Worsening depression flags poor glycemic control in type 1 diabetes
medwireNews: Researchers say that physicians should be alert for worsening depression in patients with type 1 diabetes, after finding it to be associated with poor metabolic control.
“While depressive symptoms themselves require therapy, they also contribute negatively to diabetes-related medical, social and psychological outcomes, and therefore need to be addressed,” writes the team in Diabetologia.
The team identified three trajectories of depressive symptoms, measured on the Symptom Checklist 90-R (SCL-90-R), among 313 patients, aged 28 years on average, 258 of whom participated in all five annual follow-up assessments.
Patients in the first trajectory – 79.9% of all patients – had no depressive symptoms at any time. A further 6.4% of patients were in a second trajectory; they had gender-adjusted T scores for depressive symptoms that were close to the threshold for clinical depression at baseline, worsened over the next 2 years, but then improved.
The 13.7% of patients in the third trajectory had baseline T scores indicative of depression (average 61.4), and these worsened further during follow-up, to an average 5-year score of 73.8. By this point, these patients had significantly poorer glycemic control than those in the other two groups, with glycated hemoglobin scores of 8.2% versus 7.2%, despite no differences between them at the 1-year follow-up.
These patients also had worse diabetes-related quality of life for strain, strain related to blood glucose levels, and satisfaction, compared with patients without depressive symptoms. They had higher levels of diabetes-related distress and perceived that they had less family support.
“Clinicians may benefit from this knowledge,” say Hanna Kampling (University of Freiburg, Germany) and co-researchers, suggesting that diabetes patients should undergo routine screening for depression, with referral for treatment when necessary.
The researchers note that although the burden of diabetes was high in some patients, it nevertheless affected a relatively small proportion of the patients.
“This is surprising, as one would expect that a disease with lifelong implications in terms of medication and lifestyle, and with a potential risk of secondary complications, would have a stronger impact,” they say.
However, they add that the baseline rate of major depression according to DSM-IV, at 5.8%, was more than double that reported in people without diabetes, and depression worsened over time in around 14% of the whole cohort.
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