Abstract
Objectives
To examine the association of depressive symptoms (DS) and diabetes-related distress
(DD) with severe hypoglycemia (SH) in adults with type 2 diabetes.
Methods
Baseline data from a cohort study of adults with type 2 diabetes (N=2,040) were used.
The Patient Health Questionnaire 8-items and Problem Areas in Diabetes 5-items questionnaires
were used to assess DS and DD, respectively. SH was defined as a positive report of
“calling an ambulance or visiting an emergency department because of hypoglycemia
in the past year.” Composite dummy variables for the 2 stratification levels of DS
and DD were computed and used in multivariable logistic regression analyses.
Results
Participants had a mean (± SD) age of 64±11 years, and 45% were female. The average
duration of diabetes was 12±9 years; 3% had moderate to severe DS, 8% had moderate
to severe DD and 5% had moderate to severe levels of both symptoms. Only 4.2% of participants
reported experiencing SH in the past year. The presence of any level of DD (adjusted
OR 2.3; 95% CI 1.3, 3.9) or moderate to severe DD (2.2; 1.1, 4.2) was associated with
increased risk for SH. Combinations of any levels of DD and DS (4.3; 2.5, 7.3) and
moderate to severe DD and DS (2.3; 1.1, 4.8) were associated with increased risk for
SH. The presence of any level of DS alone (1.2; 0.3, 4.9) or moderate to severe DS
(1.7; 0.6, 5.1) was not associated with increased risk for SH.
Conclusions
Patients with type 2 diabetes and symptoms of depression, but not diabetes-related
distress alone, were more likely to experience SH than those without either of these
symptoms.
Résumé
Objectifs
Examiner l'association des symptômes de dépression (SD) et de la détresse liée au
diabète (DD) à l'hypoglycémie grave (HG) chez les adultes atteints du diabète de type
2.
Méthodes
Nous avons utilisé les données initiales d'une étude de cohorte d'adultes atteints
du diabète de type 2 (N = 2040). Nous avons utilisé les questionnaires respectifs
PHQ-8 (Patient Health Questionnaire 8-items) et PAID-5 (Problem Areas in Diabetes 5-items) pour évaluer les SD et la DD. La HG a été définie ainsi lorsqu'elle a nécessité
l'« appel d'une ambulance ou une visite au service des urgences en raison d'une hypoglycémie
au cours de la dernière année ». Nous avons calculé et utilisé les variables factices
composites de 2 niveaux de stratification des SD et de la DD dans les analyses multivariées
de régression logistique.
Résultats
Quarante-cinq pour cent (45 %) des participants, dont l'âge moyen était de 64 ± 11
ans, étaient des femmes. La durée moyenne du diabète était de 12 ± 9 ans, 3 % avaient
des SD modérés à graves, 8 % avaient de la DD modérée à grave et 5 % avaient des niveaux
modérés à graves des 2 symptômes. Seuls 4,2 % des participants rapportaient avoir
subi une HG au cours de la dernière année. La présence de tout niveau de DD (RIR ajusté
2,3; IC à 95 % 1,3, 3,9) ou de DD modérée à grave (2,2; 1,1, 4,2) était associée à
une augmentation du risque de HG. Les combinaisons de tous les niveaux de DD et de
SD (4,3; 2,5, 7,3) et de DD et de SD modérés à graves (2,3; 1,1, 4,8) étaient associées
à une augmentation du risque de HG. La présence de tout niveau de SD seuls (1,2; 0,3,
4,9) ou de SD modérés à graves (1,7; 0,6, 5,1) n'était pas associée à une augmentation
du risque de HG.
Conclusions
Les patients atteints du diabète de type 2 et de symptômes de dépression, mais non
seulement de détresse liée au diabète, étaient plus susceptibles de subir une HG que
ceux qui n'avaient aucun de ces symptômes.
Keywords
Mots clés
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of DiabetesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.N Engl J Med. 1993; 329: 977-986
- The UK Prospective Diabetes Study (UKPDS): Clinical and therapeutic implications for type 2 diabetes.Br J Clin Pharmacol. 1999; 48: 643-648
- Hypoglycemia in type 2 diabetes: Pathophysiology, frequency, and effects of different treatment modalities.Diabetes Care. 2005; 28: 2948-2961
- Drug-induced hypoglycaemia in type 2 diabetes.Expert Opin Drug Saf. 2012; 11: 597-614
- Impact of hypoglycemia on patients with type 2 diabetes mellitus and their quality of life, work productivity, and medication adherence.Patient Pref Adher. 2014; 8: 683-692
- A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education.Patient Educ Couns. 2007; 68: 10-15
- Economic burden of hypoglycemia in patients with type 2 diabetes.Expert Rev Pharmacoecon Outcomes Res. 2012; 12: 47-51
- The psychosocial and financial impact of non-severe hypoglycemic events on people with diabetes: Two international surveys.J Med Econ. 2014; 17: 751-761
- Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes.Diabetes Care. 2002; 25: 464-470
- The prevalence of comorbid depression in adults with type 2 diabetes: A meta-analysis.Diabetes Care. 2001; 24: 1069-1078
- Undertreatment of mental health problems in adults with diagnosed diabetes and serious psychological distress: The behavioral risk factor surveillance system, 2007.Diabetes Care. 2010; 33: 1061-1064
- Severe hypoglycaemia in drug-treated diabetic patients needs attention: A population-based study.Scand J Prim Health Care. 2011; 29: 165-170
- Association of depression with increased risk of severe hypoglycemic episodes in patients with diabetes.Ann Fam Med. 2013; 11: 245-250
- Diabetes distress and its association with clinical outcomes in patients with type 2 diabetes treated with pramlintide as an adjunct to insulin therapy.Diabetes Technol Ther. 2008; 10: 461-466
- Clinical depression versus distress among patients with type 2 diabetes: Not just a question of semantics.Diabetes Care. 2007; 30: 542-548
- The Alberta's Caring for Diabetes (ABCD) Study: Rationale, design and baseline characteristics of a prospective cohort of adults with type 2 diabetes.Can J Diabetes. 2015; 39: S113-S119
- The PHQ-8 as a measure of current depression in the general population.J Affect Disord. 2009; 114: 163-173
- Short-form measures of diabetes-related emotional distress: The Problem Areas in Diabetes Scale (PAID)-5 and PAID-1.Diabetologia. 2010; 53: 66-69
- Measurement of diabetes-related emotional distress using the Problem Areas in Diabetes scale: Psychometric evaluations show that the short form is better than the full form.Health Qual Life Outcomes. 2014; 12: 142
- The Summary of Diabetes Self-Care Activities Measure: Results from 7 studies and a revised scale.Diabetes Care. 2000; 23: 943-950
- A simple method to assess exercise behavior in the community.Can J Appl Sport Sci. 1985; 10: 141-146
- Effect of a self-management program for patients with chronic disease.Effec Clin Prac. 2001; 4: 256-262
- Relationship of depression and diabetes self-care, medication adherence, and preventive care.Diabetes Care. 2004; 27: 2154-2160
- Disease-related distress, self-care and clinical outcomes among low-income patients with diabetes.J Epidemiol Commun Health. 2014; 68: 557-564
- Predictors of hypoglycaemia in insulin-treated type 2 diabetes patients in primary care: A retrospective database analysis.Prim Care Diabetes. 2014; 8: 127-131
- Relationships of diabetes-specific emotional distress, depression, anxiety, and overall well-being with HbA1c in adult persons with type 1 diabetes.J Psychosom Res. 2014; 77: 174-179
- Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses.Diabetes Care. 2010; 33: 23-28
- The PHQ-9: Validity of a brief depression severity measure.J Gen Intern Med. 2001; 16: 606-613
- Assessment of diabetes-related distress.Diabetes Care. 1995; 18: 754-760
- The influence of diabetes on a clinician-related assessment of depression in adults with type 1 diabetes.Diabetes Educ. 2012; 38: 695-704
- Effective interventions for reducing diabetes distress: Systematic review and meta-analysis.Int Diabetes Nurs. 2015; 12: 40-55
- Health promotion by social cognitive means.Health Ed Behav. 2004; 31: 143-164
- Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy?.Diabetes Care. 2006; 29: 823-829
- Impact of baseline patient characteristics on interventions to reduce diabetes distress: The role of personal conscientiousness and diabetes self-efficacy.Diabet Med. 2014; 31: 739-746
- Recall of severe hypoglycaemic episodes and course of hypoglycaemia awareness in insulin-treated type 2 diabetes in one-year follow-up [Abstract].Diabetologia. 2003; 46: A304
Article info
Publication history
Published online: November 14, 2018
Accepted:
November 8,
2018
Received in revised form:
May 16,
2018
Received:
August 8,
2017
Footnotes
The Canadian Diabetes Association is the registered owner of the name Diabetes Canada.
Identification
Copyright
© 2018 Canadian Diabetes Association
ScienceDirect
Access this article on ScienceDirectLinked Article
- Clinical Considerations in Adult Patients With Comorbid Type 2 Diabetes and Depressive Symptoms Associated With Severe HypoglycemiaCanadian Journal of DiabetesVol. 44Issue 4
- PreviewWe read the article written by Al Sayah et al, “Association of depressive symptoms and diabetes distress with severe hypoglycemia in adults with type 2 diabetes” (1). The authors concluded that the presence of any level of diabetes distress (DD) alone, or DD and depressive symptoms (DSs) combined, “was associated with an increased risk for experiencing severe hypoglycemia (SH)” (1). However, DSs alone are not associated with increased risk of SH. As such, the study claims that although DD and DSs have overlapping features, each plays a unique role in contributing to hypoglycemic episodes in type 2 diabetes.
- Full-Text
- Preview