May 02, 2019
2 min read

Anxiety, depressive symptoms impede diabetes self-care

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Adults with diabetes who also have anxiety or depressive symptoms may be less likely to perform beneficial self-care practices, according to findings published in the Journal of Diabetes and its Complications.

“Depression has been associated with worsened health outcomes for people across the diabetes spectrum, including persistent hyperglycemia, a higher risk for diabetes-related vascular complications, worse intervention outcomes and higher mortality rates in longitudinal studies,” Giesje Nefs, PhD, a postdoctoral researcher for the Center of Research on Psychological and Somatic Disorders at Tilburg University in the Netherlands, and colleagues wrote. “The characteristics of people with diabetes who experience comorbid anxiety and depression remain unclear, but reports suggest that this combined comorbidity may be associated with having complications.”

Nefs and colleagues examined data from 6,590 combined participants (53.3% women) from the MILES studies in Australia and the Netherlands. Of the total cohort, 42% had type 1 diabetes (mean age, 45 years) and 58% had type 2 diabetes (mean age, 60 years). Participants reported anxiety and depressive symptoms via questionnaires, which graded severity on scales from 0 to 21 and 0 to 27, respectively. A score of 10 or more indicated elevated symptoms on both questionnaires. Participants also reported self-care practices, including medication adherence, diet, exercise and blood glucose monitoring.

Nine percent of the participants reported having anxiety/depressive symptoms, with 2% reporting anxiety symptoms alone. More participants with type 2 diabetes met the criteria for elevated depressive symptoms alone compared with participants with type 1 diabetes (11% vs. 8%; P = .002).

Insulin use was less likely (OR = 0.3; 95% CI, 0.16-0.6) and diabetes duration was longer (OR = 1.05; 95% CI, 1.01-1.09) for those with type 2 diabetes who reported high rates of anxiety symptoms compared with those who did not, the researchers wrote. Researchers also observed an opposite finding in those with higher depressive symptoms, noting that diabetes duration was shorter (OR = 0.98; 95% CI, 0.96-0.99) and insulin use was more frequent (OR = 1.4; 95% CI, 1.1-1.77) in this group compared with those without high depressive symptoms.

Participants with type 1 diabetes and more anxiety and depressive symptoms were at higher odds for “suboptimal self-care behaviors,” including missing insulin injections (OR = 3.16; 95% CI, 2.13-4.69), not monitoring blood glucose (OR = 1.56; 95% CI, 1.17-2.07) and not taking blood pressure-lowering medications as prescribed (OR = 2.42; 95% CI, 1.16-5.04), compared with those without symptoms.


Participants with type 2 diabetes with higher levels of anxiety and depressive symptoms were also at risk for behaviors such as poor adherence to medications aimed at lowering blood glucose (OR = 2.49; 95% CI, 1.81-3.42), cholesterol (OR = 1.71; 95% CI, 1.24-2.33) and BP (OR = 2.22; 95% CI, 1.59-3.11) compared with those without these symptoms.

In addition, participants with anxiety and depressive symptoms had higher odds for not maintaining a healthy diet (OR = 3.47; 95% CI, 2.44-4.93 in type 1 diabetes; OR = 4.63; 95% CI, 3.5-6.14 in type 2 diabetes) and not exercising regularly (OR = 2.54; 95% CI, 1.92-3.37 in type 1 diabetes; OR = 2.75; 95% CI, 2.15-3.52 in type 2 diabetes) compared with those without symptoms, the researchers wrote.

“Apart from potentially negative effects on physical health, comorbid anxiety/depression could have other relevance for clinical practice. ... Additional attention to people presenting with this comorbidity is therefore warranted when planning treatment and allocating resources,” the researchers wrote. “It is important that health professionals screen for psychological comorbidity, by putting it on the agenda in regular care and using questionnaires, as effective treatments for anxiety and depression are available.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.