Diabetes and Depression – A Burdensome Co-morbidity

Diabetes and Depression – A Burdensome Co-morbidity

Hermanns Norbert, Kulzer Bernhard
European Endocrinology - Volume 4 - Issue II
Published: February 2009
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Diabetes and Depression
Depression is a frequent co-morbid condition in people with diabetes. A meta-analysis of 42 studies demonstrated that 31% of patients with diabetes described themselves as having elevated depressive symptoms compared with 14% of those without diabetes. A clinical depression diagnosis based on standardised criteria defined by the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) or the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) occurred in 11.4% of patients with diabetes, whereas the prevalence in people without diabetes was 5%.1

In clinical care settings this means that out of 100 patients with diabetes, approximately 11–12 meet the diagnostic criteria for clinical depression and another 20 have mild or subthreshold depression. Thus, approximately every third patient with diabetes is affected by depression or elevated depressive symptoms. The reasons for this close association between diabetes and depression are not yet fully understood. Below we will discuss three possible explanations. First, diabetes could be a consequence of depression. This was first suggested 300 years ago by the British physician Thomas Willis, who thought that diabetes might be a consequence of prolonged sorrows.2 In more recent years this historical observation has been supported by growing empirical evidence. A meta-analysis showed that the presence of depressive symptoms increased the risk of developing diabetes by 37%.3 The reason for this timely relationship between depression and diabetes manifestation is unclear. It could be that people with elevated depressive symptoms are less attentive towards a healthy lifestyle, therefore increasing their risk for type 2 diabetes. Alternative explanations for this finding refer to chronic dysregulations of the hypothalamic–pituitary–adrenal (HPA) axis such as high cortisol levels and reduced insulin sensitivity or an activation of the immune system leading to or fostering chronic inflammatory processes4 (see Figure 1). A second explanation for the close relationship between depression and diabetes comes from the observation that depressed patients with diabetes also report a high amount of diabetes-related distress.5,6 In a clinical survey, only 14.7% of patients with low or no depression reported a high amount of diabetes-related distress. However, 56.3% of patients with mild depression and 73.6% with more severe clinical depression suffered from diabetes-related distress.6 It might be that in vulnerable patients a high amount of diabetes-related distress or a deficit in coping with diabetes-related problems could result in elevated depression symptoms. A third explanation stems from study results indicating that blood glucose is itself a potent regulator for mood states. In particular, hypoglycaemia or severe hyperglycaemia are able to induce negative emotional states in patients with diabetes.7–9

It may be that these three possible explanations for the close association between diabetes and depression are not exclusive. While the understanding of the causes for the high co-morbidity of diabetes and depression clearly needs further research, there is cumulating evidence about the negative sequelae of depression in diabetes.

Depression and Quality of Life
An optimal quality of life is one of the primary objectives of diabetes therapy. Depression in diabetes impairs quality of life in patients with diabetes. In an Australian survey, depression was associated with poorer quality of life in all eight quality of life dimensions (physical functioning, role limitations due to impaired physical health, bodily pain, general health, vitality, social functioning, role limitations due to impaired emotional health and mental health) in patients with diabetes.10 A recently published World Health Organization (WHO) World Health Survey about the impact of depression on quality of life in different chronic diseases (arthritis, asthma, angina and diabetes) showed that quality of life was most impaired in patients with diabetes and depression.11

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References:
  1. Anderson RJ, Freedland KE, Clouse RE, Diabetes Care, 2001;24(6):1069–78.
  2. Willis T, Pharmaceutice rationalis sive diabtriba de medicamentorum operantionibus in humano corpore, MDCLXXV, Oxford, 1675.
  3. Knol MJ, Twisk JW, Beekman AT, et al.,Diabetologia, 2006;49(5):837–45.
  4. Pickup JC, Diabetes Care, 2004;27(3):813–23.
  5. Fisher L, Skaff MM, Mullan JT, et al., Diabetes Care, 2007;30(3):542–8.
  6. Hermanns N, Kulzer B, Krichbaum M, et al., Diabetologia, 2006;49(3):469–77.
  7. Gold EA, MacLeod KM, Deary IJ, Frier BM, Physiol Behavior, 1995;58:501–11.
  8. Hermanns N, Kubiak T, Kulzer B, Haak T, Biol Psychol, 2003;63(1):15–44.
  9. Hermanns N, Scheff C, Kulzer B, et al., Diabetologia, 2007;50(5):930–33.
  10. Goldney RD, Phillips PJ, Fisher LJ, et al., Diabetes Care, 2004;27(5):1066-–70.
  11. Moussavi S, Chatterji S, Verdes E, et al., Lancet, 2007;370(9590):851–8.
  12. Ciechanowski PS, Katon WJ, Russo JE, Arch Intern Med, 2000;160(21):3278–85.
  13. Katon WJ, Von Korff M, Lin EH, et al., Arch Gen Psychiatry, 2004;61(10):1042–9.
  14. Gonzales JS, Peyrot M, McCarl LA, et al., Diabetes Care, 2008;31(12):2398–2403.
  15. Lustman PJ, de Groot M, Anderson RJ, et al., Diabetes Care, 2000;23:934–42.
  16. Black SA, Markides KS, Ray LA, Diabetes Care, 2003;26(10): 2822–8.
  17. Egede LE, Nietert PJ, Zheng D, Diabetes Care, 2005;28(6):1339–45.
  18. Zhang X, Norris SL, Gregg EW, et al., Am J Epidemiolo, 2005;161(7):652–60.
  19. Katon WJ, Rutter C, Simon G, et al., Diabetes Care, 2005;28(11):2668–72.
  20. Egede LE, Zheng D, et al., Diabetes Care, 2002;25(3): 464–70.
  21. Egede LE, Diabetes Care, 2004;27(7):1751–3.
  22. Egede LE, Diabetes, Diabetes Care, 2004;27(2):421–8.
  23. Peyrot M, Rubin RR, Diabetes Care, 1999;22(3):448–52.
  24. Hermanns N, Kulzer B, et al., Diabetes, 53(Suppl. 2):A16.
  25. Lustman PJ, Griffith LS, Clouse RE, et al., Psychosomatic Medicine, 1997;59(3):241–50.
  26. Lustman PJ, Griffith LS, Freedland KE, et al., Ann Intern Med, 1998;129(8):613–21.
  27. Lustman PJ, Freedland KE, Griffith LS, Diabetes Care, 2000;23(5):618–23.
  28. Lustman PJ, Clouse RE, Nix BD, et al., Arch Gen Psychiatry, 2006;63(5):521–9.
  29. Paile-Hyvarinen M, et al., BMC Fam Pract, 2007;8(1):34.
  30. NIH, 4. Guideline: Depression co-orccuring with other general medical disorders, 1993.
  31. Rubin RR, Ciechanowski P, Egede LE, et al., Current Diabetes Reports, 2004;4(2):119–25.
  32. Pouwer F, Beekman AT, Lubach C, Snoek FJ, Patient Educ Couns, 2006;60(2):235–40.
  33. ADA, Diabetes Care, 2007;30(Suppl. 1):S4–41.
  34. Petrak F, Herpertz S, Kulzer B, Rose M, Results of the German Multicenter Diabetes Cohort Study (GMDC-Study), 2005.
  35. IDF Clinical Guidelines Task Force, Global guidelines for type 2 diabetes. Brussels: International Diabetes Federation, 2005.
  36. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Can J Diabetes, 2003;27(Suppl. 2):1–152.
  37. National Screening Committee, The UK´s National Screening Committee´s criteria for appaising the viability, effectiveness and appropriateness of a screening programme, 2007. Available at: www.nsc.nhs.uk/pdfs/criteria.pdf
  38. Peyrot M, Rubin RR, Diabetes Care, 1997;20(4):585–90.
  39. Hermanns N, Kulzer B, Krichbaum M, et al., Diabet Med, 2005;22(3):293–300.
  40. Arroll B, Khin N, Kerse N, BMJ, 2003;327(7424):1144–6.
  41. Lustman PJ, Clouse RE, Griffith LS, et al., Psychosomatic Medicine, 1997;59(1):24–31.
  42. Awata S, Bech P, Yoshida S, et al., Psychiatry Clin Neurosci, 2007;61(1):112–19.
  43. Gilbody S, Bower P, et al., Br J Psychiatry, 2006;189:297–308.
  44. Gilbody S, Sheldon T, et al., BMJ, 2006;332(7548):1027–30.
  45. Gilbody S, House AO, Sheldon TA, Cochrane Database of Systematic Reviews, 2005;(4):CD002792.
  46. Simon GE, Katon WJ, Lin EH, et al., Arch Gen Psychiatry, 2007;64(1):65–72.

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