A history of diagnosed depression and high diabetes-related distress were associated with significantly higher baseline HbA1c levels (10.77% vs 9.36% for diagnosed depression), though insulin therapy improved glycemic control across all groups over 24 months.
Observational (n=985)
Yes
Does insulin initiation improve glycemic control and depression parameters in patients with T2DM and comorbid depression or diabetes distress?
Insulin initiation in T2DM improves glycemic control regardless of baseline depression or diabetes distress, and is associated with a significant decline in depressed mood.
Absolute Event Rate: 10.77% vs 9.36%
p-value: p=<0.001
INTRODUCTION: Although depression is often associated with poor glycemic control in patients with type 2 diabetes mellitus (T2DM), this observation has been inconsistent. This exploratory, post hoc analysis investigated associations between depression parameters and glycemic control using data from a 24-month, prospective, observational, non-interventional study evaluating glycemic response following insulin initiation for T2DM. METHODS: We analyzed data from a 24-month, prospective, observational study that evaluated glycemic response in patients with T2DM who initiated insulin therapy (N = 985) in 5 European countries. Secondary measures included patient-reported diagnosis of depression at baseline, severity of depressed/anxious mood (EuroQol (EQ)-5D item) and diabetes-related distress (Psychological Distress domain of the Diabetes Health Profile, DHP-18). The latter two measures were assessed at baseline and 5 time points throughout the study. Glycemic control was measured by glycated hemoglobin (HbA1c) at these same time points. Analyses employed t tests to assess the unadjusted baseline difference in HbA1c between patients with and without the respective depression parameter. The potential effect of demographic and clinical confounding variables was controlled through a linear model structure. Patient HbA1c levels were analyzed by presence/absence of a history of diagnosed depression, depressed mood, and diabetes-related distress. RESULTS: Patients with higher depression parameters or distress at baseline had significantly higher rates of microvascular complications at baseline. Patients with a history of diagnosed depression or high diabetes-related distress had higher HbA1c than patients without. HbA1c of patients with or without depressed mood was not significantly different at baseline. The proportion of patients with depressed mood declined after insulin initiation, whereas the proportion of patients with high diabetes-related distress did not significantly change. HbA1c improved following insulin initiation, regardless of presence/absence of studied depression/distress parameters at baseline. CONCLUSION: History of diagnosed depression, diabetes-related distress, and depressed mood were associated with a higher rate of microvascular complications. Diagnosed depression and diabetes-related distress also showed higher HbA1c at baseline when insulin was initiated. Insulin therapy improved glycemic control, while preexisting depressed mood declined and diabetes-related distress remained unchanged.
Ascher‐Svanum et al. (2015) conducted an observational in Type 2 diabetes mellitus (n=985). History of diagnosed depression, depressed mood, and diabetes-related distress vs. Patients without these depression or distress parameters was evaluated on Baseline HbA1c in patients with vs. without a history of diagnosed depression (p=<0.001). A history of diagnosed depression and high diabetes-related distress were associated with significantly higher baseline HbA1c levels (10.77% vs 9.36% for diagnosed depression), though insulin therapy improved glycemic control across all groups over 24 months.