OBJECTIVE -To estimate the odds and prevalence of clinically relevant depression in adults with type 1 or type 2 diabetes. Depression is associated with hyperglycemia and an increased risk for diabetic complications; relief of depression is associated with improved glycemic control. A more accurate estimate of depression prevalence than what is currently available is needed to gauge the potential impact of depression management in diabetes. RESEARCH DESIGN AND METHODS -MEDLINE and PsycINFO databases andpublished references were used to identify studies that reported the prevalence of depression in diabetes. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the included studies. We used 2 statistics and odds ratios (ORs) to assess the rate and likelihood of depression as a function of type of diabetes, sex, subject source, depression assessment method, and study design.RESULTS -A total of 42 eligible studies were identified; 20 (48%) included a nondiabetic comparison group. In the controlled studies, the odds of depression in the diabetic group were twice that of the nondiabetic comparison group (OR ϭ 2.0, 95% CI 1.8 -2.2) and did not differ by sex, type of diabetes, subject source, or assessment method. The prevalence of comorbid depression was significantly higher in diabetic women (28%) than in diabetic men (18%), in uncontrolled (30%) than in controlled studies (21%), in clinical (32%) than in community (20%) samples, and when assessed by self-report questionnaires (31%) than by standardized diagnostic interviews (11%).CONCLUSIONS -The presence of diabetes doubles the odds of comorbid depression. Prevalence estimates are affected by several clinical and methodological variables that do not affect the stability of the ORs.

Hyperglycemia has been linked to the development of diabetic complications (1). Treatments that lower blood glucose levels reduce the risks of retinopathy, neuropathy, and nephropathy in patients with type 1 (2,3) or type 2 (4,5) diabetes. Accordingly, maintenance of good glycemic control is the focus of diabetes therapy, and the importance of other clinical factors is judged largely in relation to their effects on this parameter.Clinical and subclinical expressions of depression are present in Ͼ25% of patients with type 1 or type 2 diabetes (6-14) and have adverse effects on functioning and quality of life (15,16). The existing literature is not consistent and clear with regard to the association between depression and poor glycemic control. Such an association would suggest the possibility that depression treatment might have favorable effects on diabetic outcomes. We surveyed the scientific literature, identified studies that measured the association of depression (either by symptoms or the diagnosis) with glycemic control, and performed a metaanalysis to assess the reliability and strength of any association. RESEARCH DESIGN ANDMETHODS -Medline and PsycINFO were used to locate studies published in the last 25 years that reported the association of depression with glycemic control in adult diabetic subjects. The reference lists of these articles were examined to identify additional studies, and this led to the consideration of several unpublished papers and manuscripts. Inclusion and exclusion criteriaStudies were limited to adult participants (Ն18 years of age), to those that assessed glycemic control using a measure of glycohemoglobin (denoted as GHb within this article) (17,18), and to those that measured depression and GHb coincident to the study evaluation. Studies with Ͻ25 patients, those neither published nor available in English, and those that ascertained only a history of depression were excluded. Subjects in the included studies were patients diagnosed with type 1 or type 2 diabetes; studies of subjects with impaired glucose tolerance, borderline diabetes, or gestational diabetes were not considered. Studies were included without regard to the way the depression-glycemic control association was tested. In some studies, depression was the independent variable and glycemic control the dependent variable. Other studies used the reverse approach, and some reported only the correlation between the 2 variables.Study procedures and statistical analysis Study characteristics were recorded, and the studies were categorized by methodology. Type of diabetes and method of depression assessment were recorded, and effect sizes (ESs) were examined in relation to these factors. The diagnosis of depression (major depressive disorder) was established by using structured or semistructured clinical interviews and the diagnostic criteria in use at the time of the study (e.g., American Psychiatric Association' s Diagnostic and Statistical Manual of Mental Disorders [19,20] Depression and Poor Glycemic ControlA meta-an...

These findings demonstrate a significant and consistent association of diabetes complications and depressive symptoms. Prospective, longitudinal studies are needed to identify the pathways that mediate this association.

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The existing literature suggests that anxiety disorders are associated with hyperglycemia in diabetic patients. Additional studies are required to confirm the magnitude of the relationship, to elucidate moderating and causal factors, and to determine whether successful treatment of anxiety improves glycemic control.

Background Bamlanivimab and casirivimab-imdevimab are authorized for treatment of high-risk patients with mild to moderate coronavirus disease-2019 (COVID-19). We compared the outcomes of patients who received these therapies to identify factors associated with hospitalization and other clinical outcomes. Methods Adult patients who received monoclonal antibody from November 19, 2020 to February 11, 2021 were selected and divided into those who received bamlanivimab (n=2747) and casirivimab-imdevimab (n=849). The 28-day all-cause and COVID-19-related hospitalizations were compared between the groups. Results The population included 3596 patients; median age was 62 years; and 50% were female. All had ≥1 medical comorbidity; 55% had multiple comorbidities. All cause- and COVID-19-related hospitalization rates at 28 days were 3.98% and 2.56%, respectively. After adjusting for medical comorbidities, there was no significant difference in all cause- and COVID-19-related hospitalization rates between bamlanivimab and casirivimab-imdevimab (adjusted HR, 1.4, 95% CI 0.9-2.2 and 1.6, 95% CI 0.8-2.7, respectively). Chronic kidney, respiratory and cardiovascular diseases, and immunocompromised status were associated with higher likelihood of hospitalization. Conclusion This observational study on the use of bamlanivimab and casirivimab-imdevimab in high-risk patients showed similarly low rates of hospitalization. The number and type of medical comorbidities are associated with hospitalizations after monoclonal antibody treatment.

Study Objectives: To examine the effects of cognitive behavioral treatments for insomnia (CBT-I) and pain (CBT-P) in patients with comorbid fibromyalgia and insomnia.Methods: One hundred thirteen patients (M age = 53, SD = 10.9) were randomized to eight sessions of CBT-I (n = 39), CBT-P (n = 37), or a waitlist control (WLC, n = 37). Primary (self-reported sleep onset latency [SOL], wake after sleep onset [WASO], sleep efficiency [SE], sleep quality [SQ], and pain ratings) and secondary outcomes (dysfunctional beliefs and attitudes about sleep [DBAS]; actigraphy and polysomnography SOL, WASO, and SE; McGill Pain Questionnaire; Pain Disability Index; depression; and anxiety) were examined at posttreatment and 6 months.Results: Mixed effects analyses revealed that both treatments improved self-reported WASO, SE, and SQ relative to control at posttreatment and follow-up, with generally larger effect sizes for CBT-I. DBAS improved in CBT-I only. Pain and mood improvements did not differ by group. Clinical significance analyses revealed the proportion of participants no longer reporting difficulties initiating and maintaining sleep was higher for CBT-I posttreatment and for both treatments at 6 months relative to control. Few participants achieved >50% pain reductions. Proportion achieving pain reductions of >30% (~1/3) was higher for both treatments posttreatment and for CBT-I at 6 months relative to control. Conclusions:CBT-I and CBT-P improved self-reported insomnia symptoms. CBT-I prompted improvements of larger magnitude that were maintained. Neither treatment improved pain or mood. However, both prompted clinically meaningful, immediate pain reductions in one third of patients. Improvements persisted for CBT-I, suggesting that CBT-I may provide better long-term pain reduction than CBT-P. Research identifying which patients benefit and mechanisms driving intervention effects is needed. Clinical Trial: Sleep and Pain Interventions in Fibromyalgia (SPIN), clinicaltrials.gov, NCT02001077.

In February 2018, the 6th World Symposium on Pulmonary Hypertension (WSPH) brought together experts from various disciplines to review the most relevant clinical and scientific advances in the field of PH over the last 5 years. Based on careful review and discussions by members of the different task forces, major revisions were made on the hemodynamic definition for various forms of PH and new genes were added to the list of genetic markers associated with pulmonary arterial hypertension (PAH) and pulmonary veno-occlusive disease. In addition, the use of risk stratification tools was encouraged as a strategy to reduce one-year mortality risk in PAH patients through early implementation of PAH therapies. While members of the medical community are still debating some of the proposed changes, the new WSPH guidelines advocate early diagnosis and initiation of combination therapy to reduce mortality and improve quality of life in patients with PH.