Depression Is Associated With Progression of Diabetic Nephropathy in Type 1 Diabetes

Abstract

Word count main body of the text: 4303/4000 Tables: 3 2 OBJECTIVE To investigate the relationship between depression and diabetic nephropathy progression in type 1 diabetes. RESEARCH DESIGN AND METHODS Data from 3730 participants without end-stage renal disease at baseline, participating in the Finnish Diabetic Nephropathy Study, were included. Depression was assessed in three ways. Depression diagnoses were obtained from the Finnish Care Register for Health Care. Antidepressant agent purchase data were obtained from the Drug Prescription Register. Symptoms of depression were assessed using the Beck Depression Inventory (BDI). Based on their urinary albumin excretion rate (AER) participants were classified into those with normal AER, microalbuminuria, and macroalbuminuria.Progression from normal AER to either microalbuminuria, macroalbuminuria, or end-stage renal disease; or from microalbuminuria to macroalbuminuria or ESRD; or from macroalbuminuria to ESRD, during the follow-up period was investigated.RESULTS Over a mean follow-up period of 9.6 years, renal status deteriorated in 18.4% of the participants. Diagnosed depression and antidepressant purchases before baseline were associated with 53% and 32% increased risk of diabetic nephropathy progression, respectively. Diagnosed depression assessed during follow-up remained associated with increased risk of disease progression (32%). BDI-derived symptoms of depression showed no association with the progression, but the total number of antidepressant purchases modestly reduced the risk [0.989 (0.982-0.997), P=0.008]. Dividing the sample based on median age, the observations followed those seen in the whole group. However, symptoms of depression additionally predicted progression in those ≤36.5 years.CONCLUSIONS Diagnosed depression and antidepressant purchases are associated with the progression of diabetic nephropathy in type 1 diabetes. Whether successful treatment of depression reduces the risk needs to be determined.

Bidirectional association between depression and diabetic nephropathy by meta-analysis

“…Six studies were from Europe [ 21 , 23 , 28 , 37 , 40 , 46 ], one from Africa [ 29 ], 16 from Asia [ 19 , 20 , 22 , 24 , 26 , 30 – 33 , 35 , 36 , 38 , 39 , 41 , 45 , 47 ], and 7 from America [ 18 , 25 , 27 , 34 , 42 – 44 ]. There were 10 prospective cohort studies [ 18 , 22 , 25 , 35 , 37 , 40 , 43 , 44 , 46 , 47 ], 18 cross-sectional studies [ 19 – 21 , 23 , 26 – 30 , 32 , 33 , 35 , 36 , 38 , 39 , 41 ], 2 case-control studies [ 23 , 31 ]. The largest number of participants were 933,211, while the longest follow-up time was 25 years.…”

“…Second, DN and depression might be assessed differently in different studies that potentially influenced the result. For the diagnostic methods of DN, 18 studies did not describe any specific evaluation method [ 18 – 21 , 23 – 26 , 29 – 31 , 33 , 36 – 39 , 41 , 43 ], 5 studies used UAER/UACR/albuminuria to assess renal function [ 22 , 33 , 40 , 45 , 46 ], and 4 studies used eGFR [ 27 , 28 , 32 , 44 ]. For the depression assessment, diagnostic interview was a gold standard for major depression, only 2 studies adopted this method [ 19 , 21 ].…”

Bibliometrics Analysis of the Research Status and Trends of the Association Between Depression and Insulin From 2010 to 2020

“…For example, heart disease occurs more frequently in depressed patients ( 6 ), and among the factors associated with depression, diabetes have received widespread attention. Studies have shown that about 30% of diabetic patients also suffer from depression ( 7 , 8 ). Among diabetic patients, the incidence of depression is twice that of the general human ( 9 ), which indicates that there is a close association between the two diseases.…”

The critical roles of histone deacetylase 3 in the pathogenesis of solid organ injury

“…Diabetic nephropathy is a chronic renal injury in patients with diabetes mellitus. Our poor understanding of its pathogenesis makes the treatment of diabetic nephropathy challenging [ 91 ]. In mice fed a high-fat diet and treated with a low dose of streptozotocin, HDAC3 downregulated miR-10a and upregulated cAMP response element-binding protein 1 (CREB1), thereby promoting kidney injury [ 92 ].…”