Time is of the essence in depressed diabetes patients

By Sally Robertson, B.Sc.Oct 5 2012

Among patients with diabetes and comorbid depression, the time point at which they developed depression may have important implications for their clinical management, say researchers.

Presenting at the European Association for the Study of Diabetes 48th Annual Meeting in Berlin, Germany, Wendy Davis from the University of Western Australia in Fremantle told medwireNews that, for individuals who developed depression before they were diagnosed with diabetes, the therapeutic focus should probably be on preventing disease progression and comorbidity.

In those with depression that developed after diabetes diagnosis, palliation and improving quality of life is important. However, "if they are resistant to antidepressant use, then perhaps we can help other areas of their illness or illnesses."

The study of 1384 individuals with Type 2 diabetes who completed a validated patient health questionnaire showed that 21% had developed depression at least 2 years prior to being diagnosed with diabetes, while 15% developed it at least 2 years after diagnosis.

Interestingly, over 41% of the post-diabetes depression group were currently depressed compared with 19% in the prediabetes group.

Those with post-diabetes depression were significantly more likely to have a glycated hemoglobin level of less than 7% compared with those who had prediabetes depression or no depression, at 52% versus 40% and 39%,respectively.

They were also significantly more likely to have retinopathy, peripheral neuropathy, peripheral artery disease, and self reported myocardial infarction or angina.

The researchers found that 77% of individuals from the prediabetes depression group were currently taking antidepressant medication, compared with only 52% in the post-diabetes depression group, a significant between-group difference.

Furthermore, 70% of those with prediabetes depression had "controlled depression," defined as no symptoms of depression on taking antidepressant medication, while this effect was only evident in 42% of those with post-diabetes depression who were on medication.

"These patients appear to be relatively resistant to antidepressive therapy, suggesting a distinct underlying pathology," said Davis.

The temporal relationship between depression and diabetes may have important implications for clinical management, she concluded.

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