Effect of depression on mortality and cardiovascular morbidity in type 2 diabetes mellitus after 3 years follow up. The DIADEMA study protocol

Abstract

BackgroundType 2 diabetes mellitus and depression are highly prevalent diseases that are associated with an increased risk of cardiovascular disease and mortality. There is evidence about a bidirectional association between depressive symptoms and type 2 diabetes mellitus. However, prognostic implications of the joint effects of these two diseases on cardiovascular morbidity and mortality are not well-known.Method/designA three-year, observational, prospective, cohort study, carried out in Primary Health Care Centres in Madrid (Spain). The project aims to analyze the effect of depression on cardiovascular events, all-cause and cardiovascular mortality in patients with type 2 diabetes mellitus, and to estimate a clinical predictive model of depression in these patients.The number of patients required is 3255, all them with type 2 diabetes mellitus, older than 18 years, who regularly visit their Primary Health Care Centres and agree to participate. They are chosen by simple random sampling from the list of patients with type 2 diabetes mellitus of each general practitioner.The main outcome measures are all-cause and cardiovascular mortality and cardiovascular morbidity; and exposure variable is the major depressive disorder.There will be a comparison between depressed and not depressed patients in all-cause mortality, cardiovascular mortality, coronary artery disease and stroke using the Chi-squared test. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors that might alter the effect recorded will be taken into account in this analysis. To assess the effect of depression on the mortality, a survival analysis will be used comparing the two groups using the log-rank test. The control of potential confounding variables will be performed by the construction of a Cox regression model.DiscussionOur study’s main contribution is to evaluate the increase in the risk of cardiovascular morbidity and mortality, in depressed Spanish adults with type 2 diabetes mellitus attended in Primary Health Care Setting. It would also be useful to identify subgroups of patients for which the interventions could be more beneficial.

Association of Major Depressive Episode with Negative Outcomes of Tuberculosis Treatment

“…Although there are several studies showing the importance to study depression in chronic diseases as diabetes and cardiovascular diseases [22], [23], [24], [25], [26], [27], [28] and HIV [29], [30], [31], [32], [33], there is not a specific study looking longitudinal MDE and Tuberculosis treatment outcome. Some studies evaluated mental health among HIV/TB co-infected patients showing the importance of screening mental disorders as part of a comprehensive and holistic clinical approach [34], [35].…”

Prevalence of depression in patients with type 2 diabetes mellitus in Spain (the DIADEMA Study) : results from the MADIABETES cohort

“…The inclusion criteria were: a diagnosis of T2DM in the CCR (code T90 of the International Classification of Primary Care (ICPC-2)), 18 age ≥30 years, visit to a PHCC at least twice in the previous year, and agreement to take part in the study providing written informed consent. Patients were excluded for the following reasons: diagnosis of gestational diabetes mellitus, being in an institution, inability to understand Spanish, severe chronic diseases or significant physical or psychological disabilities that might invalidate informed consent or interviews (according to clinical judgement), legal incompetence or legal guardianship, and participation in clinical trials.…”

“…First, data concerning disease episodes (coded in ICPC-2), 18 prescription of medication (coded according to the Anatomical Therapeutic Chemical classification system), laboratory results, anthropometric variables and use of care facilities were obtained from the CCR. The CCR for primary healthcare in the Madrid Health Service was administered by the OMI-AP software.…”

The Incidence of Depression among the Population of Central Kazakhstan and Its Relationship with Sociodemographic Characteristics

“…The development of severe depression is associated with an increase in the amount of suicidal ideation [ 2 ] and deterioration in the quality of life compared with the general population [ 3 ]. It has been established that the presence of depression is accompanied by an increased risk of morbidity and mortality in cerebrovascular [ 4 ] and cardiovascular diseases and diabetes [ 5 , 6 ].…”