medwireNews: A bidirectional relationship between depression and severe dysglycemia exists among older people with type 1 diabetes, indicating a need for increased vigilance in this population.
Paola Gilsanz (University of California, San Francisco, USA) and colleagues found that depression is associated with a significantly increased risk for severe hypoglycemic and hyperglycemic events, particularly in the first year after depression diagnosis, while the risk for depression increases significantly after episodes of severe dysglycemia.
“This suggests that there is a critical period shortly after depression diagnosis during which patients are at extremely high risk, and treatment of depression and glucose monitoring may be particularly important for preventing these dangerous episodes,” Gilsanz et al remark.
They reviewed data for 3742 patients aged 50 years and older with type 1 diabetes between 1996 and 2015. At baseline, 20% of patients had depression, defined as major depressive disorder, depressive type psychosis, dysthymic disorder, adjustment disorder with depressed mood or with mixed anxiety and depressed mood, or depressive disorder not otherwise classified.
During the follow-up period, a further 21% developed depression and there were 376 (11%) and 641 (20%) cases of severe hyperglycemia and hypoglycemia, respectively, requiring an emergency room visit or hospitalization.
After adjustment for demographic variables, baseline glycated hemoglobin, and microvascular and macrovascular complications, patients with depression had a significant 2.5-fold increased risk for severe hyperglycemic events and a significant 1.9-fold increased risk for severe hypoglycemic events compared with people without depression.
The researchers found that the risk was highest within the first 6 months after depression diagnosis, with hazard ratios (HRs) of 7.1 and 5.6 for hyperglycemia and hypoglycemia, respectively, but remained elevated for up to 1 year, at HRs of 5.1 and 4.1 respectively.
The risk for severe hyperglycemia remained significantly elevated for more than a year (HR=1.4) but the risk for severe hypoglycemia did not.
Gilsanz and team also report that individuals who did not have depression at baseline had significant 2.4- and 1.7-fold increased risks for developing it after severe hyperglycemic and hypoglycemic events, respectively, when compared with individuals who did not experience these events.
They say: “The bidirectional relationship likely enables a harmful feed-forward cycle, with depression and severe glycemic events increasing the risk of the other.”
Writing in Diabetes Care, the authors conclude: “Understanding the association between severe dysglycemic events and depression is critical to uncovering potential targets of intervention to break the cyclical association between them.”
By Laura Cowen
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