Abstract
Depressive symptoms are prevalent among people with type 2 diabetes (T2D) and, even at low severity levels, are associated with worse diabetes outcomes. Carbohydrate restriction is an effective treatment for T2D but its long-term impacts on depressive symptoms are unclear. In the current study we explored changes in depressive symptoms over 2 years among 262 primarily non-depressed T2D patients participating in a continuous remote care intervention emphasizing carbohydrate restriction. Subclinical depressive symptoms decreased over the first 10 weeks and reductions were maintained out to 2 years. Increased frequency of blood ketone levels indicative of adherence to low carbohydrate eating predicted decreases in depressive symptoms. Concerns have been raised with recommending restrictive diets due to potential negative impacts on quality-of-life factors such as mood; however, results of the current study support positive rather than negative long-term impacts of closely monitored carbohydrate restriction on depressive symptoms.
Highlights
In the United States, over 30 million people have diabetes, which is recognized among the leading causes of morbidity and mortality (Ng et al, 2014; WHO, 2016)
Treatment with insulin therapy is associated with increased risk for depressive symptoms in type 2 diabetes (T2D) (Bai et al, 2018), suggesting that intensive treatment contributes to emotional distress
We looked at clinical cut-offs for depression using the full 20-item Center for Epidemiological Studies Depression Scale (CES-D) since cut-offs were established using that version; we used a clinical cut-off of 22 based on research showing that cut-off is most similar to established cut-offs on the PHQ-9 and Beck Depression Inventory (Choi et al, 2014) and a better indicator of Major Depressive Disorder in people with T2D (Fisher et al, 2007) than the original CES-D cut-off of 16
Summary
In the United States, over 30 million people have diabetes, which is recognized among the leading causes of morbidity and mortality (Ng et al, 2014; WHO, 2016). Medications contribute to patient burden in terms of cost, side effects such as weight gain, and increased risk of potentially life-threatening hypoglycemia (Gerstein et al, 2008; Hayes et al, 2006; Henry et al, 1993). Patients often have unfavorable views of polypharmacy and treatment intensification, especially with regards to initiation of insulin therapy (Hayes et al, 2006; Polonsky et al, 2011). The burdens of diabetes treatment are associated with emotional distress among individuals with T2D (Fisher et al, 2008; Perrin et al, 2017). Treatment with insulin therapy is associated with increased risk for depressive symptoms in T2D (Bai et al, 2018), suggesting that intensive treatment contributes to emotional distress. Depressive symptoms are associated with worse self-management (e.g., missed medical appointments, non-adherence to medications and blood glucose monitoring)
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