Diabetes as a risk factor for depression

By Sally Robertson, B.Sc.Jan 4 2013

medwireNews: Diabetes is associated with a significantly increased risk for depressive symptoms, show findings from a large meta-analysis.

"Professionals in charge of diabetes care should be aware of this problem," say F Rotella and E Mannucci from Careggi Teaching hospital in Florence, Italy.

"They should develop diagnostic abilities such as to recognize cases at greater risk," they add.

The findings come from an analysis of 16 longitudinal observational studies that included 497,223 individuals who were followed up for a mean of 5.8 years for incidence of depression associated with diabetes. In total, 42,633 cases were identified.

"The association found in the present meta-analysis confirms, on a larger scale, previous findings obtained in smaller samples of subjects," say the researchers.

As reported in Diabetes Research and Clinical Practice, a significantly higher incidence of depression was found among diabetic individuals than among those without diabetes, at 1.6% versus 1.4%.

After combining the results of all the studies, and after adjustment for a number of confounders, diabetes was associated with a significantly increased risk for incident depression, at a hazard ratio of 1.25.

The authors say the mechanisms underlying the association between diabetes and depression are probably complex, but symptoms related to hypoglycemia such as fatigue may play a role. In addition, the burden of diabetes treatment can have a negative effect, due to the impact of dietary limitations and drug side effects on mood.

"It is also conceivable that the negative expectations on future health, due to the awareness of the effect of long-term complications of diabetes, facilitate the onset of depressive symptoms," they add.

The team suggests that an earlier recognition and treatment of depressive symptoms could have a beneficial effect on the outcome of both depression and diabetes for patients. "In fact, there is a large body of evidence showing that depression can have a negative impact on diabetes control."

Furthermore, diabetes education should be designed appropriately, so as to avoid unnecessary fears of diabetes complications and excessive dietary restrictions.

"It is plausible that a different approach to diabetes management could weaken the association of diabetes with incident depression," concludes the team.

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