Depressive Symptoms Longitudinally Mediate the Negative Effects of HbA1c on Memory Change Over 6 Years

Abstract Elevated glycated hemoglobin (HbA1c) has been associated with worse episodic memory in Type 2 diabetes. Prospective links between HbA1c and incident depressive symptoms suggest that behavioral mechanisms may underlie this association. Elevations in HbA1c may lead to depressive symptoms via biochemical changes directly caused by Type 2 diabetes or through distress associated with managing the treatment demands of the disease. This study aimed to determine whether depressive symptoms longitudinally mediate associations between HbA1c and episodic memory over 6 years. Participants (N=2,155) comprised adults aged 51+ with self-reported Type 2 diabetes and clinically elevated HbA1c (≥5.7%) at the time the Health and Retirement Study initiated blood collection. A longitudinal mediation model quantified associations between baseline HbA1c and 6-year change in episodic memory through 4-year change in depressive symptoms, controlling for baseline socio-demographics, other health conditions, and medication adherence. HbA1c was assayed from dried blood spots. Depressive symptoms were self-reported twice over four years. Episodic memory, assessed three times over six years, was a z-score composite of immediate and delayed recall of a word list. Increased depressive symptoms four years after baseline partially mediated the negative association between baseline HbA1c and 6-year memory decline. Depressive symptoms partially mediated the concurrent association between HbA1c and memory at baseline. This longitudinal study provides evidence that the deleterious effects of HbA1c on subsequent episodic memory may operate partly through behavioral mechanisms. Depressive symptoms may represent a critical target for interventions to reduce the enduring negative effects of hyperglycemia on memory aging in Type 2 diabetes.

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Depression is more strongly associated with cognition in elderly women than men with type 2 diabetes

International Psychogeriatrics ◽

10.1017/s104161021800114x ◽

2018 ◽

Vol 31 (04) ◽

pp. 591-595

Author(s):

Laili Soleimani ◽

Ramit Ravona-Springer ◽

Anthony Heymann ◽

Elizabeth Guerrero-Berroa ◽

James Schmeidler ◽

...

Keyword(s):

Type 2 Diabetes ◽

Depressive Symptoms ◽

Cognitive Function ◽

Episodic Memory ◽

Elderly Women ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Neuropsychological Battery ◽

Semantic Categorization

ABSTRACTDepression and cognitive impairment are highly prevalent in type 2 diabetes (T2D), yet little is known about how their relationship varies by sex. We examined this question in a large T2D sample (N = 897) of non-demented elderly (≥ 65) participating in the Israel Diabetes and Cognitive Decline (IDCD) Study. Cognition was evaluated by a comprehensive neuropsychological battery and depressive symptoms were assessed by the Geriatric Depression Scale (GDS). The results showed that in all but the executive function domain, the association of depressive symptoms with poorer cognitive function was stronger in women than men, with a significant interaction for language/semantic categorization and missed significance for episodic memory. When defining clinical depression as GDS of ≥6, women with depression had significantly poorer language/semantic categorization, episodic memory, and overall cognitive function. Inclusion of antidepressants in the model did not alter substantively the associations. Our results suggest that depressed T2D women may have poorer cognitive performance, highlighting the significance of sex-specific personalized management of depression in elderly diabetics.

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Vitamin D concentrations from neonatal dried blood spots and the risk of early-onset type 2 diabetes in the Danish D-tect case-cohort study

Diabetologia ◽

10.1007/s00125-021-05450-2 ◽

2021 ◽

Author(s):

Amélie Keller ◽

Fanney Thorsteinsdottir ◽

Maria Stougaard ◽

Isabel Cardoso ◽

Peder Frederiksen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Vitamin D ◽

Cohort Study ◽

Early Onset ◽

Dried Blood Spots ◽

Onset Type ◽

Blood Spots

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Predictors of frailty among Chinese community-dwelling older adults with type 2 diabetes: a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2020-041578 ◽

2021 ◽

Vol 11 (3) ◽

pp. e041578

Author(s):

Linglin Kong ◽

Huimin Zhao ◽

Junyao Fan ◽

Quan Wang ◽

Jie Li ◽

...

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Depressive Symptoms ◽

Community Health ◽

Community Dwelling ◽

Central China ◽

Chinese Community ◽

Cross Sectional ◽

Community Dwelling Older Adults

ObjectivesTo assess the prevalence of frailty and identify predictors of frailty among Chinese community-dwelling older adults with type 2 diabetes.DesignA cross-sectional design.SettingTwo community health centres in central China.Participants291 community-dwelling older adults aged ≥65 years with type 2 diabetes.Main outcome measuresData were collected via face-to-face interviews, anthropometric measurements, laboratory tests and community health files. The main outcome measure was frailty, as assessed by the frailty phenotype criteria. The multivariate logistic regression model was used to identify the predictors of frailty.ResultsThe prevalence of prefrailty and frailty were 51.5% and 19.2%, respectively. The significant predictors of frailty included alcohol drinking (ex-drinker) (OR 4.461, 95% CI 1.079 to 18.438), glycated haemoglobin (OR 1.434, 95% CI 1.045 to 1.968), nutritional status (malnutrition risk/malnutrition) (OR 8.062, 95% CI 2.470 to 26.317), depressive symptoms (OR 1.438, 95% CI 1.166 to 1.773) and exercise behaviour (OR 0.796, 95% CI 0.716 to 0.884).ConclusionsA high prevalence of frailty was found among older adults with type 2 diabetes in the Chinese community. Frailty identification and multifaceted interventions should be developed for this population, taking into consideration proper glycaemic control, nutritional instruction, depressive symptoms improvement and enhancement of self-care behaviours.

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Factors associated with the onset of major depressive disorder in adults with type 2 diabetes living in 12 different countries: results from the INTERPRET-DD prospective study

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020000438 ◽

2020 ◽

Vol 29 ◽

Author(s):

C. E. Lloyd ◽

N. Sartorius ◽

H. U. Ahmed ◽

A. Alvarez ◽

S. Bahendeka ◽

...

Keyword(s):

Type 2 Diabetes ◽

Major Depressive Disorder ◽

Depressive Symptoms ◽

Depressive Disorder ◽

Life Events ◽

Stressful Life Events ◽

Regression Analyses ◽

Major Depressive

Abstract Aims To examine the factors that are associated with changes in depression in people with type 2 diabetes living in 12 different countries. Methods People with type 2 diabetes treated in out-patient settings aged 18–65 years underwent a psychiatric assessment to diagnose major depressive disorder (MDD) at baseline and follow-up. At both time points, participants completed the Patient Health Questionnaire (PHQ-9), the WHO five-item Well-being scale (WHO-5) and the Problem Areas in Diabetes (PAID) scale which measures diabetes-related distress. A composite stress score (CSS) (the occurrence of stressful life events and their reported degree of ‘upset’) between baseline and follow-up was calculated. Demographic data and medical record information were collected. Separate regression analyses were conducted with MDD and PHQ-9 scores as the dependent variables. Results In total, there were 7.4% (120) incident cases of MDD with 81.5% (1317) continuing to remain free of a diagnosis of MDD. Univariate analyses demonstrated that those with MDD were more likely to be female, less likely to be physically active, more likely to have diabetes complications at baseline and have higher CSS. Mean scores for the WHO-5, PAID and PHQ-9 were poorer in those with incident MDD compared with those who had never had a diagnosis of MDD. Regression analyses demonstrated that higher PHQ-9, lower WHO-5 scores and greater CSS were significant predictors of incident MDD. Significant predictors of PHQ-9 were baseline PHQ-9 score, WHO-5, PAID and CSS. Conclusion This study demonstrates the importance of psychosocial factors in addition to physiological variables in the development of depressive symptoms and incident MDD in people with type 2 diabetes. Stressful life events, depressive symptoms and diabetes-related distress all play a significant role which has implications for practice. A more holistic approach to care, which recognises the interplay of these psychosocial factors, may help to mitigate their impact on diabetes self-management as well as MDD, thus early screening and treatment for symptoms is recommended.

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Effects of a Multicomponent Life-Style Intervention on Weight, Glycemic Control, Depressive Symptoms, and Renal Function in Low-Income, Minority Patients With Type 2 Diabetes

Psychosomatic Medicine ◽

10.1097/psy.0000000000000348 ◽

2016 ◽

Vol 78 (7) ◽

pp. 851-860 ◽

Cited By ~ 9

Author(s):

Ashley E. Moncrieft ◽

Maria M. Llabre ◽

Judith Rey McCalla ◽

Miriam Gutt ◽

Armando J. Mendez ◽

...

Keyword(s):

Type 2 Diabetes ◽

Renal Function ◽

Depressive Symptoms ◽

Glycemic Control ◽

Low Income ◽

Life Style ◽

Life Style Intervention

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Disparities in the use of a mHealth medication adherence promotion intervention for low-income adults with type 2 diabetes

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocv082 ◽

2015 ◽

Vol 23 (1) ◽

pp. 12-18 ◽

Cited By ~ 46

Author(s):

Lyndsay A Nelson ◽

Shelagh A Mulvaney ◽

Tebeb Gebretsadik ◽

Yun-Xian Ho ◽

Kevin B Johnson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Depressive Symptoms ◽

Medication Adherence ◽

Health Literacy ◽

Low Income ◽

Mhealth Intervention ◽

Lower Health ◽

The Relationship ◽

Lower Health Literacy

Abstract Objective Mobile health (mHealth) interventions may improve diabetes outcomes, but require engagement. Little is known about what factors impede engagement, so the authors examined the relationship between patient factors and engagement in an mHealth medication adherence promotion intervention for low-income adults with type 2 diabetes (T2DM). Materials and Methods Eighty patients with T2DM participated in a 3-month mHealth intervention called MEssaging for Diabetes that leveraged a mobile communications platform. Participants received daily text messages addressing and assessing medication adherence, and weekly interactive automated calls with adherence feedback and questions for problem solving. Longitudinal repeated measures analyses assessed the relationship between participants’ baseline characteristics and the probability of engaging with texts and calls. Results On average, participants responded to 84.0% of texts and participated in 57.1% of calls. Compared to Whites, non-Whites had a 63% decreased relative odds (adjusted odds ratio [AOR] = 0.37, 95% confidence interval [CI], 0.19-0.73) of participating in calls. In addition, lower health literacy was associated with a decreased odds of participating in calls (AOR = 0.67, 95% CI, 0.46-0.99, P = .04), whereas older age ( Pnonlinear = .01) and more depressive symptoms (AOR = 0.62, 95% CI, 0.38-1.02, P = .059) trended toward a decreased odds of responding to texts. Conclusions Racial/ethnic minorities, older adults, and persons with lower health literacy or more depressive symptoms appeared to be the least engaged in a mHealth intervention. To facilitate equitable intervention impact, future research should identify and address factors interfering with mHealth engagement.

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Investigating Factors Associated with Depressive Symptoms of Chronic Kidney Diseases in China with Type 2 Diabetes

Journal of Diabetes Research ◽

10.1155/2017/1769897 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Xu Wang ◽

Biyu Shen ◽

Xun Zhuang ◽

Xueqin Wang ◽

Weiqun Weng

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Type 2 Diabetes ◽

Regression Analysis ◽

Depressive Symptoms ◽

Kidney Diseases ◽

Chronic Kidney Diseases ◽

Factors Associated

Aim.To assess the depressive symptoms status of chronic kidney diseases in Nantong, China, with type 2 diabetes and to identify factors associated with depressive symptoms.Methods.In this cross-sectional analytic study, 210 type 2 diabetic patients were recruited from the Second Affiliated Hospital of Nantong University. Depressive symptoms were assessed with the depression subscale of the Hospital Anxiety and Depression Scale (HAD-D). The quality of life was measured with the RAND 36-Item Health Survey (SF-36). And the independent risk factors of depressive symptoms were assessed by using a stepwise forward model of logistic regression analysis.Results.The mean age of the study subjects was 57.66 years (SD: 11.68). Approximately 21.4% of subjects reported depressive symptoms (n=45). Forward stepwise logistic regression analysis showed that female gender (P=0.010), hypertension (P=0.022), Stage IV (P=0.003), and Stage V (P<0.001) were significant risk factors for depressive symptoms. The quality of life of individuals with HAD-D score <11 was significantly better compared with individuals with HAD-D score ≥ 11.Conclusions.These results indicate that clinicians should be aware that female patients with chronic kidney diseases with T2DM in their late stage with hypertension are at a marked increased risk of depressive symptoms. Providing optimal care for the psychological health of this population is vital.

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