Tag Archives: Depression

Diabetes & Depression Create Adverse Synergy

There’s a clear increase in risk to your health and to your life when you have a combination of diabetes and depression

DIABETES and depression are conditions that can fuel each other. Symptoms of clinical depression include anxiety, feelings of hopelessness or guilt, sleeping or eating too much or too little, and loss of interest in life, people and activities. So, there’s a clear increase in risk to your health and to your life when you have a combination of diabetes and depression.

While diabetes can be a challenge to control, depression can be difficult to treat and keep in remission. Growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia.

What this means is that depression can affect blood sugar levels and insulin metabolism through increased cortisol, contributing to unhealthy eating habits, weight gain and diabetes. On the other hand, management of diabetes can cause chronic stress and strain, which in the long run, may increase risk of depression. The two are linked not only behaviorally, but biologically, says Dr. Frank B. Hu, a professor of medicine at Harvard Medical School.

However, doctors are unsure whether one condition causes the other or if a single underlying factor is responsible for both ailments. If a substantial causal connection is established between the two disorders, it would be rather novel and could potentially change how doctors understand and treat both disorders.

New research findings from the University of California at San Diego further reinforce the view that since depression and diabetes often co-occur, psychiatrists should be aware that depressed patients may be at risk of the metabolic disorder. The findings of the study were presented at the American Psychiatric Association’s 164th annual meeting in Honolulu last week.

In the San Diego study, reported the Los Angeles Times, researchers who reviewed the medical records of a group of 129 Hispanic diabetics discovered that diabetes was diagnosed first in 54 percent of men with both conditions, while depression was the initial diagnosis of 24 percent of men. Of women with both conditions, 59 percent were first discovered to have diabetes, while 29 percent were first diagnosed with depression.

While doctors are typically aware that someone with diabetes is at higher risk for depression, they may not look for mood disorders as a risk factor for developing diabetes, especially anxiety, the authors noted. Among men with diabetes and anxiety, 54% developed diabetes first and 45% developed anxiety first. Among women, 55% developed diabetes first and 39% developed anxiety first.

Latinos are known to have higher rates of type 2 diabetes than the general US population. Additionally, co-occurring mood disorders are common among these individuals. This made this group of patients an ideal population for studying the relationship between mood disorders and type 2 diabetes.

The San Diego researchers said it is unclear why there is this association between the two conditions, but said that their findings show that there is a strong need to monitor individuals with type 2 diabetes for future mental health issues as the metabolic condition appears to precede mood disorders.

Another research, conducted at Harvard University, found that study subjects who were depressed had a much higher risk of developing diabetes, and those with diabetes had a significantly higher risk of depression, compared to healthy study participants.

A study carried out by the German Diabetes Association (DDG) has also shown that depression can heighten the risk of developing type 2 diabetes as the mental illness also increases the likelihood of obesity and failing to take enough exercise.

The Chennai (India) Urban Rural Epidemiological Study involving around 23,000 participants found that depression can increase the risk of diabetes due to increased levels of counter-regulatory hormones, which can lead to obesity, insulin resistance and glucose intolerance. “The lesson in this is that not only should we treat diabetics for depression, but that by treating depression, the person may actually be able to side-step diabetes,” said co-author Dr. V Mohan.

The American Diabetes Association advises that individuals with type 2 diabetes should consider seeking mental health help if they begin to feel three or more common symptoms of depression, which may include loss of pleasure, loss of appetite, sadness, trouble concentrating and suicidal thoughts.

The bottom line: Since diabetes and depression can influence each other and thus become a vicious cycle, primary prevention of diabetes is important for prevention of depression, and vice versa.

Sources: American Psychiatric Association, American Diabetes Association

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Diabetes Management: Telephonic CBT Counseling for Diabetics with Depression Can Improve Treatment Outcomes

A NEW investigative study by researchers at VA Ann Arbor Healthcare System and University of Michigan Health System shows that telephonic intervention can improve patients’ access to effective depression care, improve their cardiovascular health and get them moving again, reports Endocrine Web.

As is well known, depression is a common, treatable issue for many people who have diabetes but most busy clinics cannot provide the level of intensive care these patients need. In many cases this proves to be a major hurdle for diabetics in maintaining the strict medication regimen or exercise schedule.

Patients with diabetes and depression often have self-management needs that require between-visit support. The study evaluated the impact of telephone-delivered cognitive behavioral therapy (CBT) targeting patients’ management of depressive symptoms, physical activity levels, and diabetes-related outcomes.

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The research team worked over a year to improve diabetes patients’ health by first addressing their depression. The program began with behavioral therapy sessions over the telephone with a specially trained nurse and later phased in a walking program. This was done because delivering therapy by telephone makes it feasible to reach large numbers of patients who may not attend traditional in-person appointments.

For the investigation, researchers divided a group of 291 participants with type 2 diabetes and significant depressive symptoms into two groups. One group received standard care, while the other segment was put through a year-long intervention program, which consisted of 12 weeks of cognitive behavioral therapy and nine months of supplemental phone checkups.

The findings ‒ published online ahead of print in Medical Care ‒ showed the intervention was successful in lowering patients’ blood pressure, increasing their physical activity by about four miles of walking per week and easing their depressive symptoms. At the end of the year, 58 percent of patients who received the intervention had depression symptoms that were in remission, compared to only 39 percent of the patients who did not receive counseling.

Even Telephonic Intervention Improves Diabetes Control

The cognitive behavior therapy helped the study participants address negative thought processes and behaviors that made it difficult for them to manage their diabetes and make healthy lifestyle choices.

The physical activity component of the program used pedometers to help patients set walking goals and monitor their progress. Earlier studies have shown that along with physical benefits, exercise also helps boost one’s mood.

Indeed, patients with depression and additional chronic medical conditions do better, as the study demonstrates, if their depression is addressed first, if it is addressed systematically, and if exercise is also encouraged.

Most patients entered the study with relatively good blood glucose control. So while the intervention did not lead to a drop in A1C ‒ a common measurement of blood glucose levels ‒ patients did see more than a 4-point improvement in their systolic blood pressure, walked about half a mile more per day and reported an improvement in their general quality of life.

“This study shows that telephone-delivered counseling can improve patients’ access to effective depression care, improve their cardiovascular health and get them moving again,” said lead author John Piette.

In view of this study, “health systems should consider routinely offering structured telephone psychotherapy to their patients with diabetes and depression,” concluded senior study author Marcia Valenstein.

(The research was funded by grants from the National Institutes of Health, Michigan Diabetes Research and Training Center and the Michigan Institute for Clinical and Health Research.)

Don’t Take Diabetes Lightly ‒ It Can Even Lead To Suicide

There is a general attitude that diabetes is a treatable disease, that’s it’s no big deal, that you just take medicine and you have a normal life.

The truth is diabetics have a 2.5 increased rate of death, meaning people with diabetes are 80 percent more likely to die prematurely than those without the disease.

A new British analysis ‒ published in the March 3 issue of the New England Journal of Medicine ‒ confirms that diabetes is associated with higher mortality.

And it’s not just diabetes that’s killing them. Besides dying from vascular problems caused by diabetes, people with the blood sugar disease are also more likely to die prematurely from many other causes, including cancer, infections, falls, liver disease, mental disorders and even suicide.

Although all the reasons that result in the greater risk of death among diabetics aren’t known, high blood sugar and inflammation are key players. These can decrease the body’s ability to fight off infections and even cancer.

A team lead by John Danesh, a professor of epidemiology and medicine at the University of Cambridge in the UK analyzed deaths among 820,900 people who took part in 97 studies. Among those in these studies, 123,205 died.

The risk of premature death was closely associated with blood sugar levels, with an excess risk of death at blood glucose fasting levels exceeding 100 milligrams per deciliter. There was no excess risk of death at fasting levels of 70 to 100 mg per dL, the researchers found.

The risk of dying from vascular disease, not surprisingly, was much higher in people with diabetes. But people with diabetes were also at increased risk for death from liver and kidney disease, pneumonia, other infectious diseases and chronic obstructive pulmonary disease, among other ills.

Danesh’s team also found that people with diabetes were 25 percent more likely to die from cancer, with scientists finding a moderate association between the disease and death from liver cancer, pancreatic cancer, ovarian cancer, colorectal cancer, and lung, bladder or breast cancer. They were also 70 percent more likely to die from falls than people without diabetes.

In addition, diabetics were 64 percent more likely to die from mental disorders and 58 percent more likely to die from suicide, mostly because they were more likely to be depressed. Indeed, another study showed that management of diabetes can cause chronic stress and strain, which in the long run, may increase risk of depression – the two are linked not only behaviorally but biologically. (See my post ‘Diabetes, Depression Can be a Two-Way Street’ here.)

Broken down, the hazard ratios for people with diabetes vs. people without diabetes were:

  • 2.32 for death from vascular causes
  • 1.80 for death from any cause
  • 1.73 for death from other causes
  • 1.25 for death from cancer

Summing up, the study authors write: “These findings highlight the need to better understand and prevent the multi-system consequences of diabetes.”

The challenge before researchers therefore is to continue to find a cure and to prevent diabetes ‒ it cannot just be managed with drugs.

Diabetes May Be Caused By Depression

While it is common knowledge that having a chronic disease increases chances of depression in patients, here is evidence that indicates depression could also be a factor in causing chronic diseases such as diabetes.

A paper published in Diabetes Technology and Therapeutics, 2010, from Chennai showed higher levels of depression among those newly detected with diabetes and those with impaired glucose tolerance, as against those who had normal blood sugar levels.

Authored by S. Poongothai of Madras Diabetes Research Foundation, based in Chennai in south India, as part of a series of articles she worked on for her Ph.D, the paper is significant in that the tests were done in the community and the depression noted before blood sugar tests were done.

Co-author V. Mohan, who heads Dr. Mohan’s Diabetes Specialities Centre, says, “What this article flags off is the idea that depression itself may be a likely cause of diabetes.”

The subjects for the study were recruited from the Chennai Urban Rural Epidemiological Study. Of the total of over 23,000 persons tested, there were 1218 people with newly- detected Diabetes (NDD), 7,657 with impaired fasting glucose (IFG); and 14, 912 with normal fasting glucose (NFG).

While the overall prevalence of depression was 14.3 per cent, an increasing prevalence was seen with increasing grades of glucose tolerance: NFG (13.1 per cent), IFG (15.7 per cent) and NDD (19.7 per cent), being higher among women at all grades.

Depression can increase the risk of diabetes due to increased levels of counter-regulatory hormones, which can lead to obesity, insulin resistance and glucose intolerance, Dr. Poonothai says in the paper. “The lesson in this is that not only should we treat diabetics for depression, but that by treating depression, the person may actually be able to side-step diabetes,” Dr. Mohan explains.

His recommendation is also that everyone with depression must be screened for diabetes as well.

Depression Sufferers Live With Higher Risk of Diabetes

Depression can heighten the risk of developing type 2 diabetes as the mental illness also increases the likelihood of obesity and failing to take enough exercise, a study carried out by the German Diabetes Association (DDG) has shown, reports DPA.

Bouts of depression can also lead to higher levels of the stress hormone cortisol in the blood. Cortisol, also known as hydrocortisone, counteracts insulin and contributes to type 2 diabetes, which is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency.

It is recommended that those suffering from depression undergo tests for the disease as they are 11 times more likely to suffer vascular complications than people battling diabetes alone. The risk of damage to arteries, which could lead to a heart attack, is between two and five times as high.

According to the DDG, not only are people with depression at increased risk of developing type 2 diabetes, those with diabetes are also at increased risk of developing depression.

The consequences can be serious as treatment for diabetes requires the active involvement of the patient. “Depression is a major barrier in such instances,” explains Bernhard Kulzer, chairman of the DDG’s psychology council.

Complications that can result from improperly managed type 2 diabetes include renal failure, blindness and arterial disease, including coronary artery disease. The DDG recommends that diabetics suffering from depression undergo psychological treatment.

Preventing Diabetes And Literacy Key To Beat Dementia

According to a BBC report, preventing diabetes and depression could have a dramatic impact on cutting cases of dementia, a study suggests. Boosting levels of education and upping fruit and vegetable consumption would also have a big effect, the British Medical Journal said. It comes as another study showed dementia patients are missing out on vital early treatments because GPs are being slow to diagnose them.

Several risk factors for the disease have been identified, including obesity, high blood pressure and high cholesterol. But British and French researchers wanted to assess what public health interventions could have the biggest impact on reducing the burden of dementia in the population.

They took a group of 1,400 elderly people and tested them for signs of dementia after two, four and seven years. Alongside this they recorded height, weight, education level, monthly income, mobility, dietary habits, alcohol consumption, and tobacco use and asked participants to do a reading test as a measure of intelligence.

Eliminating depression and diabetes and increasing fruit and vegetable consumption were estimated to lead to an overall 21% reduction in new cases of dementia. Increasing education would also lead to an estimated 18% reduction in new cases of dementia across the general population over the next seven years, they reported. By contrast, removing a gene linked with the disease would only cut new cases by 7%.

The team concluded that early screening for diabetes and treatment of depression would be the most useful approach for trying to reduce the future burden of dementia. And they added that encouraging literacy at all ages and trying to increase population intake of fruit and vegetables would also have an important effect but admitted that these aims were harder to achieve. Further studies including younger adults are needed to test the impact of such approaches, they added.

In the second study also in the BMJ, analysis of health records of over 135,000 people in the UK found that people with dementia were three times more likely to die in the first year after diagnosis than those without the condition.

That suggests that diagnoses are being made in the later stages of the disease.
Study leader Dr Greta Rait from the Medical Research Council said: “GPs are going to be dealing with more and more dementia cases in future and primary care must get better at detection.”

Rebecca Wood, chief executive of the Alzheimer’s Research Trust, said the links between depression, diabetes and dementia were well known. “Any policy that urges clear diagnosis and monitoring of these conditions could help make an impact on dementia.

“What is painfully evident from the study is the gaping hole that remains in our understanding and ability to diagnose or treat dementia effectively, a hole that can only be filled by more research.”

Professor Clive Ballard, director of research at the Alzheimer’s Society said a healthy lifestyle is key. “Effective prevention of diabetes, depression and heart disease could potentially improve the lives of millions of people affected by this cruel condition and reduce the billions spent on dementia care each year.”

Dr Victoria King, head of research at Diabetes UK, said there is a growing body of evidence suggesting links between diabetes and Alzheimer’s disease. “Finding ways to stop the type 2 diabetes epidemic in its tracks can only be seen as a good thing – especially as this could prevent millions of people developing the serious complications of the condition, which include heart disease, stroke, kidney failure, blindness and amputation.”

State Of Mind And Healing Linked In Diabetes Foot Ulcer Study

Scientists have found that healing of diabetes related foot ulcers differs depending on psychological state of mind. Researchers found a link between how patients with diabetes cope with potentially life threatening foot ulcers and rates of healing.

The results of the study showed that anger, frustration and depression over potentially life threatening wounds associated with microvascular diabetes complications slows the rate of healing.

Professor Kavita Vedhara from the University of Nottingham says, “My colleagues and I believe that this confrontational approach may, inadvertently, be unhelpful in this context because these ulcers take a long time to heal. As a result, individuals with confrontational coping may experience distress and frustration because their attempts to take control do not result in rapid improvements.” Depression was also linked to poor wound healing of diabetes related foot ulcers.

Patients with diabetics ulcers of the feet that can lead to amputation were monitored over a 24-week period. Researchers analysed psychological distress, coping style and levels of cortisol in saliva ( a stress hormone) among 93 men and women recruited form specialist podiatry clinics across the UK.

The results revealed a link between the way diabetics cope with foot ulcers and the way they heal. In a secondary analysis the scientists also found that depression also resulted in slower healing of foot ulcers.

The study suggests depression anger and frustration with diabetes related foot ulcers can delay wound healing. Diabetics with a desire to take control or who used a “confrontational” approach to managing foot ulcers were less likely to have healed at the end of the 24 weeks of monitoring, as were those with depression.

The findings are significant. Diabetic foot ulcers develop in up to 15 percent of patients with diabetes and can lead to early mortality. Treating depression and anxiety could have a significant impact on quality of life for patients with diabetes related foot ulcers, found in the study to heal at different rates, depending on how patients cope with the condition. Psychological state of mind was found to be a factor affecting healing of diabetes-related foot ulcers.

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