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      Relationship between depression, sleep quality, and hypoglycemia among persons with type 2 diabetes

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          Abstract

          Objective

          We analyzed two cohorts of people with type 2 diabetes to evaluate the relationships between depression, sleep quality, and history of hypoglycemia.

          Research design and methods

          Two adult cohorts from Chicago (n = 193) and Bangkok, Thailand (n = 282) with type 2 diabetes completed questionnaires to assess sleep quality, depressive symptoms, and hypoglycemia frequency. Proportional odds logistic regression models for each cohort adjusted for duration of therapy, insulin and sulfonylurea management, and other factors.

          Results

          Those with hypoglycemia in both cohorts had a longer duration of diabetes, greater use of insulin, and worse sleep quality. The Chicago cohort used less sulfonylureas but had higher depressive symptom scores. The Thailand cohort had greater sulfonylurea use. In the final Thailand regression model, depressive symptoms were independently associated with hypoglycemia frequency. In both final Chicago and Thailand models, sleep quality was not associated with hypoglycemia frequency.

          Conclusions

          In the Thailand cohort, depressive symptoms were associated with hypoglycemia frequency.

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          Most cited references16

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          Epidemiology and treatment of depression in patients with chronic medical illness

          Wayne. J. Katon (2011)
          There is a bidirectional relationship between depression and chronic medical disorders. The adverse health risk behaviors and psychobiological changes associated with depression increase the risk for chronic medical disorders, and biological changes and complications associated with chronic medical disorders may precipitate depressive episodes. Comorbid depression is associated with increased medical symptom burden, functional impairment, medical costs, poor adherence to self-care regimens, and increased risk of morbidity and mortality in patients with chronic medical disorders. Depression may worsen the course of medical disorders because of its effect on proinflammatory factors, hypothalamic-pituitary axis, autonomic nervous system, and metabolic factors, in addition to being associated with a higher risk of obesity, sedentary lifestyle, smoking, and poor adherence to medical regimens. Both evidence-based psychotherapies and antidepressant medication are efficacious treatments for depression. Collaborative depression care has been shown to be an effective way to deliver these treatments to large primary care populations with depression and chronic medical illness.
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            Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment.

            Dominique L. Musselman, Erik Larsen, Andrew Phillips … (2003)
            This article reviews the rapidly accumulating literature on the relationship between mood disorders and diabetes mellitus. Recent studies have demonstrated that depression and its associated symptoms constitute a major risk factor in the development of type 2 diabetes and may accelerate the onset of diabetes complications. Since the mid-1980s, multiple longitudinal and cross-sectional studies have scrutinized the association of diabetes with depressive symptoms and major depression. Utilizing the search terms depressive disorders, psychiatry, diabetes, and pathophysiology in MEDLINE searches (1966-2003), this article reviews studies investigating pathophysiological alterations related to glucose intolerance and diabetes in depressed patients. The few randomized, controlled studies of treatment of depression in patients with diabetes are also described. Short-term treatment of depression in patients with diabetes improves their dysphoria and other signs and symptoms of depression. Future research will confirm whether response to psychotherapy and/or psychopharmacologic treatment improves glucose control, encourages compliance with diabetes treatment, and perhaps even increases longevity.
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              Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin‐treated type 1 and type 2 diabetes: the global HAT study

              K Khunti, S. Alsifri, Alan R Aronson … (2016)
              Aims To determine the global extent of hypoglycaemia experienced by patients with diabetes using insulin, as there is a lack of data on the prevalence of hypoglycaemia in developed and developing countries. Methods This non‐interventional, multicentre, 6‐month retrospective and 4‐week prospective study using self‐assessment questionnaire and patient diaries included 27 585 patients, aged ≥18 years, with type 1 diabetes (T1D; n = 8022) or type 2 diabetes (T2D; n = 19 563) treated with insulin for >12 months, at 2004 sites in 24 countries worldwide. The primary endpoint was the proportion of patients experiencing at least one hypoglycaemic event during the observational period. Results During the prospective period, 83.0% of patients with T1D and 46.5% of patients with T2D reported hypoglycaemia. Rates of any, nocturnal and severe hypoglycaemia were 73.3 [95% confidence interval (CI) 72.6–74.0], 11.3 (95% CI 11.0–11.6) and 4.9 (95% CI 4.7–5.1) events/patient‐year for T1D and 19.3 (95% CI 19.1–19.6), 3.7 (95% CI 3.6–3.8) and 2.5 events/patient‐year (95% CI 2.4–2.5) for T2D, respectively. The highest rates of any hypoglycaemia were observed in Latin America for T1D and Russia for T2D. Glycated haemoglobin level was not a significant predictor of hypoglycaemia. Conclusions We report hypoglycaemia rates in a global population, including those in countries without previous data. Overall hypoglycaemia rates were high, with large variations between geographical regions. Further investigation into these differences may help to optimize therapy and reduce the risk of hypoglycaemia.
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                Author and article information

                Contributors
                Alana Biggers
                Journal
                Journal ID (nlm-ta): J Clin Transl Endocrinol
                Journal ID (iso-abbrev): J Clin Transl Endocrinol
                Title: Journal of Clinical & Translational Endocrinology
                Publisher: Elsevier
                ISSN (Electronic): 2214-6237
                Publication date PMC-release: 02 January 2019
                Publication date Collection: March 2019
                Publication date (Electronic): 02 January 2019
                Volume: 15
                Pages: 62-64
                Affiliations
                [a ]Division of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago, United States
                [b ]Department of Pharmacy Systems, Outcomes, & Policy, University of Illinois at Chicago, United States
                [c ]Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
                [d ]Department of Behavioral Sciences, Rush University Medical Center, United States
                [e ]Division of Endocrinology and Metabolism, University of Illinois at Chicago, United States
                Author notes
                [* ]Corresponding author at: Institute for Health Research and Policy (M/C 275), 1747 W. Roosevelt Rd., Chicago, IL 60608, United States. abigger2@ 123456uic.edu
                Article
                Publisher ID: S2214-6237(18)30135-2
                DOI: 10.1016/j.jcte.2018.12.007
                PMC ID: 6352297
                PubMed ID: 30723689
                SO-VID: d90eda9c-8190-442d-9331-3276f1162158
                Copyright © © 2019 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 1 September 2018
                Date revision received : 20 December 2018
                Date accepted : 28 December 2018
                Categories
                Subject: Research Paper

                Keywords: diabetes mellitus,type 2,hypoglycemia,depression,sleep
                Data availability:
                Keywords: diabetes mellitus, type 2, hypoglycemia, depression, sleep

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