The relationship between microvascular complications and depression in patients with type 2 diabetes mellitus who use insulin

Öz

Objective: This study aimed to assess the relationship between Type 2 Diabetes Mellitus (DM) and its complica­tions with the severity of depression. Methods: Eighty diabetics under the age of 65 using insulin were enrolled and clinical and biochemical data were recorded. The severity of neuropathy was deter­mined by the “United Kingdom neuropathy screening score” (UKNS) whereas the severity of depression was determined by the “Beck depression scale” (BDS). Ne­phropathy and retinopathy were assessed by the micro­albumin-creatinine ratio in spot urine samples and by de­tailed examination of the retina with an ophthalmoscope, respectively. Results: There were more patients who has high neurop­athy severity in the group with the highest Beck depres­sion scale score (p

Anahtar Kelimeler

• Type 2 Diabetes Mellitus; neuropathy, ne­phropathy; retinopathy; depression

İnsülin kullanan tip 2 diabetes mellitus hastalarında mikrovasküler komplikasyonlar ile depresyonun ilişkisi

Öz

Amaç: Bu çalışmada kronik bir hastalık olan Tip 2 Dia­betes Mellitus (DM) ve komplikasyonlarının depresyon şiddeti ile ilişkisi değerlendirilmesi amaçlandı. Yöntemler: Çalışmaya 65 yaşından küçük, insülin kullan­makta olan 80 Tip 2 DM hastası alınarak klinik ve biyokim­yasal verileri kaydedildi. Nöropati şiddeti “United Kingdom nöropati tarama skoru” (UKNS) ile, depresyon şiddeti ise “Beck Depresyon Envanteri” (BDE) ile belirlendi. Nefro­pati spot idrar örneğinde mikroalbumin-kreatinin oranı ile, retinopati ise göz dibi muayenesi ile değerlendirildi. Bulgular: Beck depresyon şiddeti yüksek olan hasta gru­bu içindeki nöropati şiddeti yüksek olan hasta sayısı daha fazlaydı (p

Anahtar Kelimeler

• Tip 2 Diabetes Mellitus, nöropati, nefropati, retinopati, depresyon

Kaynakça

1. Schellhase KG, Koepsell TD, Weiss NS. Glycemic control and the risk of multiple microvascular diabetic complications. Fam Med 2005;37:125-130.
2. Ma J, Yang W, Fang N, et al. The association between intensive glycemic control and vascular complica- tions in type 2 diabetes mellitus: a meta-analysis. Nutr Metab Cardiovasc Dis 2009;19:596-603.
3. Carney C. Diabetes mellitus and major depressive dis- order: an overview of prevalence, complications, and treatment. Depress Anxiety 1998;7:149–157.
4. Anderson RJ, Freedland KE, Clouse RE, et al. The prevalence of comorbid depression in adults with dia- betes: a meta-analysis. Diabetes Care 2001;24:1069- 1078
5. Lustman PJ, Griffith LS, Freedland KE, et al. Cogni- tive behavior therapy for depression in type 2 dia- betes: a randomized controlled trial. Ann Intern Med 1998;129:613-621.
6. Mazze RS, Lucido D, Shamoon H. Psychological and social correlates of glycemic control. Diabetes Care 1984;7:360-366.
7. Testa MA, Simonson DC. Health economic benefits and quality of life during improved glycemic con- trol in patients with type 2 diabetes mellitus. JAMA 1998;280:1490-1496.
8. Lin EH, Katon W, Von Korff M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care 2004;27:2154–2160.

9. Georgiades A, Zucker N, Friedman KE, et al. Changes in depressive symptoms and glycemic control in dia- betes mellitus. Psychosom Med 2007;69:235-241.
10. Katon WJ. Clinical and health services relation- ships between major depression, depressive symp- toms, and general medical illness. Biol Psychiatry 2003;54:216-226.
11. Mezuk B, Eaton WW, Albrecht S, Golden SH. Depres- sion and type 2 diabetes over the lifespan: a meta- analysis. Diabetes Care 2008;31:2383-2390.
12. de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosomatic Med 2001;63:619-630.
13. Turkington RW. Depression masquerading as diabetic neuropathy. JAMA 1980;243:1147-1150.
14. Moreira RO, Amâncio AP, Brum HR, et al. Depressive symptoms and quality of life in type 2 diabetic patients with diabetic distal polyneuropathy. Arq Bras Endocri- nol Metabol 2009;53:1103-1111.
15. Vileikyte L, Leventhal H, Gonzalez JS, et al. Diabetic peripheral neuropathy and depressive symptoms: the association revisited. Diabetes Care 2005;28:2378- 2383.
16. Takahashi Y, Hirata Y. A follow-up study of painful dia- betic neuropathy: physical and psychological aspects. Tohoku J Exp Med 1983;141:463-471.
17. Oguejiofor OC, Oli JM, Ajaero CN, et al. Are the symp- toms of diabetic peripheral neuropathy in Nigerian pa- tients objective? An evaluation using the United King- dom Screening Test (UKST) and Bio-Thesiometry. Niger J Clin Pract 2009;12:113-119.
18. Gore M, Brandenburg NA, Dukes E, et al. Pain se- verity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. J Pain Symptom Manage 2005;30:374-385.
19. Moreira RO, Papelbaum M, Fontenelle LF, et al. Co- morbidity of psychiatric disorders and symmetric dis- tal polyneuropathy among type II diabetic outpatients. Braz J Med Biol Res 2007;40:269-275.
20. Lehto SM, Hintikka J, Niskanen L, et al. Low HDL cholesterol associates with major depression in a sample with a 7-year history of depressive symp- toms. Prog Neuropsychopharmacol Biol Psychiatry 2008;32:1557-1561.
21. Lehto SM, Ruusunen A, Niskanen L, et al. Elevated depressive symptoms and compositional changes in LDL particles in middle-aged men. Eur J Epidemiol 2010;25:403-409.
22. Tyrovolas S, Lionis C, Zeimbekis A, et al. Increased body mass and depressive symptomatology are as- sociated with hypercholesterolemia, among elderly in- dividuals; results from the MEDIS study. Lipids Health Dis 2009; 8:10-11.
23. Heckbert SR, Rutter CM, Oliver M, et al. Depression in relation to long-term control of glycemia, blood pressure, and lipids in patients with diabetes. J Gen Intern Med 2010;25:524-529.
24. Gary TL, Crum RM, Cooper-Patrick L, et al. Depres- sive symptoms and metabolic control in African-Amer- icans with type 2 diabetes. Diabetes Care 2000;23:23- 29.
25. Katon WJ, Lin EH, Russo J, et al. Cardiac risk factors in patients with diabetes mellitus and major depres- sion. J Gen Intern Med 2004;19:1192-1199.
26. Wiggin TD, Sullivan KA, Pop-Busui R, et al. Elevated triglycerides correlate with progression of diabetic neuropathy. Diabetes 2009;58:1634-1640.
27. Vincent AM, Edwards JL, Sadidi M, et al. The antioxi- dant response as a drug target in diabetic neuropathy. Curr Drug Targets 2008;9:94-100.
28. Vincent AM, Hinder LM, Pop-Busui R, et al. Hyperlip- demia: A new therapeutic target for diabetic neuropa- thy. J of Periph Nerv Syst 2009;14:257-267.