Depression and diabetes: fellow travelers, researchers say

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Public release date: 17-Jun-2008

http://www.eurekalert.org/pub_releases/2008-06/jhmi-dad061508.php

Contact: Christen Brownlee

cbrownlee@...

s Hopkins Medical Institutions

Depression and diabetes: fellow travelers, researchers say

Researchers have long known that type-2 diabetes and depression often go

hand in hand. However, it's been unclear which condition develops first

in patients who end up with both. Now, a new study led by s Hopkins

doctors suggests that this chicken-and-egg problem has a dual answer:

Patients with depression have an increased risk of developing type-2

diabetes, and patients with type-2 diabetes have an increased risk of

developing depression.

For the study, published in the June 18 Journal of the American Medical

Association, diabetes expert Sherita Hill Golden, M.D., M.H.S., and her

colleagues took advantage of data generated by the Multi-Ethnic Study of

Atherosclerosis (MESA), which examined risk factors for atherosclerosis,

or hardening of the arteries, in an ethnically diverse group of 6,814

men and women between ages 45 to 84. Participants in the MESA study

identified themselves when they enrolled as white, black, Hispanic or

Chinese.

During MESA, participants made three visits to clinics over the course

of three years to be examined for various atherosclerosis risk factors,

including type-2 diabetes and symptoms of depression, which could serve

as a precursor for full-blown clinical depression.

The study also collected information on other atherosclerosis risk

factors, such as participants' body-mass indices, blood pressure, diet

and exercise patterns, and smoking habits, as well as information

correlated with health in general, such as income and socioeconomic factors.

Mining the data for their own purposes, Golden and her colleagues

excluded from their analysis all participants who had high fasting

glucose, an indication of diabetes, at the initial clinic visit. They

then looked to see whether participants who initially had elevated

symptoms of depression, as indicated through a questionnaire, were more

likely than those who didn't to develop high fasting glucose at the end

of the three-year study period.

Results showed that those with elevated depressive symptoms were 42

percent more likely overall to develop diabetes by the end of the study

than those without these symptoms. Moreover, the stronger the symptoms,

the higher the risk of diabetes, a " dose response " that lends strength

to the findings.

Even when the researchers accounted for such factors as overweight, lack

of exercise, and smoking, the risk of developing diabetes was still 34

percent higher for patients with depressive symptoms.

To investigate whether diabetes could lead to depression, Golden and her

colleagues used the same pool of MESA information and excluded those who

had elevated depressive symptoms at the initial clinic visit. Then, they

looked to see whether those who had high fasting glucose—with or without

a formal diagnosis of diabetes—were more likely to develop depressive

symptoms by the end of the study.

The researchers found that patients treated for diabetes, about 9

percent of the group, were about 54 percent more likely to develop

elevated depressive symptoms than those without diabetes.

Surprisingly, those with prediabetes or untreated diabetes were about 25

percent less likely to develop elevated depressive symptoms than people

with normal fasting glucose, a finding Golden's team cannot explain at

this time.

Golden, an associate professor of medicine and epidemiology at the s

Hopkins University School of Medicine, speculates that depression may

lead patients to develop behaviors that trigger diabetes or make it

worse, such as overeating, not exercising or smoking. Similarly, keeping

up with the often extensive treatment regimens to care for their

diabetes may make patients' depression worse. Understanding how one

condition might lead to another could improve treatments for both

problems, she says.

" Having both diabetes and depression can make it difficult for patients

to get the good clinical outcomes that we like to see for each of these

conditions, " says Golden. " To make sure that patients with diabetes and

depression receive the best care, we wanted to get to the bottom of the

connection between these two conditions.

" It's important that doctors be attuned to look for both conditions in

patients at risk for either diabetes or depression, " Golden adds. " We

may want to develop interventions for both treatments, instead of just

one or the other. "

###

Other Hopkins researchers who participated in this study include na

Lazo, M.D.. M.Sc.; Hochang Lee, M.D.; and Constantine Lyketsos,

M.D., M.H.S.

The MESA study was supported by grants from the National Heart, Lung,

and Blood Institute. Golden and her colleagues' research was supported

by a Patient-Oriented Mentored Scientist Award through the National

Institute of Diabetes and Digestive and Kidney Diseases.

For more information, go to:

http://www.hopkinshospital.org/Diabetes/

http://www.hopkinsmedicine.org/endocrinology/faculty/faculty/golden.html

--

ne Holden, MS, RD

" Ask the Parkinson Dietitian " http://www.parkinson.org/

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