The relationship between depression and metabolic control parameters in type 2 diabetic patients: A cross‐sectional and feasibility interventional study

Abstract

Background Substantial evidence supports a bidirectional relationship between diabetes and clinical depression. However, little is known about the effect of treating one condition on the control of the other. Thus, this study aimed to determine the prevalence of depression among Type II diabetes mellitus (T2DM) patients and to assess the efficacy and feasibility of escitalopram treatment of depression on their metabolic control parameters. Methods T2DM patients attending primary care clinics in the North of Jordan were enrolled in a cross‐sectional study during the period from February to December 2019 (n = 157). Depressive symptoms were screened utilising the patient health questionnaire‐9 (PHQ‐9) tool. Metabolic control was assessed by measurement of glycated haemoglobin (HbA1c), triglycerides, cholesterol, low‐density lipoprotein (LDL) and high‐density lipoprotein (HDL). Patients with moderate to severe depressive symptoms by PHQ‐9 (n = 58) were interviewed by a psychiatrist to confirm a clinical diagnosis of depression. Eligible depressed patients were administered escitalopram 10 mg orally once daily for 3 months (n = 12). Thereafter, depressive symptoms and metabolic control measures were reassessed. Results The prevalence of moderate to severe depressive symptoms among T2DM patients, according to PHQ‐9, was 36.94%, while the prevalence of clinical depression based on interview was 7.64%. Baseline PHQ‐9 scores correlated significantly with baseline levels of HbA1c, HDL, cholesterol and triglycerides. Escitalopram treatment intervention resulted in significant improvement of PHQ‐9 scores without significantly improving any of the metabolic control measures. Conclusion The relationship between depression and T2DM in the context of metabolic syndrome is plausible. However, our results show that escitalopram treatment may not be associated with significant improvement in metabolic control parameters among these patients. Our study has laid the groundwork for future randomised clinical trials with larger sample size and longer follow‐up.

Prevalence Estimates, Severity, and Risk Factors of Depressive Symptoms among Coronary Artery Disease Patients after Ten Days of Percutaneous Coronary Intervention

“…Increased depression risk among DM patients was suggested by our findings, which is concordant with a previous study conducted in Jordan, where it was reported that more than one-third of diabetic patients had depression, according to PHQ-9 [ 13 ]. A case-control study conducted by Anderson et al reported that the odds of depression in diabetic patients were twice as high as those in the non-diabetic comparison group (OR = 2.0, 95% CI 1.8–2.2) [ 70 ].…”

“…Third, PHQ-9 is a screening tool that needs a psychiatrist to conduct a structured clinical interview to confirm depression diagnosis. This could have overestimated the prevalence estimated of depression among our patients with CAD [ 78 , 13 ]. Fourth, the patients’ truthfulness for their responses to the questions asked is controversial as some responses may not have told the truth on purpose to prevent doctors’ concern for mental health rather than cardiovascular health or that negative patients' stigma to state how they really feel.…”

“…Nonetheless, depression is highly prevalent among coronary artery disease (CAD) patients; up to 45% of CAD patients could suffer from clinically significant depressive symptoms, and up to 20% diagnosed with MDD [ 7 - 9 ]. Compared to the general population and those without CAD, CAD patients were found to be two- to three-folds more likely to have a diagnosis of depression [ 10 , 11 ] and similar to the rates of MDD in patients with cancer [ 12 ], and diabetes mellitus (DM) [ 13 ].…”

Depression with Comorbid Diabetes: What Evidence Exists for Treatments Using Traditional Chinese Medicine and Natural Products?

“…Recently, some hospital-based cross-sectional studies have further clarified the comorbidity between DM and depression (Khassawneh et al, 2020;Tusa et al, 2020). In this review, we summarized TCM formulae and natural products with antidiabetic depression activities as well as several mechanisms related to their activities.…”

Impact of Clinical Pharmacist Interventions in Prescribing Errors in Hospitalized Diabetic Patients with Major Polypharmacy

“…Further, Medication safety-related research are rare in the region 19,[25][26][27][28] and diabetic care in Jordan is still primitive. 29 Patients with diabetes need more medical attention to optimize their drug therapy. Therefore, we aimed not only to investigate how clinically significant pharmacist interventions on diabetic patients' prescriptions are, but also to demonstrate feasibility of clinical pharmacy implementation.…”