Diabetes & Depression: Managing Depressive Symptoms Can Improve Blood Sugar Numbers

Diabetes and depression have long been linked. About 12% of those with diabetes have major depression, and about 10 to 20% have minor depression.
What experts have long debated, however, is whether reducing the depression can also help control diabetes.
Now, in a new analysis, German researchers have found that reducing depressive symptoms does indeed translate to better blood glucose control, even increasing the chances of getting to the goal of a hemoglobin A1C under 7.5.1
Explaining the Link
There could be many explanations for why reducing depression helps blood sugar, says study investigator Andreas Schmitt, PhD, a postdoctoral researcher at the Research Institute of the Diabetes Academy Mergentheim in Germany. It could be that the less depressed people are, the better care they take of themselves. And the more depressed, the worse care. "Evidence suggests a behavioral relationship between depression and glycemic control, mediated by impaired diabetes self-management," he tells EndocrineWeb.
"Depression is associated with reduced motivation, reduced activity, suboptimal lifestyle factors such as an unhealthy diet and smoking," he says. "Adherence to diabetes treatment regimen may be reduced."
The link could go the other way, too, he says, with poor diabetes control perhaps triggering depression or worsening it.
Depression is often stressful, of course. Dr. Schmitt says that "under chronic stress conditions, blood glucose levels may vary more strongly and poorer glycemic control can result." Chronic, low-grade inflammation is linked with both stress and depression, and Continue reading

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5 Reasons to See an Endocrinologist If You Have Diabetes

Last fall I didn’t want to go to my endocrinologist because I was worried about the possible results of my latest A1C test. Seemingly 5 pounds heavier than my last visit, I had no interest in being weighed. Although I fully know how important it is to take your blood sugar regularly when you have diabetes, I hadn’t been doing so, and when I did test it, I didn’t like what I saw. There were mornings when I woke to a spike in my glucose or late afternoons when, after skipping lunch, it dropped too low.
If only I had exercised more. Or eaten fewer carbs. Or not stressed out about every little thing. I was ashamed that I hadn’t worked harder. How had I fallen so off track? What would my doctor think of me?
The Benefits of Seeing an Endocrinologist for Diabetes
Of course, endocrinologists who specialize in diabetes care aren’t there to judge patients. Their job is to go over your blood tests, particularly your hemoglobin A1C readings, which tell you the two- to three-month average of your blood sugar level. They’re there to check your feet, to make sure your circulation is healthy; to take your blood pressure; to respond to any problems you may have encountered since the last visit; and to fine-tune your diabetes care.
Despite this knowledge, when it comes to my hesitation to visit my doctor, I have a feeling I’m not alone. But no matter about these worries, Eileen Sturner, manager of diabetes and outpatient nutrition at Abington Jefferson Health in Pennsylvania, has one message for her diabetes patients: Keep the appointment.
“Whether it's the dietitian, the pri Continue reading

Type 2 Diabetes and Comorbid Symptoms of Depression and Anxiety: Longitudinal Associations With Mortality Risk

OBJECTIVE Depression is strongly linked to increased mortality in individuals with type 2 diabetes. Despite high rates of co-occurring anxiety and depression, the risk of death associated with comorbid anxiety in individuals with type 2 diabetes is poorly understood. This study documented the excess mortality risk associated with symptoms of depression and/or anxiety comorbid with type 2 diabetes.
RESEARCH DESIGN AND METHODS Using data for 64,177 Norwegian adults from the second wave of the Nord-Trøndelag Health Study (HUNT2), with linkage to the Norwegian Causes of Death Registry, we assessed all-cause mortality from survey participation in 1995 through to 2013. We used Cox proportional hazards models to examine mortality risk over 18 years associated with type 2 diabetes status and the presence of comorbid affective symptoms at baseline.
RESULTS Three clear patterns emerged from our findings. First, mortality risk in individuals with diabetes increased in the presence of depression or anxiety, or both. Second, mortality risk was lowest for symptoms of anxiety, higher for comorbid depression-anxiety, and highest for depression. Lastly, excess mortality risk associated with depression and anxiety was observed in men with diabetes but not in women. The highest risk of death was observed in men with diabetes and symptoms of depression only (hazard ratio 3.47, 95% CI 1.96, 6.14).
CONCLUSIONS This study provides evidence that symptoms of anxiety affect mortality risk in individuals with type 2 diabetes independently of symptoms of depression, in addition to attenuating the rel Continue reading

40% of American adults will develop type 2 diabetes in their lifetime

In the US, 2 in every 5 adults are expected to develop type 2 diabetes throughout their lifetime. This is according to a new study published in The Lancet Diabetes & Endocrinology.
Type 2 diabetes accounts for 90-95% of all diabetes cases in the US. Onset occurs when the body does not produce enough insulin, or the insulin that is produced does not function properly, causing abnormal blood glucose levels.
Diabetes prevalence has increased in recent years. In 2010, 25.8 million Americans had the condition, and this rose to 29.1 million by 2012.
However, the research team - led by Dr. Edward Gregg, chief of the Epidemiology and Statistics Branch, Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC) - notes that the mortality rate in US populations with and without diabetes has declined.
"The simultaneous changes in incidence and mortality warrant re-examination of lifetime risk of diabetes and life-years lost due to diabetes," say the researchers.
Lifetime risk of type 2 diabetes rises to 40% over 26 years
With this in mind, Dr. Gregg and colleagues analyzed data from the National Health Interview Survey (NHIS), which disclosed diabetes incidence in the US from 1985 to 2011. In addition, they assessed the death certificates of 598,216 adults.
All information was used to estimate the lifetime risk of diabetes in the US, as well as years of life lost to the condition.
The team found that for an average 20-year-old American, the lifetime risk of developing type 2 diabetes increased from 20% in 1985-89 to 40% in 2000-11 for men, while lifetime Continue reading

Maternal obesity as a risk factor for early childhood type 1 diabetes: a nationwide, prospective, population-based case–control study

Abstract
Genetic and environmental factors are believed to cause type 1 diabetes. The aim of this study was to investigate the influence of maternal BMI and gestational weight gain on the subsequent risk of childhood type 1 diabetes.
Children in the Swedish National Quality Register for Diabetes in Children were matched with control children from the Swedish Medical Birth Register. Children were included whose mothers had data available on BMI in early pregnancy and gestational weight gain, giving a total of 16,179 individuals: 3231 children with type 1 diabetes and 12,948 control children.
Mothers of children with type 1 diabetes were more likely to be obese (9% [n = 292/3231] vs 7.7% [n = 991/12,948]; p = 0.02) and/or have diabetes themselves (2.8% [n = 90/3231] vs 0.8% [n = 108/12,948]; p < 0.001) compared with mothers of control children. Gestational weight gain did not differ significantly between the two groups of mothers. In mothers without diabetes, maternal obesity was a significant risk factor for type 1 diabetes in the offspring (p = 0.04). A child had an increased risk of developing type 1 diabetes if the mother had been obese in early pregnancy (crude OR 1.20; 95% CI 1.05, 1.38; adjusted OR 1.18; 95% CI 1.02, 1.36). Among children with type 1 diabetes (n = 3231) there was a difference (p < 0.001) in age at onset in relation to the mother’s BMI. Among children in the oldest age group (15–19 years), there were more mothers who had been underweight during pregnancy, while in the youngest age group (0–4 years) the pattern was reversed.
Maternal obesity, in th Continue reading