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 “Although it would seem intuitive to expect that depression would
make the already difficult job of diabetes self-management that much
harder, the available data have not been very clear,” lead author
Jeffrey S. Gonzalez of Yeshiva University in New York said by email.
It is clear, however, that treating depression may be necessary
though it is unlikely to be sufficient to improve treatment
adherence and diabetes self-management, Gonzalez told Reuters
Health.
“Diabetes-related distress reflects the emotional and psychological
reactions to the burden and stress associated with diabetes and its
management,” Gonzalez and his coauthors write in the journal
Diabetes Care.
Physical symptoms of depression like poor sleep or appetite as well
as low energy can overlap with symptoms of diabetes and with side
effects some patients blame on their diabetes medications, the
researchers write.
To identify the effects of distress and depression on whether
patients adhere to their medications, researchers recruited 104 men
and women with type 2 diabetes. The participants answered questions
about their diabetes-related emotional distress and depression
symptoms, and researchers interviewed them for further detail about
their depression experience. Participants also provided blood
samples for researchers to assess how well controlled their diabetes
was.
Just over 46 percent of participants had clinically significant
diabetes distress, and 21 percent had some depression symptoms,
although only five individuals met the criteria for major depressive
disorder.
Over the next three months the researchers monitored participants’
medication use via electronic bottle caps in addition to having them
answer the question at the end of the study, “What percentage of the
time did you take all your diabetes medications” as prescribed.
Based on the bottle cap data, the average was 76 percent of the
time.
People with higher levels of self-reported or researcher-assessed
depressive symptoms or distress tended to have fewer days on
medication than others, the study found.
Depending on the disease stage and medication, missing or skipping
medications prescribed for blood sugar, blood pressure or
cholesterol is usually not acutely dangerous for people with type 2
diabetes, said Frank J. Snoek of VU University Medical Center
Amsterdam, who was not part of the new study.
“Overall, the consequences are mostly felt on the long-term, by
means of complications resulting from uncontrolled blood sugar
levels, hypertension and high lipid levels,” leading to damage of
the kidneys, feet and nerves or to cardiovascular events like
stroke, he told Reuters Health by email.
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When the study team analyzed the relationship between depression and
medication adherence, they found that physical depression symptoms
like poor sleep and daytime fatigue were the biggest predictors of
whether people took their meds regularly and distress levels became
less significant.
“When we think of clinical depression, or major depressive disorder,
we typically think of the hallmark symptoms of depressed mood, loss
of interest, negative thoughts about the self and future, etc.,”
Gonzalez said. But in this case, symptoms involving problems with
sleep and appetite, as well as fatigue, were more closely and
independently related to medication non-adherence, he said.
“If there is a causal relationship, it's likely to be cyclical where
depression leads to non-adherence which in turn leads to poor
control and poorer health, creating further stress and worsening of
depression,” he said.
Diabetes does raise the risk of subsequent depression, he added.
“Living with and managing diabetes can often be a burden for
patients and stressful circumstances can often trigger emotional
distress and, sometimes, depression,” Gonzalez said. “The point of
diagnosis is a good time to evaluate patients' distress and their
available resources to deal with it,” but too often mental health
care is not part of the diabetes discussion.
Tying medication doses to particular routines that occur regularly
in the person's life, like morning coffee, may be more effective
than tying them to a particular time of day, he said.
“Ideally, providers would approach medication management of diabetes
as a collaborative process that is sensitive to the patient's goals
and concerns,” Gonzalez said.
SOURCE: http://bit.ly/2fBfXx5 Diabetes Care, online October 16,
2016.
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