Matthew Clyde

Association of diabetes with anxiety: A systematic review and meta-analysis

OBJECTIVES Anxiety has been shown to be associated with poor outcomes in people with diabetes. However, there has been little research which has specifically examined whether diabetes mellitus is associated with an increased likelihood of co-morbid anxiety. The aim of this systematic review and meta-analysis was to determine whether people with diabetes are more likely to have anxiety disorders or elevated anxiety symptoms than people who do not have diabetes. METHODS A systematic review was performed by three independent reviewers who searched for articles that examined the association between anxiety and diabetes in adults 16 or older. Those studies that met eligibility criteria were put forward for meta-analysis using a random-effects model. RESULTS A total of twelve studies with data for 12,626 people with diabetes were eligible for inclusion in the systematic review and meta-analysis. Significant and positive associations were found for diabetes with both anxiety disorders, 1.20 (1.10-1.31), and elevated anxiety symptoms, 1.48 (1.02-1.93). The pooled OR for all studies that assessed anxiety was 1.25 (1.10-1.39). CONCLUSIONS Results from this meta-analysis provide support that diabetes is associated with an increased likelihood of having anxiety disorders and elevated anxiety symptoms.

Recurrent Subthreshold Depression in Type 2 Diabetes: An Important Risk Factor for Poor Health Outcomes

OBJECTIVE To evaluate the association between recurrent subthreshold depressive episodes and functioning in a prospective community sample of people with type 2 diabetes. RESEARCH DESIGN AND METHODS A prospective community study in Quebec, Canada, was carried out between 2008 and 2013 (n = 1,064). Five yearly follow-up assessments (telephone interviews) were conducted. Baseline and the first three follow-up assessments were used to identify recurrent subthreshold depressive episodes (Patient Health Questionnaire [PHQ]-9). Functioning (World Health Organization Disability Assessment Schedule II [WHODAS-II]) and health-related quality of life (Centers for Disease Control and Prevention [CDC] unhealthy days) at 4- and 5-year follow-up assessments were the outcome measures. RESULTS Nearly half of the participants suffered from at least one episode of subthreshold depressive symptoms. After adjusting for potentially confounding factors, the risk of poor functioning/impaired health–related quality of life was nearly three times higher (relative risk = 2.86) for participants with four subthreshold depressive episodes compared with participants with no/minimal depression. Results suggest a dose-response relationship: the risk of poor functioning/impaired health–related quality of life increased with the number of recurrent subthreshold depressive episodes even after controlling for potentially confounding variables (significant linear trend, P < 0.001). CONCLUSIONS Recurrent subthreshold depressive symptoms might be an important risk factor for poor health outcomes in type 2 diabetes. Early identification, monitoring, and treatment of recurrent subthreshold depressive symptoms might improve functioning and quality of life in people with type 2 diabetes.

Exploring the Association of Psychological Status with Self-Rated Diabetes Control: Results from the Montreal Evaluation of Diabetes Treatment Study

AIMS There is an increasing interest in single-item self-rated indicators of perceived health and control status in people with chronic illnesses such as diabetes. However, self-rated measures can be associated with indicators of psychological status. The aim of this paper is to explore the association of anxiety, depression, and diabetes distress with self-rated diabetes control. METHODS Telephone interviews were conducted with 1,787 people with type 2 diabetes taking oral hypoglycemic medication. Diabetes control, health behaviors, and outcomes, anxiety, depression, and diabetes distress were assessed by standardized questionnaires. Self-reported diabetes control was modeled using logistic regression. RESULTS The best fit logistic regression model for self-rated poor diabetes control was a model that incorporated diabetes distress. When adjusted for age, sex, and all other health behaviors and outcomes, poor diabetes control was most associated with diabetes distress, physical inactivity, being overweight, and poor eating habits. CONCLUSIONS Results from this study indicate that poor self-rated diabetes control shares the strongest associations with diabetes-specific distress along with perceptions of diabetes-specific healthcare behaviors and outcomes.

Good vs. Poor Self-rated Diabetes Control: Differences in Cardiovascular Risk and Self-care Activities

AIM The aim of this study was to assess differences in cardiovascular risk and performance of self-care activities in people who rated their diabetes control as good or poor. METHODS A sub-sample of 77 participants who took part in the Evaluation of Diabetes Treatment telephone interview were invited into a clinic to complete a series of laboratory examinations. Self-rated diabetes control was validated using the following laboratory markers: HbA1c, total cholesterol/HDL cholesterol ratio and LDL cholesterol. Differences in blood pressure and BMI were also assessed. Finally, all participants also completed the Summary of Self-Care activities questionnaire. RESULTS Those people who rated their diabetes control as fair or poor had a significantly higher BMI, HbA1c levels, total cholesterol/HDL-cholesterol ratio and systolic blood pressure. When asked about self-care activities in the past week, those people who reported their diabetes control was fair/poor had spent significantly fewer days following a general diet and exercising. CONCLUSIONS People with poor self-rated diabetes control have unfavourable cardiovascular risk and decreased performance of self-care activities.

Assessing the longitudinal associations and stability of smoking and depression syndrome over a 4-year period in a community sample with type 2 diabetes 在一个社区2型糖尿病样本中进行的为期4年的吸烟与抑郁综合征之间的纵向相关性以及稳定性的评估

The aim of the present study was to investigate the stability and longitudinal association between depression and smoking status within a community sample with type 2 diabetes (T2D) while controlling for sociodemographic and disease‐related variables.

Association between smoking and depression in patients with type 2 diabetes: A Response 2型糖尿病患者吸烟与抑郁之间的关系：答复

We thank Dr Kawada for his interest in our manuscript on smoking and depression in people with T2D. In his letter, the author questions the role of diabetes in the association between smoking and depression by highlighting a recent review that reports an association even in samples that do not have type 2 diabetes (T2D). We wish to clarify that although we reported on the association between smoking and depression in individuals with T2D, it was not our intention to imply that this association was: (i) unique to those with T2D; or (ii) specifically influenced by T2D. Instead, our results were meant to highlight the problem and risk of depression among moderate-heavy smokers with T2D, who are already vulnerable to a number of diabetes-related complications and health problems, even after controlling for a number of demographic and disease-related factors. Unfortunately, although we adjusted for depression at baseline, we did not have sufficient information to rule out a history of depression; thus, the association between smoking and depression may have already been established at an earlier time. The author highlights the different results reported between two of our papers. The main difference lies in the depression outcome that we assessed in each study. The first papaer focused on major depression as the main outcome, as assessed via the Patient Health Questionnaire (PHQ-9) and using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria, whereas the second focused on depression syndrome. which includes major and minor depression. Previous studies (for a review, see Rodríguez et al.) have highlighted the importance of investigating subthreshold depression; our group also recently published a paper on the relationship between minor depression and poor health outcomes in those with T2D, which led to the change in outcomes between papers. As Luger et al. reported, the choice of depression measure can have an important impact on the strength of the association in question. Finally, we discussed a number of potential pathways in our paper, but agree with the author that further research is needed into the mechanisms that explain the association between smoking and depression. Through highlighting the persistence of this association, we also hoped to underscore to clinicians the potential dangers that concurrent smoking and depression can have in those with T2D. Both are associated with poor outcomes in diabetes and the presence of one can also negatively influence the other. Similarly, depression may impact the individual’s ability to successfully quit, or its presence may impact a health care provider’s willingness to counsel smoking.

Association between smoking and depression in patients with type 2 diabetes: A Response.

We thank Dr Kawada for his interest in our manuscript on smoking and depression in people with T2D. In his letter, the author questions the role of diabetes in the association between smoking and depression by highlighting a recent review that reports an association even in samples that do not have type 2 diabetes (T2D). We wish to clarify that although we reported on the association between smoking and depression in individuals with T2D, it was not our intention to imply that this association was: (i) unique to those with T2D; or (ii) specifically influenced by T2D. Instead, our results were meant to highlight the problem and risk of depression among moderate-heavy smokers with T2D, who are already vulnerable to a number of diabetes-related complications and health problems, even after controlling for a number of demographic and disease-related factors. Unfortunately, although we adjusted for depression at baseline, we did not have sufficient information to rule out a history of depression; thus, the association between smoking and depression may have already been established at an earlier time. The author highlights the different results reported between two of our papers. The main difference lies in the depression outcome that we assessed in each study. The first papaer focused on major depression as the main outcome, as assessed via the Patient Health Questionnaire (PHQ-9) and using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria, whereas the second focused on depression syndrome. which includes major and minor depression. Previous studies (for a review, see Rodríguez et al.) have highlighted the importance of investigating subthreshold depression; our group also recently published a paper on the relationship between minor depression and poor health outcomes in those with T2D, which led to the change in outcomes between papers. As Luger et al. reported, the choice of depression measure can have an important impact on the strength of the association in question. Finally, we discussed a number of potential pathways in our paper, but agree with the author that further research is needed into the mechanisms that explain the association between smoking and depression. Through highlighting the persistence of this association, we also hoped to underscore to clinicians the potential dangers that concurrent smoking and depression can have in those with T2D. Both are associated with poor outcomes in diabetes and the presence of one can also negatively influence the other. Similarly, depression may impact the individual’s ability to successfully quit, or its presence may impact a health care provider’s willingness to counsel smoking.

Association between smoking and depression in patients with type 2 diabetes: A Response 2型糖尿病患者吸烟与抑郁之间的关系：答复: Letter to the Editor

We thank Dr Kawada for his interest in our manuscript on smoking and depression in people with T2D. In his letter, the author questions the role of diabetes in the association between smoking and depression by highlighting a recent review that reports an association even in samples that do not have type 2 diabetes (T2D). We wish to clarify that although we reported on the association between smoking and depression in individuals with T2D, it was not our intention to imply that this association was: (i) unique to those with T2D; or (ii) specifically influenced by T2D. Instead, our results were meant to highlight the problem and risk of depression among moderate-heavy smokers with T2D, who are already vulnerable to a number of diabetes-related complications and health problems, even after controlling for a number of demographic and disease-related factors. Unfortunately, although we adjusted for depression at baseline, we did not have sufficient information to rule out a history of depression; thus, the association between smoking and depression may have already been established at an earlier time. The author highlights the different results reported between two of our papers. The main difference lies in the depression outcome that we assessed in each study. The first papaer focused on major depression as the main outcome, as assessed via the Patient Health Questionnaire (PHQ-9) and using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria, whereas the second focused on depression syndrome. which includes major and minor depression. Previous studies (for a review, see Rodríguez et al.) have highlighted the importance of investigating subthreshold depression; our group also recently published a paper on the relationship between minor depression and poor health outcomes in those with T2D, which led to the change in outcomes between papers. As Luger et al. reported, the choice of depression measure can have an important impact on the strength of the association in question. Finally, we discussed a number of potential pathways in our paper, but agree with the author that further research is needed into the mechanisms that explain the association between smoking and depression. Through highlighting the persistence of this association, we also hoped to underscore to clinicians the potential dangers that concurrent smoking and depression can have in those with T2D. Both are associated with poor outcomes in diabetes and the presence of one can also negatively influence the other. Similarly, depression may impact the individual’s ability to successfully quit, or its presence may impact a health care provider’s willingness to counsel smoking.

Assessing the longitudinal associations and stability of smoking and depression syndrome over a 4-year period in a community sample with type 2 diabetes 24.

The aim of the present study was to investigate the stability and longitudinal association between depression and smoking status within a community sample with type 2 diabetes (T2D) while controlling for sociodemographic and disease‐related variables.

Assessing the longitudinal associations and stability of smoking and depression syndrome over a 4-year period in a community sample with type 2 diabetes 在一个社区2型糖尿病样本中进行的为期4年的吸烟与抑郁综合征之间的纵向相关性以及稳定性的评估: Depression and smoking in diabetes

The aim of the present study was to investigate the stability and longitudinal association between depression and smoking status within a community sample with type 2 diabetes (T2D) while controlling for sociodemographic and disease‐related variables.