Elizabeth H.B. Lin , MD, MPH 1 , Carolyn M. Rutter , PHD 1 , Wayne Katon , MD 2 , Susan R. Heckbert , MD, PHD 3 , Paul Ciechanowski , MD, MPH 2 , Malia M. Oliver , BA 1 , Evette J. Ludman , PHD 1 , Bessie A. Young , MD, MPH 4 , Lisa H. Williams , MD, MS 5 , David K. McCulloch , MD 1 , Michael Von Korff , SCD 1
23 November 2009
To prospectively examine the association of depression with risks for advanced macrovascular and microvascular complications among patients with type 2 diabetes.
A longitudinal cohort of 4,623 primary care patients with type 2 diabetes was enrolled in 2000–2002 and followed through 2005–2007. Advanced microvascular complications included blindness, end-stage renal disease, amputations, and renal failure deaths. Advanced macrovascular complications included myocardial infarction, stroke, cardiovascular procedures, and deaths. Medical record review, ICD-9 diagnostic and procedural codes, and death certificate data were used to ascertain outcomes in the 5-year follow-up. Proportional hazard models analyzed the association between baseline depression and risks of adverse outcomes.
After adjustment for prior complications and demographic, clinical, and diabetes self-care variables, major depression was associated with significantly higher risks of adverse microvascular outcomes (hazard ratio 1.36 [95% CI 1.05–1.75]) and adverse macrovascular outcomes (1.24 [1.0–1.54]).
Among people with type 2 diabetes, major depression is associated with an increased risk of clinically significant microvascular and macrovascular complications over the ensuing 5 years, even after adjusting for diabetes severity and self-care activities. Clinical and public health significance of these findings rises as the incidence of type 2 diabetes soars. Further research is needed to clarify the underlying mechanisms for this association and to test interventions to reduce the risk of diabetes complications among patients with comorbid depression.