Depression Linked to HbA1c Levels
in Patients With Type 1 But Not Type 2 Diabetes
Type 1 diabetes appears to be associated with
depressive symptoms and glycosylated hemoglobin
(HbA1c) levels, according to the findings of a
new cross-sectional observational study.
Nearly a third of patients with diabetes may
experience significant depressive symptoms, and
about 10% may experience major depression, although
studies have found conflicting results on this
association.
To evaluate this issue further, Paul S. Ciechanowski,
MD, MPH, Department of Psychiatry and Behavioral
Sciences, University of Washington, Seattle, United
States, and colleagues conducted a study of 276
type 1 and 199 type 2 diabetics.
The researchers collected self-reported data
on depressive symptoms, complications, medical
comorbidity, diabetes symptoms, diabetes self-care
behaviors, physical functioning, and demographics.
They found that among patients with type 1 and
2 diabetes, those that reported depressive symptoms
(SCL-20 score > 1.72) were more likely to report
diabetes symptoms, poorer physical functioning,
and poor adherence to exercise regimens and diet
(P<.0001 for all measures) than those with
SCL-20 score below 1.72.
A significant association between depressive
symptoms and HbA1c levels was found, however,
in only type 1, but not type 2 diabetic patients.
Of depressed patients with type 1 diabetes, 66.7%
reported HbA1c levels over 8%, compared to only
38.6% of depressed patients with type 2 diabetes
(P=.02).
According to the researchers, these results are
consistent with other studies that suggest the
impact of depression on glucose control is considerably
greater for type 1 diabetic patients, whether
it is mediated through its effect on self-care
behaviors or via central effects, such as by influencing
the hypothalamic-pituitary adrenal axis.
"The clinician treating diabetic patients
should strive to recognize depression among these
patients because of the strong possibility that
diabetes symptoms, physical functioning, diabetes
self care and HbA1c levels may all improve with
depression treatment," Dr. Ciechanowski and
colleagues conclude. Gen Hosp Psychiatry 2003;25:4:246-252
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FACT: The average American consumes
almost two teaspoons of salt a day, almost double
the highest level recommended.
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