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Depressive symptoms in type 1 diabetes linked to extended hyperglycemia, brain lesions

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January 31, 2019

Middle-aged adults with type 1 diabetes are more likely to experience depressive symptoms than those without, and extended hyperglycemia and more white matter hyperintensities in the brain may play a role in this difference, according to findings published in Diabetic Medicine.

“For unknown reasons, depression appears to be two to three times more common among people with type 1 diabetes mellitus than among the general population,” Caterina Rosano, MD, MPH, professor in the department of epidemiology at the Graduate School of Public Health at the University of Pittsburgh, and colleagues wrote. “Addressing depression in aging adults with type 1 diabetes deserves high public health priority, not only because of the high personal and societal costs of depression, but also because of the potential detrimental effects on glycemic control and diabetes-related complications.”

Rosano and colleagues analyzed data from 130 adults with type 1 diabetes (mean age, 51 years; 52% women) diagnosed between 1950 and 1980 at the Children’s Hospital of Pittsburgh and 133 adults without diabetes (mean age, 49 years; 54% women) to assess the rates of depressive symptoms. Participants underwent neuroimaging and neurocognitive testing at the University of Pittsburgh Medical Center between 2010 and 2015.

The researchers defined depressive symptoms with a Beck Depression Inventory score of 10 or more in participants with type 1 diabetes. A score of 16 or more on the Center for Epidemiological Studies – Depression scale was used for participants without type 1 diabetes. Poor glycemic control was defined by a 16-year average HbA1c of at least 7.5%.

Neuroimaging showed that participants with type 1 diabetes had higher volumes of white matter hyperintensities compared with those without (P = .005). The researchers noted an eight times greater odds of developing depressive symptoms related to white matter hyperintensities (OR = 8.3; 95% CI, 1.1-62.43). Higher white matter hyperintensities (P = .034), less physical activity (P = .007), poor glycemic control (P = .016) and self-reported disability (P = .047) were all associated with depressive systems after adjusting for antidepressant use, sex and education level. Participants with extended bouts of hyperglycemia had a 4.6 times greater odds of developing depressive symptoms than those without diabetes (OR = 4.59; 95% CI, 1.36-15.56).

Among participants with type 1 diabetes, 28% had depressive symptoms compared with 3% of participants without diabetes (P < .001). Adjusting for age and education level further confirmed this difference (OR = 12.2; 95% CI, 4.1-35.8). According to the researchers, 40% of the link between type 1 diabetes and depressive symptoms was due to white matter hyperintensities. – by Phil Neuffer

Disclosures: Rosano reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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