Glycemic control of type 2 diabetics and associated depressive disorders spectrum - descriptive comparative study in Ismailia city -Egypt

Abstract

Background: Depressive disorders are highly prevalent in the general population worldwide. Evidence suggests a longitudinal reciprocal bi-directional relationship between depression and type 2 diabetes. This study aims at detecting the relationship between diabetic control and spectrum of depressive disorders among patients with type II diabetes attending health insurance medical complex, between January and March 2022, Ismailia city, Egypt. Methods: This study recruited 105 patients with type II diabetes randomly selected from patients attending the specialized endocrinology and diabetes center, and matched on a regular basis with another 105 non-diabetic individuals randomly selected from new patients attending for general medical check up covered by the comprehensive medical insurance pilot in Egypt run in Ismailia Governorate. Brief medical history and examination was carried out for all participants including, duration of type 2 DM diagnosis, presence of diabetic complications, and smoking status, and BMI recording, followed by interview for self-completion of the “Beck Depression inventory II scale”. A venous blood sample, in a non-fasting state, was drawn for measuring the HbA1C% in the same session. Results: The means of HbA1c% in in diabetic group was 8.7% +2.1, compared with 5.3 + 0.44 in non-diabetic group. Assessment of the prevalence and grades of depression in the two study groups, showed a highly statistically significant difference in the prevalence of depression, with 55 subjects representing 52.4% in the diabetic group, compared with 11 subjects, representing 10.5% in the non-diabetic group. The grades of severity of depression between the two groups showed also a highly statistically significant difference with 33.3%, 15.2%, and 3.8% respectively for mild, moderate, and severe depression in the diabetic groups, compared with 8.6%, 1.9%, and 0% respectively for mild, moderate, and severe depression in the non-diabetic groups. High statistically significant difference in Beck ‘depression inventory Score (BDI-II) between the two groups was shown, with mean score of 14.2 + 7.6 in the diabetic group, compared with 9.8 + 3.3 in the non-diabetic group. A linear correlation manner was shown between HbA1c%, and BDI-II score in all of the study participants, and in the diabetic group a moderate correlation was shown between BDI-II and HbA1c% with r coefficient 0.37 that was highly statistically significant (P< 0.001). The results of binary regression analysis model for prediction of depression, showed among several independent factors selected, that smoking, and presence of diabetic complications were statistically significant predictors (P = 0.016, and 0.013, respectively), and glycemic control (HbA1c%) was highly statistically significant predictor (P < 0.001) Conclusion: In this study, poor glycemic control reflected in glycosylated hemoglobin percent (HbA1c%), was shown to be closely related to higher percentages of all grades of depressive disorders as assessed by BDI-II scale when comparing type 2 diabetic and non-diabetic patients, and among the type 2 diabetic patients. The correlation between glycemic control and the spectrum of depressive disorders was moderate, and depicted a linear relationship. Glycemic control was shown to be the strongest predictor of depressive disorders, followed by presence of diabetic complications, and smoking.