Depressive Symptoms and Glycemic Control among Puerto Rican Adults with Diabetes

Abstract

A bidirectional relationship between depression and diabetes risk has been suggested. Less is known about the dynamics between depressive symptomatology and glycemic control among individuals already at risk of both conditions. We aimed to examine the prospective bidirectional associations between depressive symptomatology and glycemic control. We used data from 488 participants of the Boston Puerto Rican Health Study (mean (SD) age= 58.9 (7.2) y) with type 2 diabetes (fasting plasma glucose ≥ 126 mg/dL or use of medication). At baseline, participants were categorized as having uncontrolled hemoglobin A1c (≥7%) vs. controlled, and as having depressive symptomatology (Center for Epidemiological Studies-Depression (CES-D) score ≥16) vs. not. Categories for 2-year changes in glycemic control were set as (>-0.5%=improved; -0.5% to 0.5%=stable; ≥0.5%=worsened); 2-year changes in CES-D score as (>-3=improved; -3 to 3=stable; ≥3=worsened). In logistic regressions adjusted for sociodemographic and lifestyle variables and number of medical conditions, having baseline depressive symptomatology was associated with 1.96 (95% CI: (1.10, 3.50; p=0.022) higher odds of having worsened hemoglobin A1c at 2-year compared to keeping it stable. Baseline uncontrolled hemoglobin A1c was not associated with change in depression score. When modeling 2-year change categories as predictors, improved depression score (vs. stable) was associated with lower odds (0.42 (0.21, 0.81); p=0.01) of worsened hemoglobin A1c, while worsened glycemic control (vs. stable) was associated with lower odds (0.40 (0.21, 0.78); p=0.007) of improved depression score. In conclusion, a bidirectional association between changes in depressive symptomatology and glycemic control over 2 years among individuals with diabetes suggests that timely attention to both conditions should be given simultaneously. Interconnected diabetes and depression management practices should be recommended for adults with diabetes. Disclosure J. Mattei: None. L.M. Falcon: None. K.L. Tucker: None.