Depression in Relation to Long-term Control of Glycemia, Blood Pressure, and Lipids in Patients with Diabetes
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Little information is available about the association of depression with long-term control of glycemia, blood pressure, or lipid levels in patients with diabetes.
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.
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.
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.
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.
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.
KEY WORDSdepression diabetes glycemia hypertension hyperlipidemia
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.