Depressive Symptoms, Antidepressant Medication Use, and New Onset of Diabetes in Participants of the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study

Abstract

Objective To assess in participants in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study (DPP/DPPOS) whether diagnosis of diabetes predicted: elevated depressive symptoms (DS) or antidepressant medicine (ADM) use after diagnosis; diabetes status or duration had significant effect on DS or ADM use; and associations between A1C, fasting plasma glucose (FPG), normalization of FPG and DS or ADM use post diagnosis. Methods DPP participants in 3 treatment arms [intensive lifestyle (ILS), metformin (MET), placebo (PLC)] were assessed semiannually or annually for diabetes, glucose control, ADM use, and DS. DS was measured using Beck Depression Inventory (BDI) questionnaire. Among the total 3234 enrolled participants, 1285 developed diabetes whose levels of depression were measured before and after their diabetes diagnosis. Results Neither DS nor ADM use increased significantly following diabetes diagnosis. After diabetes diagnosis, higher FPG was associated with greater ADM use in the ILS arm independent of potential confounders; a 10 mg/dl higher in FPG is associated with 8.8% more odds of ADM use. Higher FPG, and higher A1C were associated with higher BDI scores in all three arms. On average, a participant with 10 mg/dl higher rise in FPG had a 0.07 increase in BDI score. Similarly, 1% higher A1c was associated with a 0.21 point increase in BDI score. On contrary, normalization of FPG was associated with lower BDI scores. In participants with FPG that had normalized, there was a decrease of 0.30 points in the BDI score compared to those whose FPG had not normalized. Conclusions Contrary to clinical attributions, the diagnosis of diabetes did not show an immediate impact on BDI scores or ADM use. However, higher glucose levels after diagnosis were associated with small but significant higher BDI score and more ADM use.

<p>Prevalence of Depressive Symptoms in Patients with Type 1 and 2 Diabetes Mellitus</p>

“…23 The increased risk of depression in patients with T2DM was also caused by poorly controlled glycemia with higher HbA1c level. 3,4,10,11,24 As in our study, the prevalence of depression in T2DM was higher in women than in men and increased with age. 21 This study is associated with some limitations.…”

Diagnosis and management of hyperglycaemia in patients treated with antipsychotic drugs

“…Among the patients diagnosed with DM within a year, there was a significant improvement in the Beck Depression Inventory scale in the group of patients using MET or intensive lifestyle modification. However, elevated depressive symptoms or the use of antidepressants have not been found to be associated with subsequent significantly increased frequency of DM diagnoses [62,63]. The benefits of MET 1500 mg/day for 4 months in patients taking antipsychotics and with early comorbid preDM and DM were confirmed in the study by Agarval et al MET was shown to be associated with a significant decrease over time in the HOMA-IR and FG compared to people not using hypoglycaemic drugs.…”

Elevated depressive symptoms and risk of all-cause and cardiovascular mortality among adults with and without diabetes: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study

“…Moreover, findings from a meta-analysis showed that depression was associated with a small increase in insulin resistance (as a measure of high-risk for diabetes), but this association was not statistically significant after adjustment for confounders 46 Because prediabetes is considered a high-risk state for developing type 2 diabetes, 47 it is plausible that depression may increase the risk of mortality in this group. 31 Our study found that elevated depressive symptoms were associated with a 56% increase in the risk of all-cause mortality among individuals with prediabetes that persisted after multivariable adjustment, and highlights the potential relevance of depression screening in this high-risk group to provide appropriate mental health care.…”

“…[18][19][20][21][22][23][24][25][26][27] However, it is unclear whether depressive symptoms increases the risk of mortality among individuals with prediabetes specifically, who are at high risk of developing type 2 diabetes. Although no association between depression and prediabetes has been reported, [28][29][30][31][32] recent data from the Atherosclerosis Risk in Communities Study reported the prevalence of depressive symptoms was higher among adults with prediabetes than those with diabetes. 3 The American Diabetes Association recommends that individuals with diabetes or prediabetes be screened for depression.…”