Elevated Depressive Symptoms and Disability Among Patients Newly Diagnosed with Diabetes

Depression and new diagnosis of diabetes in older adults can increase time to disability.

Diabetes-related disabilities affect people who are elderly in many ways. It can reduce quality of life, lead to institutionalization, and add a major economic burden on the patient. Depressive symptoms have shown to correlate with medical issues in late life. In seniors who are newly diagnosed with diabetes, there is an even greater elevation in depressive symptoms due to several factors. The symptoms of diabetes can consist of decreased  energy, frequent urination, recurrent infections and other symptoms that can lead to lower quality of life. The adjustment of a person who is newly diagnosed with diabetes can include changes in one’s lifestyle, such as dietary changes, medication management, and establishing an exercise routine.

In studies on chronic disease, health outcomes get worse over time when depressive symptoms are present. There are few studies to show the trajectory of depressive symptoms and worsening conditions among newly diagnosed patients with diabetes. The following study aimed to understand if the trajectory of disability before and after diabetes diagnosis is different in older adults with or without depressive symptoms. This study used a longitudinal data set from the Health and Retirement Study (HRS). It tracked around 20,000 people over 50 years of age every 1-2 years for 10 years and asked multiple health-related questions. Data indicating new onset of diabetes, age over 55, and complete depressive symptoms and disability data were included. A total of 419 participants were eligible and data was collected during five different waves that spanned 10 years. Waves included were waves 9-12 with 12 being the most recent from 2012-2014. Disability was measured by 5 activities of daily living (ADL) and instrumental ADL (IADL) tasks. Depressive symptoms were measured by the 8 item Center of Epidemiologic Studies Depression Scale.

Results found differences in disability among the different waves of participants. Post hoc analysis was done for waves 8-12 and significant difference between groups was found for disability after the onset of diabetes in waves 10 and 11 but no difference in wave 12. No significant difference was found before the onset of diabetes in waves 8 and 9. Small-to-moderate effect sizes were found from waves 10 to 12 and negligible effect sizes were found at waves 8 and 9.

Examining data within groups, among adults with elevated depressive symptoms, those diagnosed with diabetes (waves 10-12) had significantly more disability than with a diagnosis of prediabetes (wave 8 and 9). Up to 15% of those with elevated depressive symptoms reported difficulty with 10 ADL and IADL tasks versus up to 8.5% of those with no depressive symptoms. Those with elevated depressive symptoms 1 in 7 adults reported difficulty dressing and shopping and 1 in 10 reported difficulty walking and meal preparation.

An older adult with elevated depressive symptoms and a new diagnosis of diabetes has a faster trajectory to disablement than someone without depressive symptoms at diabetes diagnosis according to this study. Clinically overt disability occurred by 2 years and was still present at 4 years when the patient had elevated depressive symptoms at the time of diabetes diagnosis.

Practice Pearls:

• Elevated depressive symptoms in the elderly can increase chances of disability when newly diagnosed with diabetes.
• Activities of daily living tasks are more difficult to do with elevated depressive symptoms.
• Early treatment is important for older adults newly diagnosed with diabetes and who have depression as disability emerged within 2 years of diabetes diagnosis.

Reference:

Chao-Yi Wu, Lauren Terhorst, Jordan F. Karp, Elizabeth R. Skidmore, Juleen Rodakowski Trajectory of Disability in Older Adults With Newly Diagnosed Diabetes: Role of Elevated Depressive Symptoms. Diabetes Care (2018), dc180007; DOI: 10.2337/dc18-0007

Angela Reyes, Pharm.D. Candidate, LECOM College of Pharmacy