Association of Depressive Symptoms and Diabetes Distress With Severe Hypoglycemia in Adults With Type 2 Diabetes

Published:November 14, 2018DOI:



      To examine the association of depressive symptoms (DS) and diabetes-related distress (DD) with severe hypoglycemia (SH) in adults with type 2 diabetes.


      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.


      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.


      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.



      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.


      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.


      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.


      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.


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      Linked Article

      • Clinical Considerations in Adult Patients With Comorbid Type 2 Diabetes and Depressive Symptoms Associated With Severe Hypoglycemia
        Canadian Journal of DiabetesVol. 44Issue 4
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          We 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.
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