OBJECTIVEThe prevalence of depression and depressive symptoms is increased twofold in people with type 2 diabetes compared with the general population and is associated with worse biomedical outcomes and increased mortality. Type 2 diabetes, cardiovascular disease, and depression in nondiabetes subjects are independently associated with raised concentrations of circulating inflammatory markers, but it is not known if a similar association is observed in type 2 diabetes. We tested the hypothesis that higher depressive symptom scores in newly diagnosed type 2 diabetes patients were associated with higher concentrations of inflammatory markers. RESEARCH DESIGN AND METHODSDepressive symptoms in adults with newly diagnosed type 2 diabetes recruited from primary care were assessed using the Patient Health Questionnaire-9. RESULTSThe baseline cohort consisted of 1,790 participants. After adjusting for covariates, CRP (B = 0.13, P < 0.001), IL-1b (B = 0.06, P = 0.047), IL-1RA (B = 0.13, P < 0.001), MCP-1 (B = 0.11, P = 0.001), WBC (B = 0.13, P < 0.001), and TG (B = 0.10, P < 0.001) were associated with depressive symptoms. CONCLUSIONSIncreased inflammation may be involved in the pathogenesis of depressive symptoms in type 2 diabetes and contribute to the increased risk of complications and mortality in this group.

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Age, verbal intelligence, female gender and HbA1c are associated with cognitive performance in T2DM soon after diagnosis. Previously reported associations with depression and inflammatory markers may occur later as causes or consequences of T2DM. Longitudinal analyses are needed to assess potentially modifiable factors predicting cognitive decline in early T2DM.

Background: For some common cancers, survival is lower in the UK than in comparable high-income countries. Aim: To assess the effectiveness of a targeted postal intervention (promoting awareness of cancer symptoms and earlier help-seeking) on patient consultation rates. Design and Setting: A two-arm randomised controlled trial (RCT) of adult patients registered at 23 general practices in England. Method: Adult patients who had not consulted their general practice in the previous 12 months and had at least two other risk factors for late presentation with cancer were randomised to intervention and control arms. The intervention consisted of a mailed letter. The primary outcome was number of consultations at the practice in the six months subsequent to mailing of the intervention. All patients with outcome data were included in the intention-to-treat analyses. The trial was registered prospectively on the International Standard Randomised Controlled Trial Number (ISRCTN) registry (ISRCTN95610478). Results: 1,513 patients were individually randomised to the intervention (n=783) and control (n=730) arms, between November 2016 and May 2017. Outcome data was available for 749 and 705 patients respectively. There was a significantly higher rate of consultation in the intervention arm: 436 consultations compared to 335 in the control arm (RR = 1.40, 95% CI 1.11-1.77, p=0.004). However, there was no difference in the numbers of patients consulting. Conclusion: Targeted interventions of this nature can change behaviour. There is a need to develop interventions which can be more effective at engaging patients with primary care.