endocrinology and Nephrology, Chongqing Emergency Medical Center, the Fourth People’s Hospital of Chongqing, Chongqing, China Background: The efficacy of psychosocial intervention has been proven in treatment of diabetic patients with depression in some studies. This meta-analysis was conducted to explore the efficacy as well as additional effects of this method during diabetic management in patients with type 2 diabetes mellitus (T2DM) and comorbid depression. Methods: Electronic databases were searched from March 2000 to March 2017 for randomized controlled trials (RCTs) studying the effects of psychosocial intervention on T2DM patients with depression. There was no language limitation. Outcome measurements were symptoms of depression and anxiety, as well as glycemic control. A random effects model was conducted. Results: In total, 31 RCTs composed of 2,616 patients were eligible for this analysis. The psychosocial intervention was effective for depression symptoms with pooled standardized mean difference (SMD) of –1.50 (95% CI =–1.83, –1.18) and anxiety symptoms with SMD of –1.18 (95% CI =–1.50, –0.85). Meanwhile, the additional effects indicated a better improvement of glycemic control, including the fasting blood-glucose with SMD of –0.93 (95% CI =–1.15, –0.71), 2-hour postprandial plasma glucose with SMD of –0.84 (95% CI =–1.13, –0.56), and hemoglobin A1c with SMD of –0.81 (95% CI =–1.10, –0.53). Conclusion: These results demonstrate that the psychosocial intervention is very effective in treating T2DM patients with depression. Keywords: psychosocial intervention, type 2 diabetes mellitus, depression, meta-analysis 1. World Health Organisation [webpage on the Internet]. The top 10 causes of death [cited January 2017]. Continue reading >>

Depression And Treatment Nonadherence In Type 2 Diabetes: Assessment Issues And An Integrative Treatment Approach

Depression And Treatment Nonadherence In Type 2 Diabetes: Assessment Issues And An Integrative Treatment Approach

Abstract Research has found that depression is more common among individuals with diabetes and is associated with worse diabetes outcomes including treatment nonadherence, worse glycemic control, higher risk of diabetes complications, greater functional impairment, and increased risk of mortality. These patterns of association have led to an increase in research investigating the relationship between diabetes and depression. There remain important questions about the relationship between depression and diabetes and an unmet need for treatment approaches that are successful in ameliorating depression and improving diabetes outcomes. The current commentary discusses several conceptual issues related to the measurement of depression in diabetes, argues for the importance of health behavior and treatment adherence in approaching the problem of depression in diabetes, and provides an example of a treatment approach that incorporates the treatment of depression with strategies aimed at improving treatment adherence in order to maximize effects on diabetes outcomes. Continue reading >>

Diabetes, Depression And Death

Diabetes, Depression And Death

Startling statistics are only one reason sufferers should get help and whyresearch into this lethal combination must continue. On the list of deadly diseases in the United States, diabetes ranks fifth. Andfor so many reasons: major killers like heart attack and stroke are among a slewof diabetes' potentially lethal complications. Depression isn't typically cited among them. But it should be. Researchers for one study, published in the June 2005 issue of Diabetes Care,reported that depression increased the risk of mortality in people with diabetesby 30 percent. What's more, separate studies reveal both the odds of developing depression andthe rate of depression is doubled for people who have diabetes to begin with.Published reports also suggest up to one-fourth of all people with diabetessuffer from depressive symptoms. "There is a lot of evidence the connection goes both ways," says Dr. SusanGuzman of the Behavioral Diabetes Institute in San Diego. "Having diabetes makesyou at higher risk for depression and depression makes diabetes worse. It'sreally scary." Diabetes isn't always the first of a duel diagnosis, either. In fact, thereverse is true. Studies suggest depression increases the risk of developingtype 2. When diabetes comes first, it may be a little easier to understand the linkbetween the two chronic illnesses. A diabetes diagnosis, as well as the stressof self-management, is overwhelming at best. In fact, according to a study published in the October 2005 issue of DiabeticMedicine, more than 40 percent of patients with diabetes worldwide reported poorpsychological well-being, with thoughts ranging from fears about the diseaseworsening to worries that diabetes will make it difficult for them to care fortheir families. Posts from people with diabetes, caregivers Continue reading >>

Depression And Diabetes: A Potentially Lethal Combination.

Depression And Diabetes: A Potentially Lethal Combination.

Abstract OBJECTIVE: To assess whether Medicare fee-for-service beneficiaries with depression and diabetes had a higher mortality rate over a 2-year period compared with beneficiaries with diabetes alone. DESIGN: Evidence of depression was based on a physician diagnosis or self-reported prescription of an antidepressant in the year prior to screening, or a score of > or = 3 on the Patient Health Questionnaire two-item questionnaire. Mortality was assessed bi-monthly by checking Medicare claims and eligibility files or from information from telephone contact with the participant's family. Cox proportional hazard regression models were used to calculate adjusted hazard ratios of death in depressed versus nondepressed beneficiaries with diabetes. PARTICIPANTS: A total of 10,704 beneficiaries with diabetes enrolled in a disease management program were surveyed with a health assessment questionnaire and followed over a two-year period. MAIN RESULTS: Comorbid depression in Medicare beneficiaries with diabetes participating in a disease management program was associated with an increased risk for all-cause mortality over a two-year period of approximately 36% to 38%, depending on the definition of depression that was used. No significant increase in rates of cause-specific mortality from macrovascular disease were found in depressed versus nondepressed beneficiaries. CONCLUSION: Among a large Medicare cohort of fee-for-service beneficiaries with diabetes, comorbid depression was associated with an increase in all-cause mortality over a two-year period. Future research will be required to determine whether the increase in mortality associated with depression is due to potential behavioral mediators (i.e., smoking, poor adherence to diet) or physiologic abnormalities (i.e., hypot Continue reading >>

The Interrelationship Between Diabetes And Depression

The Interrelationship Between Diabetes And Depression

Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea. Both diabetes and depression are highly prevalent health problems that have a negative impact on various aspects of health, quality of life, and mortality. It has been well documented that depression is more common among people with diabetes than among the general population. Although the exact nature of the relationship between diabetes and depression is not fully understood, the bidirectional relationship of these two diseases has been suggested.1) A meta-analysis by Mezuk et al.2) showed that depression is associated with a 60% increased risk of type 2 diabetes and type 2 diabetes is associated with 15% increased risk of depression. Depression is associated with biochemical changes including increased activity of counter-regulatory hormones, altered glucose transport function, and increased production of proinflammatory cytokines, which contribute to insulin resistance, beta islet cell dysfunction, and ultimately diabetes. Depression is also associated with unhealthy behaviors including smoking, physical inactivity, and hypercaloric diets, which are risk factors for the development of diabetes. In patients with diabetes, the psychosocial burden of having a chronic illness may result in development of depression.3,4) Comorbid depression in patients with diabetes is related to poor glycemic control, higher severity of diabetic complications, increased risk of cardiovascular diseases, higher functional disability, and higher all-cause mortality.5) In the present issue, Sung et al.6) investigated the relationship between diabetes and depressive symptoms among Korean women using a nationally representative data of Korean. They obtained the data from the fifth Korea Natio Continue reading >>

Diabetes And Depression: Global Perspectives

Diabetes And Depression: Global Perspectives

CAPRELSA can prolong the QT interval in a concentration-dependent manner. Torsades de pointes, ventricular tachycardia and sudden deaths have occurred in patients treated with CAPRELSA Do not start CAPRELSA treatment in patients whose QTcF interval (corrected QT interval, Fridericia) is greater than 450 ms or who have a history of Torsades de pointes, bradyarrhythmias, or uncompensated heart failure. CAPRELSA has not been studied in patients with ventricular arrhythmias or recent myocardial infarction Stop CAPRELSA in patients who develop a QTcF greater than 500 ms until QTcF returns to less than 450 ms. Dosing of CAPRELSA can then be resumed at a reduced dose Because of the risk of QT prolongation, obtain an ECG and serum potassium, calcium, magnesium, and thyroid-stimulating hormone (TSH) at baseline, 2-4 weeks and 8-12 weeks after starting treatment with CAPRELSA, and every 3 months thereafter. Following any dose reduction or interruptions greater than 2 weeks, conduct QT assessments as described above Severe skin reactions (including Stevens-Johnson syndrome and Toxic Epidermal Necrolysis), some leading to death, have occurred in patients treated with CAPRELSA. For severe skin reactions, refer patients for urgent medical advice. Systemic therapies e.g., steroids, may be appropriate in such cases and permanent discontinuation of CAPRELSA is recommended Interstitial lung disease (ILD) or pneumonitis, including fatalities, has occurred in patients treated with CAPRELSA. Interrupt CAPRELSA for acute or worsening pulmonary symptoms and discontinue CAPRELSA if ILD is confirmed Ischemic cerebrovascular events, including fatalities, occurred in patients treated with CAPRELSA. The safety of resumption of CAPRELSA therapy after resolution of an ischemic cerebrovascular event Continue reading >>

1 Department Of Psychosomatic Medicine And Psychotherapy, University Of Giessen, Giessen, Germany, 2 Department Of Psychosomatic Medicine And Psychotherapy,

1 Department Of Psychosomatic Medicine And Psychotherapy, University Of Giessen, Giessen, Germany, 2 Department Of Psychosomatic Medicine And Psychotherapy,

Depression as a Risk Factor for Mortality in Individuals with Diabetes: A Meta-Analysis of Prospective Studies Mareike Hofmann1*, Birgit Köhler1, Falk Leichsenring1, Johannes Kruse1,2 1 Department of Psychosomatic Medicine and Psychotherapy, University of Giessen, Giessen, Germany, 2 Department of Psychosomatic Medicine and Psychotherapy, University of Marburg, Marburg, Germany Abstract Objective: To quantify the impact of depression measured by self-reports and depression measured by clinical interview on all-cause mortality in individuals with diabetes and to analyze the strength of both associations, the influence of covariates, and possible differences between studies assessing self-rated depressive symptoms and those using a clinical interview to measure depression as predictors of mortality. Research Design and Methods: PUBMED and PsycINFO were searched up to July 2013 for prospective studies assessing depression, diabetes and mortality. The pooled hazard ratios were calculated using random-effects models. Results: Sixteen studies met the inclusion criteria. After adjustment for demographic variables depression measured by self- reports was associated with an increased all-cause mortality risk (pooled HR = 2.56, 95% CI 1.89–3.47), and the mortality risk remained high after additional adjustment for diabetes complications (HR = 1.76, 95% CI 1.45–2.14,). Six studies reporting adjusted HRs for depression measured by clinical interviews supported the results of the other models (HR = 1.49, 95% CI 1.15–1.93). Conclusions: Both depression measured by self-report and depression measured by clinical interview have an unfavorable impact on mortality in individuals with diabetes. The results, however, are limited by the heterogeneity of the primary Continue reading >>

More in diabetes