Abstract
To investigate the independent effect on depression of painless diabetic polyneuropathy, painful diabetic polyneuropathy, and general and diabetes-related comorbidities. In 181 patients, the presence of painless diabetic polyneuropathy, painful diabetic polyneuropathy, comorbidities and depression was assessed using the Michigan Neuropathy Screening Instrument Questionnaire, the Michigan Diabetic Neuropathy Score, nerve conduction studies, the Douleur Neuropathique en 4 Questions, the Charlson Comorbidity Index and the Beck Depression Inventory-II. In all, 46 patients met the criteria of confirmed painless diabetic polyneuropathy and 25 of painful diabetic polyneuropathy. Beck Depression Inventory-II scores indicative of mild-moderate-severe depression were reached in 36 patients (19.7%). In a multiple logistic regression analysis (including age, sex, body mass index, being unemployed, duration, haemoglobin A1c, insulin treatment, systolic blood pressure, nephropathy, retinopathy, Charlson Comorbidity Index and painful diabetic polyneuropathy), female sex (odds ratio: 5.9, p = 0.005) and painful diabetic polyneuropathy (odds ratio: 4.6, p = 0.038) were the only independent predictors of depression. Multiple regression analysis, including Douleur Neuropathique en 4 Questions and Michigan Diabetic Neuropathy Score instead of painful diabetic polyneuropathy, showed that Douleur Neuropathique en 4 Questions, in addition to female sex, was a significant predictor of depressive symptoms severity (p =0.005). Painful diabetic polyneuropathy is a greater determinant of depression than other diabetes-related complications and comorbidities. Painful symptoms enhance depression severity more than objective insensitivity.
Highlights
Convincing evidence that depression represents a substantial comorbidity of painful diabetic polyneuropathy (PDPN)[9,10,11] with its severity depending on pain intensity.[12]
Patients with painful and painless DPN exhibited a higher age, a longer diabetes duration, a higher body mass index (BMI), a higher percentage of micro-vascular and macro-vascular disease, a lower percentage of physically active people and of high school graduates, and higher scores of Charlson Comorbidity Index compared to patients without DPN
After adjustment for multiple covariates, including diabetes-related and unrelated conditions associated with PDPN and depression, we found that PDPN together with female sex was an independent predictor of the presence of depression and Douleur Neuropathique en 4 Questions (DN4) was a main determinant of the severity of depressive symptoms
Summary
While rates of depression are elevated in patients with chronic illnesses, in diabetes the excess risk has been mostly attributed to lifestyle and health-related behaviours[4] and to diabetes-related complications, such as macro- and micro-vascular disease,[5] including retinopathy, nephropathy and neuropathy.[6,7]. A particular link has been observed between depressive symptoms and diabetic polyneuropathy (DPN) that is said to be mediated by neuropathic symptoms, that is, feet insensitivity, pain and unsteadiness.[8] There is D’Amato et al. Convincing evidence that depression represents a substantial comorbidity of painful diabetic polyneuropathy (PDPN)[9,10,11] with its severity depending on pain intensity.[12] PDPN, has been found to be associated with other general and diabetes-related comorbidities,[12,13] previously not always taken into account when evaluating the relationship between PDPN and depression
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