Depressive symptoms linked to DKA risk in type 1 diabetes
medwireNews: People with type 1 diabetes who have depressive symptoms may have an increased risk for diabetic ketoacidosis (DKA) as well as deteriorating glycemic control, research suggests.
Data from the T1D Exchange registry show that during 5 years of follow-up the highest rates of DKA occurred among people with persistent or new-onset elevated depressive symptoms, defined as a score of at least 10 on the eight-item Patient Health Questionnaire depression scale (PHQ-8), at 10.0% and 6.5%, respectively.
The rate was lower in people whose baseline depressive symptoms resolved, at 4.1%, and lowest of all in people who remained free of depression, at 1.6%. The findings were similar when depression was defined using the Behavioral Risk Factor Surveillance Survey algorithm, and the relationship between PHQ-8 score and DKA was significant after accounting for DKA at baseline and annual income at baseline and follow-up.
Nicole Foster (Jaeb Center for Health Research, Tampa, Florida, USA) and study co-authors caution that their findings do not prove whether depressive symptoms directly affect diabetes outcomes or vice versa.
But they stress that “the evidence for their association over time confirms that adults with [type 1 diabetes] who have elevated depression symptoms are a highly vulnerable group that is at increased risk of serious short-term negative diabetes-related consequences as well as long-term complications.”
The study involved 2744 adults who at baseline were aged an average of 42 years and with an average glycated hemoglobin (HbA1c) level of 7.6% (60 mmol/mol).
HbA1c increased over time in all groups, but was also significantly associated with depressive symptoms, with the average adjusted increases being 0.6% and 0.6% in people with persistent and new-onset depression, respectively, versus 0.3% and 0.4% in those with resolved or no depression, respectively.
Foster and team highlight as “noteworthy” that 53% of the 253 people who had elevated depressive symptoms at baseline (9% of the whole cohort) still did so at the 5-year follow-up. In addition, 7% developed elevated depressive symptoms over this time, and 15% had depression at some point during follow-up.
“These data support national clinical practice guidelines calling for routine depression screening among individuals with diabetes,” they conclude in Diabetes Care.
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