Impact of anxiety, depression and disease-related distress on long-term glycaemic variability among subjects with Type 1 diabetes mellitus

Abstract

Background Anxiety, depression, and disease-related distress are linked to worse overall glycaemic control, in terms of HbA1c. This study was aimed to evaluate whether traits of these emotional disorders are associated with long-term glycaemic variability in subjects with Type 1 diabetes. Methods Longitudinal retrospective study. Six-year HbA1c data (2014–2019) from 411 subjects with Type 1 diabetes who had participated in a previous study to design a diabetes-specific quality of life questionnaire in the year 2014 were included. Scores for Spanish versions of the Hospital Anxiety and Depression Scale (HADS) and Problem Areas in Diabetes (PAID) scale were obtained at baseline, along with sociodemographic and clinical data. Long-term glycaemic variability was measured as the coefficient of variation of HbA1c (HbA1c-CV). The association between HADS and PAID scores and HbA1c-CV was analysed with Spearman correlations and multiple regression models, both linear and additive, including other covariates (age, sex, diabetes duration time, type of treatment, baseline HbA1c, use of anxiolytic or antidepressant drugs, education level and employment status). Results Scores of depression, anxiety and distress were positively and significantly correlated to HbA1c-CV in univariate analyses. Multiple regression study demonstrated an independent association only for diabetes distress score (p < 0.001). Age, diabetes duration time, baseline HbA1c, education level and employment status were also significantly associated with HbA1c-CV. However, when subjects were analyzed separately in two age groups, distress scores were associated with HbA1c-CV only among those aged 25 years or older, while anxiety scores, but not distress, were associated with HbA1c-CV among those younger than 25 years. Conclusions Psychological factors, particularly disease-related distress and anxiety, are associated with long-term glycaemic variability in subjects with Type 1 diabetes.

Comparison of diabetes distress and depression screening results of emerging adults with type 1 diabetes onset at different ages: findings from the German early-onset T1D study and the German Diabetes Study (GDS)

“…Diabetes distress is increasingly considered one of the most important psychosocial issues in the care of people with T1D; therefore, an international consensus study recommended that the measurement of diabetes-related burden or stress should be a key clinical outcome measure in studies of emerging adults [ 7 ]. Diabetes distress in emerging adults is still an understudied phenomenon, even though it is common and occurs more frequently in this age- group and is suspected to contribute to adverse outcomes [ 2 ], such as higher haemoglobin A1c (HbA1c) levels [ 8 – 10 ], higher glycaemic variability [ 11 ], impaired quality of life [ 9 ], more severe depressive symptoms [ 8 ], and worse physical and mental health [ 8 , 9 ]. Since diabetes distress, depressive symptoms and HbA1c levels are interrelated, it seems appropriate to examine these factors simultaneously [ 6 , 8 , 12 ].…”

The Interaction of Glycemia with Anxiety and Depression Is Related to Altered Cerebellar and Cerebral Functional Correlations

“…Adequate insulin production, insulin sensitivity, glucose intake, along with a variety of other endocrine factors (glucagon like peptide-1, glucagon) establish glycemic control and are related to diabetes severity [5]. Depression and anxiety have been examined across multiple diabetes subgroups including individuals with type 1 [6], type 2 [7], and gestational diabetes [8].…”

“…Regardless of diabetes type, anxiety and depression are associated with poorer glycemic control [6][7][8]. Overall, research indicates that mental and physical health are closely linked, particularly between hyperglycemia and depression and anxiety.…”

Literature Review: Management of Depression with Physical Exercise on Changes in Blood Sugar Levels in the Family of Diabetes Mellitus

“…Psychological factors, especially disease-related stress, and anxiety, are associated with long-term glycemic variability in subjects with type 1 diabetes resulting in higher levels of oxidative stress and vascular and tissue damage than permanent hyperglycemia, and many observational studies with posthoc analyses of clinical trials have reported associations between glycemic variability and the development of micro-and macrovascular diabetic complications, severe and nocturnal hypoglycemia and overall mortality 24 .…”