Diabetic peripheral neuropathic pain is a stronger predictor of depression than other diabetic complications and comorbidities

Abstract

Aims: To investigate the independent effect on depression of painless diabetic polyneuropathy, painful diabetic polyneuropathy, and general and diabetes-related comorbidities. Methods: In 181 patients, the presence of painless diabetic polyneuropathy, painful diabetic polyneuropathy, comorbidities and depression was assessed using the Michigan Neuropathy Screening Instrument Questionnaire, the Michigan Diabetic Neuropathy Score, nerve conduction studies, the Douleur Neuropathique en 4 Questions, the Charlson Comorbidity Index and the Beck Depression Inventory-II. Results: In all, 46 patients met the criteria of confirmed painless diabetic polyneuropathy and 25 of painful diabetic polyneuropathy. Beck Depression Inventory-II scores indicative of mild-moderate-severe depression were reached in 36 patients (19.7%). In a multiple logistic regression analysis (including age, sex, body mass index, being unemployed, duration, haemoglobin A1c, insulin treatment, systolic blood pressure, nephropathy, retinopathy, Charlson Comorbidity Index and painful diabetic polyneuropathy), female sex (odds ratio: 5.9, p = 0.005) and painful diabetic polyneuropathy (odds ratio: 4.6, p = 0.038) were the only independent predictors of depression. Multiple regression analysis, including Douleur Neuropathique en 4 Questions and Michigan Diabetic Neuropathy Score instead of painful diabetic polyneuropathy, showed that Douleur Neuropathique en 4 Questions, in addition to female sex, was a significant predictor of depressive symptoms severity (p =0.005). Conclusion: Painful diabetic polyneuropathy is a greater determinant of depression than other diabetes-related complications and comorbidities. Painful symptoms enhance depression severity more than objective insensitivity.

Quality of life and time since diagnosis of Diabetes Mellitus among the elderly

“…With more than ten years of illness patients with DM may have greater physical limitations, intensity of pain and discomfort, with a negative affect on their daily life and even increasing feelings of sadness, social isolation and fear of death. In addition, the loss of autonomy and decision-making power may influence self-esteem and lead to disregard for health, reducing self-care and thus favoring the appearance of chronic complications from the disease [25][26][27][28][29] .…”

Minocycline reduces mechanical allodynia and depressive-like behaviour in type-1 diabetes mellitus in the rat

“…In the present study, diabetic animals displayed depressivelike behaviour in the FST. The association between chronic PDN and the development of emotional disorders is well established in patients [88,89] and rats [48,90]. In the rat, the attempt at controlling diabetes-induced depressive-like behaviour has been explored using several drugs including antidepressants such as fluoxetine [91] and imipramine [92], antioxidants such as N-acetylcysteine [93] and endocannabinoids such as anandamide [48] among others.…”

Risk factors for neuropathic pain in diabetes mellitus

“…1,2,6,8,11,17 In other studies, it is not possible to determine the nature of the control group from the description of the methods. There was considerable heterogeneity in PDN case ascertainment, with only 6 studies using a validated NP screening questionnaire (the DN4 6,7,17,21,38 or the Leeds assessment of neuropathic symptoms and signs 11 ) with the remainder using nonvalidated questionnaires or clinical examinations. This makes it difficult to assess the sensitivity and specificity of each study to identify PDN cases and to make direct comparisons between studies as effect size estimations and associations are likely to be different.…”

“…Increased depression, anxiety, enjoyment of life, and social relationships are associated with PDN, but without prospective studies and longitudinal analysis, the temporal relationship cannot be established. 7,15 …”