Diabetes Mellitus Depression Research Articles

Dapagliflozin inhibits the activity of lateral habenula to alleviate diabetes mellitus-induced depressive-like behavior

The prevalence of depression in diabetes mellitus (DM) patients is very high, and it severely impacts the prognosis and quality of life of these patients. Sodium-glucose co-transporter 2 (SGLT2) inhibitors, a new type of oral hypoglycemic drugs, have been shown to alleviate depressive symptoms in DM patients; however, the mechanism underlying this effect is not well understood. The lateral habenula (LHb) plays an important role in the pathogenesis of depression expresses SGLT2, suggesting that the LHb may mediate antidepressant effects of SGLT2 inhibitors. The current study aimed to investigate the involvement of the LHb in the antidepressant effects of the SGLT2 inhibitor dapagliflozin. Chemogenetic methods were used to manipulate the activity of LHb neurons. Behavioral tests, Western blotting, immunohistochemistry, and neurotransmitter assays were used to determine the effects of dapagliflozin on the behavior of DM rats, AMP-activated protein kinase (AMPK) pathway and c-Fos expression in the LHb and 5-hydroxyindoleacetic acid (5-HIAA)/5-hydroxytryptamine (5-HT) ratio in the dorsal raphe nucleus (DRN). We found that DM rats demonstrated depressive-like behavior, increased c-Fos expression, and decreased AMPK pathway activity in the LHb. Inhibition of LHb neurons alleviated the depressive-like behavior of DM rats. Both systemic and local LHb administration of dapagliflozin alleviated the depressive-like behavior and reversed the changes of the AMPK pathway and c-Fos expression in the LHb of DM rats. Dapagliflozin, when microinjected into the LHb, also increased 5-HIAA /5-HT in the DRN. These results suggest that dapagliflozin directly acts on the LHb to alleviate DM-induced depressive-like behavior and that the underlying mechanism involves activating the AMPK signaling pathway, leading to the inhibition of LHb neuronal activity, which in turn increases serotonergic activity in the DRN. These results will help develop new strategies for the treatment of DM-induced depression.

The Association between Type-1 Diabetes Mellitus and Risk of Depression among Saudi Patients: A Cross-Sectional Study.

The importance of screening type-1 diabetic patients in Saudi Arabia is related to a high incidence rate of diabetes mellitus (DM) and the susceptibility to developing depression during or after the diagnosis. The objectives of the present study were to establish the relationship between type-1 diabetes mellitus (T1DM), depression, and depression risk among Saudi patients; estimating the prevalence and examining the relationship of depression with duration of diagnosis, the effect of glycemic control, and the presence of comorbidities. For this observational retrospective chart review, an analytical tool was used. The population of our study comprised Saudi patients with T1DM at King Khaled University Hospital, Riyadh. Data were collected from the hospital's electronic medical records. A depression screening tool (Patient Health Questionnaire "PHQ-9") was used to measure the depression risk of the diabetic patients, who had not been assessed before. The SPSS program was used to analyze the data. The present study included 167 males (~45.75%) and 198 females (~54.25%). Patients with a normal body mass index (BMI) constituted 52%, while 21% were underweight, 19% were overweight, and 9% were obese. The investigators randomly selected 120 patients from the total of 365, and called them to assess their risk of developing depression. The results of the depression assessment were as follows: positive, 17 patients out of 22 (77.27%); negative, five patients out of 22 (22.73%). In total, 75 out of 120 (62.50%) patients were at risk of developing depression, while 45 patients out of 120 (37.50%) were not at risk of depression. There was a relationship between glycemic non-control, comorbidities with depression, and risk of developing depression in DM. The presence of complications was associated with diabetic and depressed patients, and the risk of developing depression may be increased with T1DM. To overcome the negative consequences of undiagnosed depression, screening for depression is recommended for patients with T1DM who have multiple comorbidities, glycemic non-control, diabetic complications, and unfavorable lifestyles, as well as those undergoing combination therapy with metformin.

Potential Biomarkers for Predicting Depression in Diabetes Mellitus.

Objective: To identify the potential biomarkers for predicting depression in diabetes mellitus using support vector machine to analyze routine biochemical tests and vital signs between two groups: subjects with both diabetes mellitus and depression, and subjects with diabetes mellitus alone.Methods: Electronic medical records upon admission and biochemical tests and vital signs of 135 patients with both diabetes mellitus and depression and 187 patients with diabetes mellitus alone were identified for this retrospective study. After matching on factors of age and sex, the two groups (n = 72 for each group) were classified by the recursive feature elimination-based support vector machine, of which, the training data, validation data, and testing data were split for ranking the parameters, determine the optimal parameters, and assess classification performance. The biomarkers were identified by 10-fold cross validation.Results: The experimental results identified 8 predictive biomarkers with classification accuracy of 78%. The 8 biomarkers are magnesium, cholesterol, AST/ALT, percentage of monocytes, bilirubin indirect, triglyceride, lactic dehydrogenase, and diastolic blood pressure. Receiver operating characteristic curve analysis was also adopted with area under the curve being 0.72.Conclusions: Some biochemical parameters may be potential biomarkers to predict depression among the subjects with diabetes mellitus.

PI3K/AKT pathway mediates the antidepressant- and anxiolytic-like roles of hydrogen sulfide in streptozotocin-induced diabetic rats via promoting hippocampal neurogenesis

We have previously demonstrated that hydrogen sulfide (H2S), the third endogenous gasotransmitter, ameliorates the depression- and anxiety-like behaviors in diabetic rats, but the underlying mechanism remains unclear. The present was aimed to investigate whether the hippocampal phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway mediates H2S-ameliorated depression- and anxiety-like behaviors in diabetic rats by improving the hippocampal neurogenesis. The depression-like behaviors were examined by Tail suspension test (TST), the anxiety-like behaviors were examined by Elevated plus maze test (EPM), and the locomotor activity was detected by Open Field Test (OFT). The expressions of doublecortin (DCX), neuron-specific nuclear protein (NeuN), glial fibrillary acidic protein (GFAP), p-AKT, and AKT in the hippocampus were determined by Western blot analysis. Results showed that NaHS, a donor of exogenous H2S, not only activated the hippocampal PI3K/AKT pathway, as evidenced by the increase of phosphorylated AKT, but also favorably reversed streptozotocin (STZ)-disturbed hippocampal neurogenesis, as evidenced by the increases in the expressions of DCX and NeuN as well as the decrease in the expression of GFAP in the hippocampus of STZ-induced diabetic rats. Furthermore, inhibited PI3K/AKT pathway by LY294002 significantly abolished H2S-exerted the improvement of hippocampal neurogenesis and the antidepressant- and anxiolytic-like effects in the STZ-induced diabetic rats. Taken together, these results uncover that the activation of hippocampal PI3K/AKT pathway plays an important role to restore hippocampal neurogenesis and subsequently to mediate the antidepressant- and anxiolytic-like roles of H2S in STZ-induced diabetic rats and enhance our understanding of the robustness of H2S as a therapeutic strategy for treatment of depression in diabetes mellitus.

Managing Depression in Diabetes Mellitus: A Multicentric Randomized Controlled Trial Comparing Effectiveness of Fluoxetine and Mindfulness in Primary Care: Protocol for DIAbetes Mellitus ANd Depression (DIAMAND) Study.

Background:Suboptimal management of depression in type 2 diabetes mellitus (T2DM) often translates into poor glycemic control, medical complications, and impaired quality of life. Feasibility and effectiveness of collaborative care models of depression in diabetes in low- and middle-income countries (LMICs) remain unexplored. DIAbetes Mellitus ANd Depression (DIAMAND) study, a multicentric single-blind randomized controlled trial (SBRCT) comparing effectiveness of fluoxetine and mindfulness in primary care settings, addresses this gap in scientific literature.Methods:This trial conducted in diverse geographic settings of New Delhi, Bengaluru, and Bhubaneswar will comprise module-based training of primary care providers (PCPs) for screening, diagnosing, and managing depression in diabetes in phase I. Phase II will involve four-arm parallel group RCT on 350 participants with T2DM with comorbid depressive episode randomly allocated to receive fluoxetine, mindfulness therapy, fluoxetine plus mindfulness therapy, or treatment as usual at primary care settings. Interventions would include fluoxetine (up to 60 mg/day) and/or sessions of mindfulness for 16 weeks. Primary outcomes on standardized rating scales include depression scores (Hamilton Depression Rating Scale), treatment adherence (Adherence to Refill and Medication Scale), self-care (Diabetes Self-Management Questionnaire), diabetes-related distress (Diabetes Distress Scale), and glycemic control. Secondary outcomes include quality of life (World Health Organization Quality of Life Brief version [WHO-QOL BREF]) and mindfulness (Five Facets Mindfulness Questionnaire).Discussion:This RCT will investigate the effectiveness of module-based training of PCPs and feasibility of collaborative care model for managing depression in T2DM in primary care settings in LMICs and effectiveness of fluoxetine and/or mindfulness in improving diverse outcomes of T2DM with major depression.

Potential Biomarkers for Predicting of Depression in Diabetes Mellitus

Potential Biomarkers for Predicting of Depression in Diabetes Mellitus

Prevalence of Depression in Diabetes Mellitus and its Determinants

Prevalence of Depression in Diabetes Mellitus and its Determinants

Correlation Between Depression and Glycemic Control in Patients with Diabetes Mellitus: A Cross-Sectional Study in a Clinical Setting in India in the Year 2013

Background: Diabetes mellitus is a medical disorder running a chronic course and often co-morbid with depressive disorders. Many physicians do not consider the presence of depressive symptoms per se to be adequate reason for further workup unless they are severe (e.g. suicidal thoughts). Objectives: We aimed to assess depression in adult patients suffering from diabetes mellitus, to study the socio-demographic data associated with depression in patients suffering from diabetes mellitus, and to assess glycemic control in patients with and without co-morbid depression suffering from diabetes mellitus. Methods: This is a cross-sectional hospital-based study. The sample of the study comprised 100 outpatients with diabetes mellitus of either type-1 or type-2. After a semi-structured clinical interview, all patients were administered with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and Becks depression inventory-II. The Chi-square test was utilized for testing the association between variables. To examine the difference between the two or three variables, the Mann-Whitney U test and the Kruskal-Wallis test were used. Results: Among the individuals recruited for the study, 72% had depression and 28% were not affected by depression. The results showed there was a positive correlation between glycemic control, the presence of complications, the type, and duration of diabetes mellitus and depression. Conclusions: The results clearly indicated a high rate of occurrence of depression in diabetes mellitus. Patients with a long duration of diabetes mellitus, poor glycemic control, and the presence of complications of diabetes mellitus were more likely to be severely depressed.

Dinamika Penerimaan Diri (Self Acceptance) Pada Lansia Penderita Diabetes Mellitus Tipe II DI Posyandu Lansia Desa Tasikhargo Jatisrono Wonogiri Tahun 2015

Abstract: Dynamics, Self-Acceptance, Elderly Patients, Diabetes Mellitus Type II. As getting older, an elderly suffered from many physical and mental consequences. The characteristics of geriatric syndrome most often experienced by diabetes mellitus depression, withdrawl and away from social activities. Some of them are suffering from severe and long diabetes mellitus. This research aims to describe how the dynamics of self-acceptance in elderly patients type II of Diabetes Mellitus in Posyandu Tasikhargo, Jatisrono, Wonogiri district in 2015.The research method used is qualitative method with the collection of data using in-depth interviews and Focus Group Discussion (FGD). The sample comprised 9 respondents with the inclusion criteria. According the results of the research on the results of the dynamics of self-acceptance to elderly patients with diabetes mellitus type 2, seven of the nine respondents able doing the good dynamics of research self. The good Self-acceptance backed by two. The inside factor including the state of his own altruistic, feeling confident, capable of receiving the advantages and the rest after suffering from diabetes mellitus. The outside factors are the environment and support social. The good dynamics of self- acceptance in elderly patients with type II of diabetes mellitus in posyandu Tasikhargo, Jatisrono, Wonogiri is by doing diabetes management, pray and genuinely accept the state of being experienced by patients. Social support and environmental influence self-acceptance. Lack of education is a factor make the difficult of self-acceptance, so the family support is actually useful to improve health. However, this support sometimes is perceived negatively by the patients as a restraint for themself, because they feel set up and was not released. For nurses with more emphasis on health education about diabetes mellitus that diabetics have sufficient knowledge of the conditions experienced.

Depression in diabetes mellitus-A comprehensive systematic review of literature from an Indian perspective.

Systematic review of the epidemiological data, risk factors and relationship between depression and glycaemic control among the Indian studies. We searched Pubmed, Pubmed Central, Google Scholar and Directory of Open Access Journal (DOAJ) databases to identify relevant Indian studies. Substantial variation in the prevalence of depression in people with diabetes was found across the 41 selected studies; according to this review the range is 2% to 84% (T1DM - 2-7%; T2DM - 8%-84%). Correlates of depression in diabetic patients are advancing age, female gender, low literacy rate, burden of being from a lower socioeconomic status, rural domicile, marriage and duration of diabetes of >2years, diabetes related complications and poor glycaemic control. Sedentary life without adequate physical activities, lack of self-care are often the factors that precipitates depression in a T2DM patient and vice versa. According to this review, among Indian population there is a significant association between depression and diabetes.

Prevalence and Predictors of Depression among Diabetes Mellitus in Adult Population

Introduction Diabetes mellitus and depression are chronic debilitating conditions that are associated with high rates of complications and death. People with diabetes who have depression often find it more difficult to follow diabetes treatment recommendation, had increased healthcare costs, and poor lower quality of life. This study was conducted to determine the prevalence and determinants of depression among diabetes mellitus patients. Methods This was a descriptive cross-sectional study done in 100 diabetes mellitus patients in Rajmahal Villas Hospital, Bangalore, India. Nonprobability convenient sampling technique was used. Depression was assessed by using Major Depression Inventory. The collected data were analysed by using descriptive and inferential statistics. Results Of 100 patients with diabetes mellitus, 91% of the enrolled patients were above 40 years old. The study findings showed that the prevalence of depression among diabetes mellitus patient was 9%. Among enrolled patients, 23% had other health problems and 49% didn’t exercise daily. The depression in diabetes mellitus was significantly more common in those patients who had other health problems (P=0.02) and didn’t exercise regularly (P=0.03). Discussion Among diabetes mellitus, depression is common co-morbidity. The presence of other health problems and sedentary lifestyle predict the depression among diabetes mellitus patients.

Metabolic control and depression in type 1 diabetes mellitus

The most common mental disorder in patients with diabetes mellitus (DM) is depression (DS). Despite the large number of papers about DS in DM, its prevalence in type 1 DM (T1DM) remains unclear. Aim. The aim of this study was to investigate the prevalence of DS in T1DM and its possible association with metabolic control disorders. Materials and Methods. The study included 163 patients with T1DM. The patients were aged 18?65 years, and the mean duration of T1DM was 11.18 years (range 4.28?22.33 years). The control group included 75 apparently healthy individuals. The subjects underwent physical examination, and the standard self-report Hospital Anxiety and Depression Scale questionnaire was administered to evaluate the level of anxiety and DS. Psychological counselling was conducted to diagnose DS and its severity. The continuous glucose monitoring system (CGMS) was used to monitor interstitial fluid glucose levels. Statistical analysis was conducted using SPSS Statistics 17.0 and StatSoft Statistica 6.0. Results. The prevalence of DS among the patients with T1DM was much higher (approximately two-fold) than the prevalence among the healthy individuals. Female sex and age over 40 years were associated with the presence of DS. Conclusion. The development of DS in patients with T1DM is accompanied by poor glycaemic control and increased risk of hypoglycaemic episodes.

Comorbidity of Depression and Diabetes: In a Nutshell

Depression and diabetes mellitus (DM) have existed since ages. Yet, the etiologies of both diseases are unclear till date. However, the effects resulting from these diseases are well documented. Comorbidity of both disorders leads to increase disability and mortality rates. Besides presenting the epidemiological status of depression in DM, this review aims to highlight the different hypotheses governing the association of depression in DM and summarize the current trend in detection and management of depression. A high index of suspicion is required to detect depression in diabetic patients. There seems to be higher prevalence of depression in type 2 diabetes than in type 1 diabetes. Treatment should be tailored as per the individual needs and presence of comorbidity. Though there is no gold standard treatment for depressive diabetics, combinations of both pharmacological and non-pharmacological interventions are likely to improve outcomes. Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are preferred to conventional antidepressants. Collaborative care, psychoeducation and behavioral interventions are helpful in motivating patients to maintain treatment and improve psychological well-being and quality of life. Untreated depression in diabetics is costly to the health care and economic system as there is an increase in functional impairment and mortality rate. More efforts need to be made to effectively screen, diagnose and treat patients with comorbidity of diabetes and depression.

Depression in diabetes mellitus: to screen or not to screen? A patient-centred approach

Background Comorbid major depressive disorder (MDD) occurs frequently in diabetes mellitus and is associated with high symptom burden, disability and costs. Effective treatments are available but persons with diabetes with comorbid MDD are generally under-detected. A survey showed that comorbid MDD should be identified in a systematic way, such as by screening. Aim To identify and describe possible strategies to screen for MDD in persons with diabetes. Method After a survey exploring patients’ needs, a description of best practice is provided based on a review of the literature and clinical experience. Results Valid instruments for screening are the Center for Epidemiological Studies-Depression Scale (CES-D), the Beck Depression Inventory (BDI), and the Patient Health Questionnaire (PHQ-9). Research shows that screening and informing patients and physicians about comorbid MDD in diabetes is inadequate and more intensive treatment as follow-up is needed to change treatment and outcomes. Screening should identify patients willing and able to follow treatment if comorbid MDD is detected and should be followed by a stepwise approach to tailor treatment to patient need and ability. Conclusion Screening is best performed in a clinical setting, not by mail, and may be achieved by healthcare professionals using a collaborative care model.

A Study of Prevalence of Depression in Diabetes Mellitus: Analysis from Urban India

The chronic debilitating conditions, i.e., diabetes and depression are associated with significant morbidity, mortality, and healthcare costs. Both these interlinked chronic conditions contribute to their worst outcomes. The objective of the present study was to analyze the frequency of depression in diabetes and its correlation with demographic details like age, sex, domicile, education, income, and marital status. The study was conducted in the private diabetic clinic in outer Delhi (Rohini). Totally, 250 patients attending the outpatient department of private diabetic clinic were assessed with Beck Depression Inventory Scale which was a 21-question multiple-choice self-report inventory. Among the study population, 11.6% of the patients had co-morbid depression with more prevalence in females when compared with males. The demographic analysis revealed that depression incidence was higher in urban population, lower socio-economic class, and in patients with diabetes more than 5 years when compared with their counterparts and similar in graduate and undergraduate student population. Interestingly, the numbers of depression cases were found only in married population contrary to none in unmarried category. Present study concluded that co-morbidity of depression is prevalent in diabetic population with three times higher frequency than the considered feature of mild depression.

Gesundheitsökonomische Aspekte psychischer Komorbidität bei somatischen Krankheiten

Physical-mental comorbidity is often associated with worse clinical and psychosocial outcomes, reduced health-related quality of life, and increased healthcare utilization. The following article is dedicated to the health economic aspects of physical-mental comorbidity. It presents basic theoretical and methodological aspects of cost-of-illness studies and economic evaluations related to physical-mental comorbidity, which are explained and discussed for the practical example of comorbid depression in diabetes mellitus. The results show that mental comorbidity in diabetes is associated with increased healthcare costs, which can in part be attributed to an increased somatic health service use. Appropriate interventions can lower these excess costs. Economic evaluations assessing the effectiveness of interventions for depressive diabetics have shown that overall health can be improved and costs saved. However, especially in health economics, mental comorbidity in somatic diseases has not been comprehensively investigated and further research is warranted.

Impact of Depression on Health Related Quality of Life in Patients with Diabetes

Diabetes mellitus (DM) is a serious chronic illness that has a major impact on the quality of life of the individuals. Our aim was to examine the determinants of health-related quality of life (HRQOL) in patients with DM. Adult outpatients attending a Diabetes Centre were recruited on consecutive basis between August 2006 and February 2007. Clinical data were collected from interviews with the subjects and from medical records. Assessment of depressive symptoms was done using the Center for Epidemiologic Studies Depression Scale (CES-D) and HRQOL using the Short Form 36 Health Survey (SF-36). A two-step regression analysis was conducted for identifying factors affecting patients' quality of life. Five hundred and thirty-seven patients participated in the study. The mean (SD) age of the participants was 54.7 (13.3) years and 315 (58.7%) were males. The prevalence of depressive symptoms was 31.1% (n = 167). After adjusting for other variables, the effects of depressive symptoms persisted for all the 8 domains of SF-36 (P <0.001 for all). The medical factors that were negatively associated with HRQOL were a diagnosis of Type 1 DM, duration of the illness of more than 10 years, HbA1c levels of ≥7%, and comorbidity of stroke and retinopathy. Being male and a regular exerciser had a positive effect on HRQOL. These findings highlight the importance of detecting and treating comorbid depression in DM.

Diabetes mellitus e depressão: uma revisão sistemática

A presença de depressão no paciente com diabetes mellitus (DM) parece relacionar-se a alterações no curso clínico da doença. O objetivo deste trabalho é realizar uma revisão sistemática sobre a associação entre o DM e depressão. Foi realizada uma pesquisa bibliográfica utilizando as bases de dados MEDLINE e LILACS para identificar artigos relevantes, publicados entre 1990 e 2001, que avaliassem esta associação. Foram analisadas informações referentes à prevalência, ao impacto e ao tratamento da depressão no DM. A prevalência de depressão no DM variou de 0 a 60,5%. Sintomas depressivos relacionaram-se a um pior controle glicêmico, a um aumento e a uma maior gravidade das complicações clínicas, a uma piora da qualidade de vida e ao comprometimento de aspectos sociais, econômicos e educacionais ligados ao DM. O tratamento da depressão está relacionado à melhora dos níveis glicêmicos, podendo contribuir para um melhor controle de diversos aspectos relacionados ao DM.

Depression in diabetes mellitus: a national survey of office-based encounters, 1990-1995.

Depression in diabetes mellitus: a national survey of office-based encounters, 1990-1995.