The joint association of diabetes distress and depressive symptoms with all-cause mortality in Japanese individuals with type 2 diabetes: a prospective cohort study (Diabetes Distress and Care Registry in Tenri [DDCRT 20])

Abstract

Aims/hypothesis The independent association of depressive symptoms and diabetes distress with mortality risk in individuals with diabetes has not been evaluated. We examined the temporal joint association of diabetes distress and depressive symptoms at baseline and the subsequent risk of all-cause mortality. Methods The longitudinal data of 3118 individuals with type 2 diabetes were obtained from a large Japanese diabetes registry. To assess the joint association of diabetes distress and depressive symptoms at baseline with the subsequent risk of all-cause mortality, the Cox proportional hazards model was used with adjustment for potential confounders. Results The mean age, BMI and HbA 1c levels were 64.7 years, 24.6 kg/m 2 and 58.6 mmol/mol (7.5%), respectively, and 38.1% of the participants were women. In the multivariable-adjusted models evaluating the diabetes distress and depressive symptoms separately, the HRs for all-cause mortality were 1.67 (95% CI 1.14, 2.43; p = 0.008) and 1.40 (95% CI 1.05, 1.85; p = 0.020), respectively. In such models evaluating the joint association of diabetes distress and depressive symptoms, compared with individuals without diabetes distress or depressive symptoms (DD − /DS − ), the HRs for all-cause mortality for the group without diabetes distress but with depressive symptoms (DD − /DS + ), with diabetes distress but without depressive symptoms (DD + /DS − ), and with diabetes distress and depressive symptoms (DD + /DS + ) were 1.34 (95% CI 0.99, 1.86; p = 0.056), 1.96 (95% CI 1.10, 3.50; p = 0.023) and 1.71 (95% CI 1.06, 2.77; p = 0.029), respectively. We did not observe a significant interaction between diabetes distress and depressive symptoms with all-cause mortality risk (p = 0.2636). In the stratified analysis by sex, a significant joint association of diabetes distress and depressive symptoms with the risk of all-cause mortality was observed only in men. Conclusions/interpretation Diabetes distress and depressive symptoms were independently associated with all-cause mortality risk in male participants with type 2 diabetes, but we did not observe a significant interaction between diabetes distress and depressive symptoms in relation to all-cause mortality. Keywords Depressive symptom . Diabetes distress . Epidemiology . Human . Mortality risk . Patient-reported outcome . Type 2 diabetes Abbreviations CES-D Center for Epidemiologic Studies Depression CRC Clinical research coordinator DD − /DS − Without diabetes distress or depressive symptoms DD − /DS + Without diabetes distress but with depressive symptoms DD + /DS − With diabetes distress but without depressive symptoms Members of the Diabetes Distress and Care Registry at Tenri Study Group are listed in the Appendix.

Implications of Patient-Reported Outcome Measures among patients with recently diagnosed type 2 diabetes

“…Our study found, in agreement with previous studies, that women, young patients, and those with low education reported worse general health [ 19 , 42 – 46 ], high diabetes-related distress [ 37 , 47 – 53 ] and low confidence in diabetes self-management [ 54 , 55 ]. Physiological and lifestyle factors, including diet and physical activity, may contribute to the gender and educational differences [ 46 , 55 , 56 ].…”

“…This is in line with previous studies [ 47 , 49 , 65 ] that focused, as this study does, on recently diagnosed patients. While others have shown that poor glycemic control was associated with high diabetes-related distress [ 37 , 51 , 52 , 66 – 68 ], most of these studies included patients with a long-standing diabetes. Thus it would be interesting to test whether the associations are modified by diabetes duration.…”

“…The answers of the 20-items of PAID were summed and multiplied by 1.25 to generate a total score ranging from 0 to 100. And then dichotomized (PAID ≥ 40 vs. < 40), a score ≥ 40 indicates a high diabetes-related distress [ 37 ].…”

Psychological Distress and All-Cause, Cardiovascular Disease, Cancer Mortality Among Adults with and without Diabetes

“…This finding is consistent with a previous study conducted in diabetic patients, indicating that patients with psychological distress (measured by Mental Health Inventory 5) were at increased risk of all-cause mortality and CVD events. 15 Another study found a 1.76-fold higher risk of mortality and a 1.69-fold higher incidence of CVD events with psychological distress in participants with vs those without diabetes. 38 Psychological distress is already acknowledged as an important risk factor for CVD events.…”

“… 8–12 Women with diabetes have a higher risk of psychological problems than men, particularly in those taking non-insulin glucose-lowering drugs for treatment. 13 However, other studies 14 , 15 have reported an association between psychological distress and increased all-cause mortality in men, but not in women, and participants’ age ≥65 years. 16 Although studies have shown an association between psychological distress and increased mortality, it is unclear whether the association differs in participants with and without diabetes.…”