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Depression in Relation to Long-term Control of Glycemia, Blood Pressure, and Lipids in Patients with Diabetes

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Abstract

Background

Little information is available about the association of depression with long-term control of glycemia, blood pressure, or lipid levels in patients with diabetes.

Objective

To determine whether minor and major depression at study enrollment compared with no depression are associated with higher average HbA1c, systolic blood pressure (SBP) and LDL cholesterol over the long term in patients with an indication for or receiving drug treatment.

Design

Cohort study.

Patients

A total of 3,762 patients with type 2 diabetes mellitus enrolled in the Pathways Epidemiologic Study in 2001–2002 and followed for 5 years.

Main Measures

Depression was assessed at study enrollment using the Patient Health Questionnaire-9 (PHQ-9). SBP and information on cardiovascular co-morbidity were abstracted from medical records, and LDL cholesterol and HbA1c measured during clinical care were obtained from computerized laboratory data during a median of 4.8 years’ follow-up.

Key Results

Among those with an indication for or receiving drug treatment, after adjustment for demographic and clinical characteristics, average long-term HbA1c, SBP, and LDL cholesterol did not differ in patients with comorbid diabetes and minor or major depression compared with those with diabetes alone.

Conclusions

The adverse effect of depression on outcomes in patients with diabetes may not be mediated in large part by poorer glycemic, blood pressure, or lipid control. Further study is needed of the biologic effects of depression on patients with diabetes and their relation to adverse outcomes.

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Acknowledgments

Supported by grant MH073686 from the National Institute of Mental Health, Bethesda, MD.

Conflict of interest

Dr. Ciechanowski is CEO and founder of Samepage, Inc., a consulting company providing services for improving patient-provider relationships; Dr. Lin has received honoraria from Health Star Communications and Prescott Medical; Dr. Katon has received honoraria for lectures from Wyeth, Lilly, Forest, and Pfizer, and is on advisory boards for Lilly and Wyeth; Dr. Von Korff has one grant to Group Health Research Institute funded by Johnson & Johnson and another grant pending.

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Authors and Affiliations

  1. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Susan R. Heckbert MD, PhD

  2. Department of Medicine (Dermatology), University of Washington, Seattle, WA, USA

    Lisa H. Williams MD, MS

  3. Department of Psychiatry, University of Washington, Seattle, WA, USA

    Paul Ciechanowski MD, MPH & Wayne J. Katon MD

  4. Biostatistics Unit, Group Health Research Institute, Seattle, WA, USA

    Carolyn M. Rutter PhD

  5. Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA

    Susan R. Heckbert MD, PhD, Malia Oliver BA, Elizabeth H. B. Lin MD, MPH & Michael Von Korff ScD

  6. University of Washington Cardiovascular Health Research Unit, 1730 Minor Avenue, Suite 1360, Seattle, WA, 98101-1448, USA

    Susan R. Heckbert MD, PhD

Authors
  1. Susan R. Heckbert MD, PhD
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  2. Carolyn M. Rutter PhD
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  3. Malia Oliver BA
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  4. Lisa H. Williams MD, MS
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  5. Paul Ciechanowski MD, MPH
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  6. Elizabeth H. B. Lin MD, MPH
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  7. Wayne J. Katon MD
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  8. Michael Von Korff ScD
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Corresponding author

Correspondence to Susan R. Heckbert MD, PhD.

Additional information

Financial support: Supported by grant MH073686 from the National Institute of Mental Health, Bethesda, MD.

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Heckbert, S.R., Rutter, C.M., Oliver, M. et al. Depression in Relation to Long-term Control of Glycemia, Blood Pressure, and Lipids in Patients with Diabetes. J GEN INTERN MED 25, 524–529 (2010). https://doi.org/10.1007/s11606-010-1272-6

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  • DOI: https://doi.org/10.1007/s11606-010-1272-6

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