Depression: a common and burdensome complication of diabetes that warrants the continued attention of clinicians, researchers and healthcare policy makers

Abstract

There is ample evidence that depression is a common comorbid health issue in people with type 1 or type 2 diabetes. Reviews have also concluded that depression in diabetes is associated with higher HbA 1c levels, less optimal self-care behaviours, lower quality of life, incident vascular complications and higher mortality rates. However, longitudinal studies into the course of depression in people with type 1 diabetes remain scarce. In this issue of Diabetologia, Kampling and colleagues (doi:10.1007/s00125-016-4123-0) report the 5 year trajectories of depression in adults with newly diagnosed type 1 diabetes (mean age, 28 years). Their baseline results showed that shortly after the diagnosis of type 1 diabetes a major depressive episode was diagnosed in approximately 6% of participants, while 8% suffered from an anxiety disorder. The longitudinal depression data showed that, in a 5 year period, 79% reported no depressive symptoms at any time, while 7% had a high depression score that improved and 14% reported worsening of depressive symptoms. Here, the clinical relevance of these findings is discussed and areas for further research are described.

Elucidating factors associated with non-adherence among Type 1 diabetes patients in primary care setting in Southeastern Brazil

“…We have shown T1DM patients need continuous emotional support to achieve glycemic goals, and continuing diabetes education. The risk of diabetes complications (CD) increases with depression and may negatively influence adherence to treatment [18,19]. Unfortunately, the direction of this relationship could not be established since most of the studies are crosssectional.…”

Management and Treatment of Patients With Major Depressive Disorder and Chronic Diseases: A Multidisciplinary Approach

“…Patients with MDD and those with diabetes patients share reciprocal susceptibility and a high degree of comorbidity ( Canadian Diabetes Association Clinical Practice Guidelines Expert Committee et al, 2013 ; Pouwer, 2017 ). The prevalence of depressive symptoms among patients with diabetes is in the range of 30%, and the prevalence of MDD is approximately 10%, which is double the overall prevalence in people without a chronic disease ( Canadian Diabetes Association Clinical Practice Guidelines Expert Committee et al, 2013 ).…”

“…Moreover, long-term use of antidepressants has been related with an increased risk of diabetes (Andersohn et al, 2009). In patients with type 1 diabetes, the presence of MDD has been associated with severe hyperglycaemia and hypoglycaemia (Gilsanz et al, 2018) and with increased cardiovascular mortality (Pouwer, 2017;Farooqi et al, 2019). The prognosis for comorbid MDD and diabetes is worse than when each illness occurs separately: MDD amplifies the diabetes symptom burden and worsens clinical outcomes.…”

Identification of barriers to insulin therapy and approaches to overcoming them

“…These improvements, albeit slight, were across a range of variables and might reflect a significant change in prognosis. Effective communication is also particularly crucial when addressing concerns of people with T2D and anxiety or comorbid depression; therefore, a psychologist with knowledge of diabetes should be readily available to help with severe cases of psychological insulin resistance in people with diabetes as well as treating depression when required …”