Naslov
Interaction of depressive symptoms and diabetes-related distress with glycemic control in type 2 diabetic patients

Autori
Pibernik-Okanović, Mirjana ; Begić, Dražen ; Szabo, Silvija ; Renar, Ivana, Metelko, Željko

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Diabetologia Vol 50 (Suppl 1), 2007 / Gale, Edwin - Heidelberg : Springer, 2007, S72-S72

Skup
43rd EASD (European Association for the Study of Diabetes) Annual Meeting

Mjesto i datum
Amsterdam, Nizozemska, 18.09.2007. - 21.09.2007

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
depression ; diabetes-related distress ; type 2 diabetes ; glycemic control

Sažetak
Background and aims: Psychological well-being and diabetes self-management have been shown to be interdependent. However, associations between psychological symptoms and glycemic control are not quite consistent. This study was aimed at examining patterns of glycemic control in emotionally burdened subgroups versus symptom- free individuals with type 2 diabetes. Materials and Methods: A random sample of 470 type 2 diabetic patiens (aged 58± 8yrs, 52% female, with diabetes duration of 9± 6 yrs, 33% insulin treated) were assessed for depression and diabetes-related distress by using the Center for Epidemiologic Studies-Depression (CES-D) and the Problem Areas in Diabetes (PAID) scales. Relying on the standard cut offs (CES-D>16, PAID>40), four discrete subgroups were analysed: patients with severe depressive symptoms and high diabetes distress, patients with severe depressive symptoms only, patients with high diabetes-related distress only and symptom-free patients. The indicators of glycemic control, as determined by Hba1C values, were analysed at the point of psychological assessment and after one year. Pearson's correlation coefficients were used to determine univariate associations between glycemic control, disease-related and psychological variables. Analysis of covariance was used to compare glycemic control in the four groups while controlling for the disease-related variables. Results: Twelve percent of the examined patients suffered severe depressive symptoms combined with high diabetes-related distress, 10% reported severe depressive symptoms, 22% expressed high distress and 56% were symptom-free. The entire group's glycemic control was associated with diabetes duration (r=0, 14 p<0.05), diabetes therapy (r=0.17 p<0.05), body mass index (r=0.12 p<0.05), the CES-D scores (r=0.10 p<0.05) and the PAID scores (r=0.27 p<0.05). After controlling for diabetes duration, diabetes therapy and body mass index, the four groups differed with respect to glycemic control (F=8.25 p<0.0001). The Tukey 's HSD for unequal N indicated that the HbA1C values were significantly higher in depressed-distressed group vs depressed group (8.6%± 1.6 vs 7.3% ± 1.3 p=0.0003) and symptom-free group (8.6%± 1.6 vs 7.6%± 1.4 p=0.005). Depressed group had lower HbA1C values than distressed group (7.3%± 1.3 vs 8.1± 1.7 p=0.05). After one-year follow-up, glycemic control remained associated with depressive symptoms and diabetes-related distress after controlling for diabetes-related variables (F=6.94 p=<0.0001). Between group differences were significant for depressed-distressed vs depressed group (8.2%± 1.7 vs 7.3%± 1.3). While distressed group improved glycemic control during a one-year follow-up period (8.2± 1.7 to 7.6± 1.3 p=0.0004), the depressed-distressed and depressed groups did not (8.6%± 1.6 vs 8.2%± 1.8 p=0.11 and 7.3± 1.3 vs 7.2± 1.3 p=0.95 respectively). Conclusions: Depressive symptoms and diabetes-related distress were both cross-sectionally and longitudinally shown to adversely interact with glycemic control. Patients suffering from severe depressive symptoms and high diabetes-related distress seem to have the greatest difficulties in achieving good glycemic control. Screening for both may be recommended in order to provide appropriate psychological help and to improve glycemic control.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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