Abstract
Aims
While depression has been linked to serious adverse outcomes in diabetes, associations with glycemic control are not conclusive. Inconsistencies could be due to the complex symptomatology of depression. Aim of this study was to analyze the associations of depressive subtypes with glycemic control in people with type 1 and type 2 diabetes.
Methods
Patients completed the Center for Epidemiological Studies-Depression scale which comprises affective, somatic, and anhedonic symptoms. These subtypes were analyzed in a joint linear regression analysis with glycemic control as a dependent variable. Subtype scores were calculated as mean item scores. Separate analyses for people with type 1 and type 2 diabetes were conducted. All analyses were controlled for demographic and medical confounders.
Results
The sample comprised 604 patients with type 1 and 382 patients with type 2 diabetes. In people with type 1 diabetes, the somatic and affective subtype showed diametrically opposed associations with glycemic control (somatic: β =+0.23, p < .05; affective: β = −0.23, p < .05). Anhedonia was not significantly associated with glycemic control. In people with type 2 diabetes, none of the depressive subtypes was significantly associated with glycemic control.
Conclusions
For people with type 1 diabetes, the distinction of subtypes offered a detailed picture of the associations of depressive symptoms with glycemic control. However, due to the cross-sectional design, inferences about the direction of these associations cannot be made. In clinical practice, instead of focusing on overall depression, healthcare providers should examine the nature of depressive symptoms and how they might be related to having diabetes.
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References
Ali S, Stone MA, Peters JL, Davies MJ, Khunti K (2006) The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med 23(11):1165–1173
Barnard KD, Skinner TC, Peveler R (2006) The prevalence of co-morbid depression in adults with Type 1 diabetes: systematic literature review. Diabet Med 23(4):445–448
Katon W, Fan MY, Unutzer J, Taylor J, Pincus H, Schoenbaum M (2008) Depression and diabetes: a potentially lethal combination. J Gen Internal Med 23(10):1571–1575
Schram MT, Baan CA, Pouwer F (2009) Depression and quality of life in patients with diabetes: a systematic review from the European depression in diabetes (EDID) research consortium. Curr Diabetes Rev 5(2):112–119
Gonzalez JS, Safren SA, Delahanty LM et al (2008) Symptoms of depression prospectively predict poorer self-care in patients with Type 2 diabetes. Diabet Med 25(9):1102–1107
Black SA, Markides KS, Ray LA (2003) Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care 26(10):2822–2828
van Dooren FE, Nefs G, Schram MT, Verhey FR, Denollet J, Pouwer F (2013) Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis. PLoS ONE 8(3):e57058
Lustman PJ, Anderson RJ, Freedland KE, De Groot M, Carney RM, Clouse RE (2000) Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 23(7):934–942
Aikens JE, Perkins DW, Lipton B, Piette JD (2009) Longitudinal analysis of depressive symptoms and glycemic control in type 2 diabetes. Diabetes Care 32(7):1177–1181
Fisher L, Mullan JT, Arean P, Glasgow RE, Hessler D, Masharani U (2010) Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care 33(1):23–28
Asuzu CC, Walker RJ, Williams JS, Egede LE (2016) Pathways for the relationship between diabetes distress, depression, fatalism and glycemic control in adults with type 2 diabetes. J Diabetes Complicat 31(1):169–174
McGrady ME, Laffel L, Drotar D, Repaske D, Hood KK (2009) Depressive symptoms and glycemic control in adolescents with type 1 diabetes mediational role of blood glucose monitoring. Diabetes Care 32(5):804–806
van Bastelaar KM, Pouwer F, Geelhoed-Duijvestijn PH et al (2010) Diabetes-specific emotional distress mediates the association between depressive symptoms and glycaemic control in Type 1 and Type 2 diabetes. Diabet Med 27(7):798–803
Schmitt A, Reimer A, Kulzer B, Haak T, Gahr A, Hermanns N (2015) Negative association between depression and diabetes control only when accompanied by diabetes-specific distress. J Behav Med 38(3):556–564
Baumeister H, Hutter N, Bengel J (2014) Psychological and pharmacological interventions for depression in patients with diabetes mellitus: an abridged Cochrane review. Diabet Med 31(7):773–786
Petrak F, Herpertz S, Albus C et al (2015) Cognitive behavioral therapy versus sertraline in patients with depression and poorly controlled diabetes: the diabetes and depression (DAD) study: a randomized controlled multicenter trial. Diabetes Care 38(5):767–775
Georgiades A, Zucker N, Friedman KE et al (2007) Changes in depressive symptoms and glycemic control in diabetes mellitus. Psychosom Med 69(3):235–241
van der Feltz-Cornelis CM, Nuyen J, Stoop C et al (2010) Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis. Gen Hosp Psychiatry 32(4):380–395
Hermanns N, Schmitt A, Gahr A et al (2015) The effect of a Diabetes-Specific Cognitive Behavioral Treatment Program (DIAMOS) for patients with diabetes and subclinical depression: results of a randomized controlled trial. Diabetes Care 38(4):551–560
Lux V, Kendler KS (2010) Deconstructing major depression: a validation study of the DSM-IV symptomatic criteria. Psychol Med 40(10):1679–1690
de Jonge P (2011) Depression deconstruction lessons from psychosomatic research. J Psychosom Res 71(2):59–60
Nefs G, Pop VJM, Denollet J, Fo Pouwer (2015) Depressive symptom clusters differentially predict cardiovascular hospitalization in people with type 2 diabetes. Psychosomatics 56(6):662–673
Stewart JC, Zielke DJ, Hawkins MAW et al (2012) Depressive symptom clusters and 5-year incidence of coronary artery calcification: the CARDIA study. Circulation 126:410–417
Bot M, Pouwer F, de Jonge P, Tack CJ, Geelhoed-Duijvestijn PH, Snoek FJ (2013) Differential associations between depressive symptoms and glycaemic control in outpatients with diabetes. Diabet Med 30(3):e115–e122
Baechle C, Lange K, Stahl-Pehe A et al (2015) Associations between HbA1c and depressive symptoms in young adults with early-onset type 1 diabetes. Psychoneuroendocrinology 55:48–58
van Steenbergen-Weijenburg KM, de Vroege L, Ploeger RR et al (2010) Validation of the PHQ-9 as a screening instrument for depression in diabetes patients in specialized outpatient clinics. BMC Health Serv Res 10:235
Manea L, Gilbody S, McMillan D (2015) A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry 37(1):67–75
Radloff LS (1977) The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Meas 3:385–401
Shafer AB (2006) Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung. J Clin Psychol 62(1):123–146
Ehrmann D, Bergis-Jurgan N, Haak T, Kulzer B, Hermanns N (2016) Comparison of the efficacy of a diabetes education programme for type 1 diabetes (PRIMAS) in a randomised controlled trial setting and the effectiveness in a routine care setting: results of a comparative effectiveness study. PLoS ONE 11(1):e0147581
Hermanns N, Kulzer B, Maier B, Mahr M, Haak T (2012) The effect of an education programme (MEDIAS 2 ICT) involving intensive insulin treatment for people with type 2 diabetes. Patient Educ Couns 86(2):226–232
Polonsky WH, Anderson BJ, Lohrer PA et al (1995) Assessment of diabetes-related distress. Diabetes Care 18(6):754–760
Melin EO, Thunander M, Svensson R, Landin-Olsson M, Thulesius HO (2013) Depression, obesity, and smoking were independently associated with inadequate glycemic control in patients with type 1 diabetes. Eur J Endocrinol 168(6):861–869
Reutrakul S, Thakkinstian A, Anothaisintawee T et al (2016) Sleep characteristics in type 1 diabetes and associations with glycemic control: systematic review and meta-analysis. Sleep Med 23:26–45
Denic-Roberts H, Costacou T, Orchard TJ (2016) Subjective sleep disturbances and glycemic control in adults with long-standing type 1 diabetes: the Pittsburgh’s epidemiology of diabetes complications study. Diabetes Res Clin Pract 119:1–12
Gonzalez JS, Kane NS, Binko DH, Shapira A, Hoogendoorn CJ (2016) Tangled up in blue: unraveling the links between emotional distress and treatment adherence in type 2 diabetes. Diabetes Care. doi:10.2337/dc16-1657
Stewart JC, Rand KL, Muldoon MF, Kamarck TW (2009) A prospective evaluation of the directionality of the depression-inflammation relationship. Brain Behav Immun 23(7):936–944
King DE, Mainous AG, Buchanan TA, Pearson WS (2003) C-reactive protein and glycemic control in adults with diabetes. Diabetes Care 26(5):1535–1539
De Groot M, Jacobson AM, Samson JA, Welch G (1999) Glycemic control and major depression in patients with type 1 and type 2 diabetes mellitus. J Psychosom Res 46(5):425–435
Surwit RS, van Tilburg MAL, Parekh PI, Lane JD, Feinglos MN (2005) Treatment regimen determines the relationship between depression and glycemic control. Diabetes Res Clin Pract 69(1):78–80
Nefs G, Pouwer F, Denollet J, Kramer H, Wijnands-van Gent CJ, Pop VJ (2012) Suboptimal glycemic control in type 2 diabetes: a key role for anhedonia? J Psychiatr Res 46(4):549–554
Hawkins MAW, Callahan CM, Stump TE, Stewart JC (2014) Depressive symptom clusters as predictors of incident coronary artery disease events: a 15-year prospective study of older adults. Psychosom Med 76(1):38
Authors’ contribution
DE and NH researched the data and wrote the manuscript. AS and AR contributed to the discussion and reviewed/edited the manuscript. TH and BK contributed to the discussion. DE is the guarantor of the article, therefore taking full responsibility for the contents of the article.
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The authors declare that they have no conflict of interest.
Ethical standard
As this was a retrospective analysis, formal consent is not required. The three studies which were combined for this analysis were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments.
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Informed consent was obtained from all individual participants included in the study.
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Ehrmann, D., Schmitt, A., Reimer, A. et al. The affective and somatic side of depression: subtypes of depressive symptoms show diametrically opposed associations with glycemic control in people with type 1 diabetes. Acta Diabetol 54, 749–756 (2017). https://doi.org/10.1007/s00592-017-1006-x
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DOI: https://doi.org/10.1007/s00592-017-1006-x