Depression and Diabetes Impact of Depressive Symptoms on Adherence, Function, and Costs

Box 356560, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 12/2000; 160(21):3278-85. DOI: 10.1001/archinte.160.21.3278
Source: PubMed

ABSTRACT Depression is common among patients with chronic medical illness. We explored the impact of depressive symptoms in primary care patients with diabetes on diabetes self-care, adherence to medication regimens, functioning, and health care costs.
We administered a questionnaire to 367 patients with types 1 and 2 diabetes from 2 health maintenance organization primary care clinics to obtain data on demographics, depressive symptoms, diabetes knowledge, functioning, and diabetes self-care. On the basis of automated data, we measured medical comorbidity, health care costs, glycosylated hemoglobin (HbA(1c)) levels, and oral hypoglycemic prescription refills. Using depressive symptom severity tertiles (low, medium, or high), we performed regression analyses to determine the impact of depressive symptoms on adherence to diabetes self-care and oral hypoglycemic regimens, HbA(1c) levels, functional impairment, and health care costs.
Compared with patients in the low-severity depression symptom tertile, those in the medium- and high-severity tertiles were significantly less adherent to dietary recommendations. Patients in the high-severity tertile were significantly distinct from those in the low-severity tertile by having a higher percentage of days in nonadherence to oral hypoglycemic regimens (15% vs 7%); poorer physical and mental functioning; greater probability of having any emergency department, primary care, specialty care, medical inpatient, and mental health costs; and among users of health care within categories, higher primary (51% higher), ambulatory (75% higher), and total health care costs (86% higher).
Depressive symptom severity is associated with poorer diet and medication regimen adherence, functional impairment, and higher health care costs in primary care diabetic patients. Further studies testing the effectiveness and cost-effectiveness of enhanced models of care of diabetic patients with depression are needed. Arch Intern Med. 2000;160:3278-3285.

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    • "Based on the results of the meta-analysis, the aggregate estimate of the prevalence of depression was 21% for patients with type 1 diabetes, and 27% for patients with T2DM (Anderson et al., 2001). The clinical relevance of this finding is emphasized by results which indicate that patients with depressive symptoms have poorer diet and medication adherence, functional impairment and higher healthcare costs (Ciechanowski, Katon, & Russo, 2000). Moreover, depressive symptoms are significantly associated with a variety of diabetes complications including retinopathy, nephropathy, neuropathy, macrovascular complications and sexual dysfunction (de Groot, Anderson, Freedland, et al., 2001). "
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    ABSTRACT: To determine the relationship between ABC goal attainment, depression, and health-related quality of life (HRQoL) among a national sample of patients with type 2 diabetes (T2DM). A retrospective, cross-sectional analysis was performed examining 808 non-pregnant patients ≥20years old with T2DM from the National Health and Nutrition Examination Survey (NHANES) 2007-2012. ABC goals were defined as HbA1c<7%, BP<130/80mm Hg, and LDL-C<100mg/dL. Patient characteristics associated with ABC goal attainment were examined. Overall, 23.7% of participants achieved simultaneous ABC goals. Severe depression was significantly associated with lower rates of ABC goal attainment compared to those with no depression (5.0% vs. 25.4%, p=0.048). ABC goal attainment rates were lower among females, Hispanic and non-Hispanic black minority groups, and patients with a duration of diabetes over five years, while increased visits with health care professionals were significantly associated with meeting all three ABC goals for patients with T2DM. The relationship between simultaneous ABC goal attainment, depression and HRQoL is complex. Patients with T2DM unable to meet ABC goals may benefit from increased contact with health care professionals. Copyright © 2015. Published by Elsevier Inc.
    Journal of Diabetes and its Complications 04/2015; 29(6). DOI:10.1016/j.jdiacomp.2015.04.009 · 3.01 Impact Factor
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    • "c o m [13] [14] [15] [16]. Most investigations are specifically related to depression among persons with diabetes [17] [18] [19] [20] [21] [22], whereas health care utilization and expenditures of persons with diabetes comorbid with anxiety disorder are seldom discussed. More importantly, to date, few or none have provided information about the time factors associated with health care utilization and expenditures in persons with diabetes. "
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    ABSTRACT: The aim of this study was to investigate and compare health care utilization and expenditures between persons with diabetes comorbid with and without anxiety disorder in Taiwan. Health care utilization and expenditures among persons with diabetes with and without comorbid anxiety disorder in the period 2000-2004 were examined using the Taiwan's National Health Insurance claims data. Health care utilization included outpatient visits and use of hospital inpatient services, while expenditures included outpatient, inpatient and total medical expenditures. General estimation equation (GEE) models were used to analyze the factors associated with outpatient visits and expenditures, and multiple logistic regression analysis was applied to identify factors associated with hospitalization. In the study period, the average number of annual outpatient visits was 43.11-50.37 and 29.82-31.42 for persons with diabetes comorbid with anxiety disorder and for those without anxiety disorder, respectively. The average annual total expenditure was NT$74,875-92,781 and NT$63,764-81,667, respectively. Controlling for covariates, the GEE models revealed that age and time were associated with outpatient visits. Income and time factor were associated with total expenditure. Health care utilization and expenditures for persons with diabetes with comorbid anxiety disorder are significantly higher than those without anxiety disorder. The factors associated with health care utilization and expenditures are age, income and time. Copyright © 2015. Published by Elsevier Inc.
    General hospital psychiatry 04/2015; 37(4). DOI:10.1016/j.genhosppsych.2015.04.008 · 2.61 Impact Factor
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    • "The typical symptoms of diabetes include polyuria, polyphagia and polydipsia as well as the elevation of blood glucose level (Alberti et al., 1998; Cooke and Plotnick, 2008). Despite the symptoms of diabetes mellitus and psychiatric disorders (e.g., anxiety and depression) are very much non-overlapping, these two disorders are somehow co-occurred (Ciechanowski et al., 2000; Anderson et al., 2001). For example, the prevalence of anxiety/depression is 2–3 times higher in patients with diabetes mellitus compared with the general population (Popkin et al., 1988; Blanz et al., 1993), and this observation has sparked the hypothesis that an increased risk of developing anxiety and depression may be a complication of diabetes mellitus. "
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    ABSTRACT: Dysfunction of central serotonin (5-HT) system has been proposed to be one of the underlying mechanisms for anxiety and depression, and the association of diabetes mellitus and psychiatric disorders has been noticed by the high prevalence of anxiety/depression in patients with diabetes mellitus. This promoted us to examine these behaviors in central 5-HT-deficient mice and those also suffering with diabetes mellitus. Mice lacking either 5-HT or central serotonergic neurons were generated by conditional deletion of Tph2 or Lmx1b respectively. Simultaneous depletion of both central serotonergic neurons and pancreatic islet cells was achieved by administration of diphtheria toxin (DT) in Pet1-Cre;Rosa26-DT receptor (DTR) mice. The central 5-HT-deficient mice showed reduced anxiety-like behaviors as they spent more time in and entered more often into the light box in the light/dark box test compared with controls; similar results were observed in the elevated plus maze test. However, they displayed no differences in the immobility time of the forced swimming and tail suspension tests suggesting normal depression-like behaviors in central 5-HT-deficient mice. As expected, DT-treated Pet1-Cre;Rosa26-DTR mice lacking both central serotonergic neurons and pancreatic islet endocrine cells exhibited several classic diabetic symptoms. Interestingly, they displayed increased anxiety-like behaviors but reduced immobility time in the forced swimming and tail suspension tests. Furthermore, the hippocampal neurogenesis was dramatically enhanced in these mice. These results suggest that the deficiency of central 5-HT may not be sufficient to induce anxiety/depression-like behaviors in mice, and the enhanced hippocampal neurogenesis may contribute to the altered depression-like behaviors in the 5-HT-deficient mice with diabetes. Our current investigation provides understanding the relationship between diabetes mellitus and psychiatric disorders.
    Frontiers in Behavioral Neuroscience 09/2014; 8:325. DOI:10.3389/fnbeh.2014.00325 · 3.27 Impact Factor
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