Depression link with macrovascular complications after type 2 diabetes diagnosis
medwireNews: UK research suggests that depressive symptoms have little impact on glycemic control in patients recently diagnosed with type 2 diabetes, but could be linked to macrovascular complications.
The researchers admit that the latter finding may reflect pre-existing vulnerability to cardiovascular disease, but speculate that “depression is also a proxy marker for future cardiovascular risk.”
The findings come from 1735 people in primary care who were recruited to the South London Diabetes (SOUL-D) study within 6 months of being diagnosed with type 2 diabetes.
Of these individuals, 1651 (95.2%) had available baseline scores for both the Patient Health Questionnaire (PHQ)-9 to assess depressive symptoms, and the Problem Areas in Diabetes (PAID) scale to assess diabetes distress. The participants were aged 56.2 years on average, 55.1% were men, and 49.1% were non-White.
Khalida Ismail (King’s College London, UK) and colleagues report in Diabetologia that 14.1% of the group had depressive symptoms, defined as a PHQ-9 score of at least 10, and 6.7% had diabetic distress, identified by a PAID score of at least 40.
Neither depressive symptoms nor diabetes distress were associated with the primary outcome of worsening glycated hemoglobin levels at 2 years, after adjusting for potential confounders, nor were they associated with the secondary outcome of microvascular complications.
But depressive symptoms were associated with the secondary outcome of incident macrovascular complications, including myocardial infarction (MI), coronary artery bypass graft (CABG), stroke, or carotid/limb revascularization or amputation, which occurred in 40 individuals.
This association remained significant, with an odds ratio of 2.78, after adjusting for age, gender, ethnicity, vascular risk factors, and diabetes treatments.
And it was mainly explained by incident MI, although the researchers acknowledge that the number of these was low, with MI or CABG occurring in 24 participants.
The link between depressive symptoms and macrovascular complications attenuated after adjustment for baseline serum concentrations of the inflammatory cytokine interleukin-1 receptor antagonist “pointing towards a possible inflammatory mechanism,” the researchers suggest.
They maintain: “Intervention studies that would allow testing of the directionality of the association between depressive symptoms, inflammation and biomedical outcomes are needed.”
By Anita Chakraverty
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