Depression in Youth-Onset Type 2 Diabetes

Gulley, L.D. & Shomaker, L. B. (2020) |Depression in Youth-Onset Type 2 Diabetes | Current Diabetes Reports | 20| 51 

This study highlights the paucity of literature around youth onset type 2 diabetes (T2D), and synthesizes what is known about the prevalence of depression in this particular patient group.

Abstract

Purpose of Review

The current review summarizes extant knowledge regarding the prevalence of depression in youth-onset type 2 diabetes (T2D) and how depression might impact glycemic control through stress-related behavioral and physiological mechanisms. The current review also discusses depression intervention studies in adult-onset T2D, as there are no such studies in youth-onset T2D, and provides recommendations for clinical research.

Recent Findings

The prevalence of elevated depression symptoms in youth-onset T2D is approximately 20%. Some studies suggest depression may negatively impact glycemic control through inadequate medication adherence and disordered eating, but there is a dearth of studies investigating associations with depression and physical activity/sedentary time, sleep, and stress-related physiological mechanisms. In adult-onset T2D, evidence-based behavioral interventions tailored to address diabetes-related issues have shown positive effects for depression and glycemic control.

Summary

Future research is needed to characterize the epidemiology of depression in youth-onset T2D and test interventions to improve depression, glycemic control, and health outcomes in this specific pediatric population.

The full article can be requested by Rotherham NHS staff here 

Depression in type 1 diabetes and risk of dementia

Paola Gilsanz et al. | Depression in type 1 diabetes and risk of dementia | Aging & Mental Health | Volume 23:7, p880-886

Objective: Depression afflicts 14% of individuals with type 1 diabetes (T1D). Depression is a robust risk factor for dementia but it is unknown if this holds true for individuals with T1D, who recently started living to an age conferring dementia risk. We examined if depression is a dementia risk factor among elderly individuals with T1D.

Methods: 3,742 individuals with T1D aged over 50 were followed for dementia from 1/1/96-9/30/2015. Depression, dementia, and comorbidities were abstracted from electronic medical records. Cox proportional hazard models estimated the association between depression and dementia adjusting for demographics, glycosylated hemoglobin, severe dysglycemic epidsodes, stroke, heart disease, nephropathy, and end stage renal disease. The cumulative incidence of dementia by depression was estimated conditional on survival dementia-free to age 55.

Results: Five percent (N = 182) were diagnosed with dementia and 20% had baseline depression. Depression was associated with a 72% increase in dementia (fully adjusted HR = 1.72; 95% CI:1.12-2.65). The 25-year cumulative incidence of dementia was more than double for those with versus without depression (27% vs. 12%).

Conclusions: For people with T1D, depression significantly increases dementia risk. Given the pervasiveness of depression in T1D, this has major implications for successful aging in this population recently living to old age.

How psychosocial factors can influence diabetes outcomes

This publication explores the role that psychosocial factors play in the management of diabetes and the importance of addressing these to improve diabetes outcomes | Katharine Barnard | Roche

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Diabetes doesn’t just affect someone physically. This chronic and complex condition, which requires close and frequent monitoring of blood sugar levels alongside careful  consideration of activity and nutrition, places high behavioural demands on the person living with the illness on a daily basis. This can have a significant impact on a person’s mental health, well-being and their quality of life.

A survey by Diabetes UK during 2017 found that 64% of people with diabetes “sometimes or often” feel down because of their disease. It also revealed, significantly, that there is a need for more emotional and psychological support to make living with diabetes easier.

In this publication, the author argues that “there is a growing consensus that calls for a change in how diabetes is treated and managed, with a need to focus on the concept of living with diabetes rather than just treating the disease.”

Full document: How psychosocial factors can influence diabetes outcomes

Depression in type 1 diabetes and risk of dementia

Study find that for people with Type 1 Diabetes, depression significantly increases dementia risk | Aging & Mental Health

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Objective: Depression afflicts 14% of individuals with type 1 diabetes (T1D). Depression is a robust risk factor for dementia but it is unknown if this holds true for individuals with T1D, who recently started living to an age conferring dementia risk. We examined if depression is a dementia risk factor among elderly individuals with T1D.

Methods: 3,742 individuals with T1D age ≥50 were followed for dementia from 1/1/96-9/30/2015. Depression, dementia, and comorbidities were abstracted from electronic medical records. Cox proportional hazard models estimated the association between depression and dementia adjusting for demographics, glycosylated hemoglobin, severe dysglycemic epidsodes, stroke, heart disease, nephropathy, and end stage renal disease. The cumulative incidence of dementia by depression was estimated conditional on survival dementia-free to age 55.

Results: Five percent (N = 182) were diagnosed with dementia and 20% had baseline depression. Depression was associated with a 72% increase in dementia (fully adjusted HR = 1.72; 95% CI:1.12-2.65). The 25-year cumulative incidence of dementia was more than double for those with versus without depression (27% vs. 12%).

Conclusions: For people with T1D, depression significantly increases dementia risk. Given the pervasiveness of depression in T1D, this has major implications for successful aging in this population recently living to old age.

Full reference: Gilsanz, P. et al. | Depression in type 1 diabetes and risk of dementia | Aging & Mental Health | Published online: 10 Apr 2018 DOI: 10.1080/13607863.2018.1455167

Negative feelings and diabetes

Science Daily | May 2018 | Brain activity helps explain diabetics’ negative feelings, risk for depression

A US study suggests that negative feelings in people with a diagnosis of diabetes, or prediabetes,  might be due to problems regulating blood sugar levels that influence emotional response in the brain (via Science Daily).
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Researchers  gauged the startle response of participants, to provide a measure of their central nervous system activity, using tiny electrodes placed below their eye. The participants were shown a series of negative, positive and neutral images designed to elicit an emotional response. The electrodes captured the rate of flinch or startle, a contraction we cannot control, associated with each image.

Their findings show that participants with higher levels of insulin resistance were more startled by negative pictures.  They argue the evidence is even more compelling when combined with the results of EEG tests recording activity when the brain is at rest. Study participants with prediabetes and Type 2 diabetes had more activity on the right side of the brain, which is associated with depression and negative emotions.  By extension, if someone is predisposed to focusing on negative things, it may become a barrier for losing weight and reversing health issue

Tovah Wolf, an author of the study said: “For people with blood sugar problems, being more stressed and reactive can cause blood sugar to spike. If people with prediabetes and diabetes are trying to reverse or treat the disease, stressful events may hinder their goals,” Wolf said. “Frequent negative reactions to stressful events can lead to a lower quality of life and create a vicious cycle that makes it difficult to be healthy.

The full news item is available from Science Daily 

This paper has now been published in Psychosomatic Medicine

Abstract

Objective

Pre-diabetes and type 2 diabetes (i.e., hyperglycemia) are characterized by insulin resistance (IR). These problems with energy metabolism may exacerbate emotional reactivity to negatively valenced stimuli and related phenomena like predisposition toward negative affect, as well as cognitive deficits. Higher emotional reactivity is seen with hyperglycemia and IR. Yet, it is largely unknown how metabolic dysfunction correlates with related neural, hormonal, and cognitive outcomes.

Methods

Among 331 adults from the Midlife in the United States (MIDUS), we cross-sectionally examined eye- blink response (EBR) to gauge reactivity to negative, positive, or neutrally-valenced pictures from international affect picture system (IAPS) stimuli proximal to an acoustic startle probe. Increased EBR to negative stimuli was considered an index of stress reactivity. Frontal alpha asymmetry, a biomarker of negative affect predisposition, was determined using resting electroencephalography (EEG).

Methods

Baseline urinary cortisol output was collected. Cognitive performance was gauged using the Brief Test of Adult Cognition by telephone (BTACT). Fasting glucose and insulin characterized hyperglycemia or the homeostatic model assessment of IR (HOMA-IR).

Results

Higher HOMA-IR corresponded to an increased startle response, measured by EBR magnitude, for negative versus positive stimuli [R2=0.218, F(1,457)=5.48, p=.020, euglycemia: Mean±SD=.092±.776, hyperglycemia: Mean±SD=.120±.881]. Participants with hyperglycemia vs. euglycemia showed greater right frontal alpha asymmetry [F(1,307)=6.62, p=.011, euglycemia: Mean±SD=.018±.167, hyperglycemia: Mean±SD=-.029±.160] and worse BTACT arithmetic performance [F(1,284)=4.25, p=.040, euglycemia: Mean±SD=2.390±1.526), hyperglycemia: Mean±SD=1.920±1.462]. Baseline urinary cortisol (log10 μg/12 hr) was also dysregulated in individuals with hyperglycemia [[F(1,324)=5.09, p=.025, euglycemia: Mean±SD=1.052±.332, hyperglycemia: Mean±SD=.961±.362].

Conclusion

These results suggest that dysmetabolism is associated with increased emotional reactivity, predisposition toward negative affect, and specific cognitive deficits.
Wolf, T, Tsenkova, V,  Ryff, C.,  Richard, D. , J. Davidson, Auriel A. Willette. Neural, Hormonal, and Cognitive Correlates of Metabolic Dysfunction and Emotional ReactivityPsychosomatic Medicine, 2018; 1 DOI: 10.1097/PSY.0000000000000582

The full article may be requested by Rotherham NHS staff here