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 Diabetics can be more prone to depression and stress than other
individuals, and these mental health problems are linked to
increased risks of dangerously high blood sugar levels and other
serious complications, previous research has found.
When diabetics do get depressed, however, taking antidepressants is
linked to 95 percent higher odds that their blood sugar will be well
controlled, the current study found.
“We don’t know the mechanism by which the use of antidepressants is
associated with better blood sugars in those patients with both
conditions,” said lead study author Dr. Jay Brieler of Saint Louis
University School of Medicine.
It’s possible that when depression improves, people may be more
likely to follow a healthy diet, exercise, check their blood sugars
and keep up with medications for diabetes, Brieler said by email.
Scientists are also exploring whether there’s a physiologic
connection between the two diseases, which might mean shifts in
stress hormones tied to antidepressant use might also affect blood
sugars.
“Regardless of the mechanism, I think that our study adds to the
evidence that it is important to properly diagnose and treat
depression in diabetics,” Brieler added.
Brieler and colleagues reviewed electronic medical records for about
1,400 diabetics, including lab tests for blood sugar and
prescription data on antidepressant use, from 2008 to 2013.
On average, patients were around 62 years old. Most were obese.
All of them had type 2, or adult-onset, diabetes, which happens when
the body can't properly use or make enough of the hormone insulin to
convert blood sugar into energy.
Many had other health problems, too, such as high blood pressure or
cholesterol.
Most – 1,134 of them – didn’t suffer from depression, but the study
included 225 people being treated for depression and 40 individuals
who were diagnosed with depression but were not taking medication
for it.
Researchers estimated average blood sugar levels over the course of
several months by measuring the percentage of hemoglobin – the
protein in red blood cells that carries oxygen – that is coated with
sugar.
This sugar-coated form of hemoglobin is known as hemoglobin A1c, or
HbA1c. With diabetes, keeping HbA1c test results below 7 percent is
generally considered to be good blood sugar control.
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Overall, only 44 percent of diabetics in the study had their blood
sugar under control, or below 7 percent, and average HbA1c levels
were 7.7 percent.
About 51 percent of people with treated depression had their blood
sugar under control, compared to only 35 percent of those with
untreated depression.
One limitation of the study is that researchers couldn’t determine
whether treating depression led to better blood sugar control or
whether lowering blood sugar eases depression symptoms, the authors
acknowledge in Family Practice. Both scenarios are possible.
It’s also important for patients to know that certain
antidepressants and antipsychotics can be associated with weight
gain and poor blood sugar control, noted Dr. Robert Cohen, a
researcher at the University of Cincinnati College of Medicine and
the Cincinnati VA Medical Center who wasn’t involved in the study.
“That’s why it is important to have those medications prescribed by
a health care provider who will be following along closely enough to
detect that and determine when changes are needed,” Cohen said by
email.
These risks shouldn’t deter diabetics from seeking depression
treatment, however.
“From my experience, getting depression under control by whatever
means can help people overcome their inertia that prevents them from
making their best efforts to deal with their diabetes,” Cohen added.
SOURCE: http://bit.ly/1Rkh7sR Family Practice, online January 7,
2016.
[© 2016 Thomson Reuters. All rights
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