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Severe Complications of Diabetes Higher in Patients with Major Depression

Posted: Sunday, February 14, 2010

Major depression raises risks of advanced and severe complications from diabetes, according to a prospective study. These complications include kidney failure or blindness, the result of small vessel damage, as well as major vessel problems leading to myocardial infarction (MI) or stroke.

Among their research volunteers with Type 2 diabetes followed over 5 years, major depression was associated with a 36% higher risk of developing advanced micro-vascular complications, such as end-stage kidney disease or blindness, and a 25% higher risk of developing advanced macrovascular complications, such as stroke or MI, compared with patients with diabetes without depression.

The clinically significant risks remained even after the researchers adjusted for diabetes severity and self-care activities.

Between 2000 and 2002, the Pathways Epidemiological Follow-up Study enrolled 4,632 primary-care Group Health Cooperative patients with diabetes. These patients were tracked through 2005-2007. The final sample size was 3,723.

Elizabeth Lin, MD, Group Health Research Institute, Seattle, Washington, and colleagues reviewed medical records, diagnostic and procedural codes, lists of prescribed medications, and death certificates to determine what happened to each patient over nearly 5 years. The researchers used proportional hazard models to calculate the association between depression and the risk of advanced complications.

Even among patients with diabetes who had no prior indication of microvascular or macrovascular problems, depression increased the chances that these problems would develop.

As in earlier reports, patients with diabetes and major depression tended to be slightly younger, heavier, have more co-existing medical conditions, and were more likely to be treated with insulin than were patients with diabetes without depression. The major depression group had a higher proportion of women and smokers. However, after controlling for these differences between depressed and non-depressed patients with diabetes, the increased risk of complications associated with depression remained.

Several previous studies suggest the negative relationship between depression and diabetes cuts both ways. People with depression are prone to diabetes, and vice versa. Impairment from diabetes, such as blindness or kidney failure requiring long-term dialysis, interferes with a person's daily life and can be overwhelming. The person may become depressed or an existing depression may worsen.

As the incidence of Type 2 diabetes soars, the clinical and public health significance of these findings increases, the authors noted. Further research is needed, the authors added, to clarify the underlying biological mechanism for the association between depression and complications of diabetes, and to test interventions which might be effective in lowering the risk of complications among patients who have both diabetes and depression.

Source: Diabetes In Control: Diabetes Care, Feb. 2010

 
 
 
 
 
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