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      Impact of Diabetic Foot on Selected Psychological or Social Characteristics

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          Abstract

          With great interest, we read the recent paper [1] “Does the diabetic foot have a significant impact on selected psychological or social characteristics of patients with diabetes mellitus?”. The authors aimed to compare selected psychological and social characteristics between diabetic patients with and without the diabetic foot (DF). They have concluded that patients with DF had a predominantly worse standard of living and patients with DF appeared to have good stress tolerability and mental health and did not reveal severe forms of depression or any associated consequences. It is very well known that comorbidity of depression with diabetes mellitus is related to poor glycemic control, higher severity of diabetic complications, increased risk of cardiovascular diseases, higher functional disability, and poor treatment adherence [2, 3]. In contradiction to what is mentioned above and the authors' expectation, the study results showed no significant differences between the two groups regarding depression scores. In addition to the authors' reasonable discussion, we want to stress another possible factor not mentioned in the study which is that the patients in both groups may be on or have history of antidepressant treatment. We believe it seems important to assess the presence of antidepressant treatment in the future studies to assess presence of depressive symptoms.

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          The relationship of depression and diabetes: pathophysiological and treatment implications.

          Dominique L. Musselman, Charles Nemeroff, James K Rustad (2011)
          Diabetes is a highly prevalent, chronic disease that requires ongoing, multi-specialty medical care combined with patient self-management, family support, and education to prevent or delay end-organ morbidity and mortality. There is clearly an increased prevalence of major depressive disorder, a relatively common and costly central nervous system syndrome, in diabetic patients. During the past two decades, multiple studies reveal that not only are depressive symptoms a risk factor for the development of type 2 diabetes, but they have also been shown to contribute to hyperglycemia, diabetic complications, functional disability and all-cause mortality among diabetic patients. This article reviews studies examining the relationship between depression and diabetes, neurochemical underpinnings of the two disorders, and the diagnosis and treatment of depression associated with diabetes. We examine the validity of rating scales used to diagnose depression in diabetic patients and review the literature on psychotherapeutic and psychopharmacologic management for these patients. The challenges of optimal depression screening and treatment in primary care settings of diabetic patients are currently under close scrutiny, especially regarding their potential impact related to improvements in diabetes-related outcomes and decreased health care costs, be it "depression" or "diabetes" relevant. Much of the current literature regarding the intertwined nature of diabetes and depression is cross-sectional in nature. Future research should focus on longitudinal, prospective studies to determine causal factors. What is clear from the research reviewed in this article is that depression and diabetes should be treated together rather than as isolated diseases. The mind/body dualism is a false dichotomy and a truly team-based approach is necessary to address both issues of depression and diabetes. Collaborative care and the "patient-centered medical home" have emerged as potentially effective interventions to improve quality of care and patient outcomes in patients with depression and medical illnesses such as diabetes. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Comparative study of the influence of diabetes distress and depression on treatment adherence in Chinese patients with type 2 diabetes: a cross-sectional survey in the People’s Republic of China

            Jie-Jie Zhang, Cui-Ping Xu, Hong-xia Wu … (2013)
            Background The purpose of this study was to explore diabetes-related distress and depression and their influence on treatment adherence in Chinese patients with type 2 diabetes. Methods We surveyed 200 type 2 diabetic patients from two public hospitals using the Diabetes Distress Scale (DDS), Zung Self-rating Depression Scale, and Revised Treatment Adherence in Diabetes Questionnaire (RADQ). A multiple regression model was used to explore the relationship between diabetes distress, depression, and treatment adherence. Results In the 200 eligible patients, the incidence of depression and diabetes distress was approximately 24% and 64%, respectively. The mean score on the RADQ was 23.0 ± 6.0. Multiple regression analysis showed that DDS scores (β = 5.34, P = 0.000), age (β = 0.15, P = 0.014), and family history (β = 3.2, P = 0.016) had a positive correlation with depression. DDS scores (β = −2.30, P = 0.000) and treatment methods (β = −0.93, P = 0.012) were risk factors for poor treatment adherence, whereas age (β = 0.089, P = 0.000) and cohabitation (β = 0.93, P = 0.012) increased treatment adherence. The independent-samples t- test showed that depression also affected treatment adherence (t = 2.53, P < 0.05). Conclusion These findings suggest that the DDS is a predictor of depression and that diabetes distress plays a more important part than depression in treatment adherence. Screening for diabetes distress may be useful for primary prevention of psychologic problems; however, some form of specialized psychologic intervention should be incorporated to promote patient adherence with treatment.
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              Does the Diabetic Foot Have a Significant Impact on Selected Psychological or Social Characteristics of Patients with Diabetes Mellitus?

              Vladimira Fejfarová, Alexandra Jirkovska, Eva Dragomirecka … (2014)
              The aim of our case-control study was to compare selected psychological and social characteristics between diabetic patients with and without the DF (controls). Methods. 104 patients with and 48 without DF were included into our study. Both study groups were compared in terms of selected psychosocial characteristics. Results. Compared to controls, patients with DF had a significantly worse quality of life in the area of health and standard of living as shown by lower physical health domain (12.7 ± 2.8 versus 14.7 ± 2.5; P < 0.001) and environment domain (14.1 ± 2.2 versus 15 ± 1.8; P < 0.01) that negatively correlated with diabetes duration (r = −0.061; P = 0.003). Patients with DF subjectively felt more depressed in contrast to controls (24.5 versus 7.3%; P < 0.05); however, the depressive tuning was objectively proven in higher percentage in both study groups (83.2 versus 89.6; NS). We observed a significantly lower level of achieved education (P < 0.01), more patients with disability pensions (P < 0.01), and low self-support (P < 0.001) in patients with the DF compared to controls. In the subgroup of patients with a previous major amputation and DF (n = 6), there were significantly worse outcomes as in the environment domain (P < 0.01), employment status, and stress readaptation (P < 0.01) in contrast to the main study groups. Conclusions. Patients with DF had a predominantly worse standard of living. In contrast to our expectations, patients with DF appeared to have good stress tolerability and mental health (with the exception of patients with previous major amputation) and did not reveal severe forms of depression or any associated consequences.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Diabetes Res
                Journal ID (iso-abbrev): J Diabetes Res
                Journal ID (publisher-id): JDR
                Title: Journal of Diabetes Research
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2314-6745
                ISSN (Electronic): 2314-6753
                Publication date (Print): 2014
                Publication date (Electronic): 21 October 2014
                Volume: 2014
                Electronic Location Identifier: 981721
                Affiliations
                1Department of Psychiatry, Abant Izzet Baysal University, School of Medicine, Bolu, Turkey
                2Department of General Surgery, Abant Izzet Baysal University, School of Medicine, Bolu, Turkey
                3Department of Orthopaedics and Traumatology, Abant Izzet Baysal University, School of Medicine, Golkoy, 14280 Bolu, Turkey
                Author notes

                Academic Editor: James Wrobel

                Author information
                http://orcid.org/0000-0003-2221-4731
                Article
                DOI: 10.1155/2014/981721
                PMC ID: 4221861
                SO-VID: b677f6ec-7d2c-4f8b-b8d6-5c8312f52dbf
                Copyright © Copyright © 2014 Ugur Cakir et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 July 2014
                Date accepted : 27 August 2014
                Categories
                Subject: Letter to the Editor

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