The risk for depression in patients with newly diagnosed or existing diabetes may not be as high as previously suggested, a new report indicates.

Earlier studies have found a substantially increased risk for depression among patients with diabetes but have not controlled for number of outpatient visits or other contact with health care professionals. Researchers performed a prospective study in patients with incident (n=2,932) or prevalent (n=14,144) diabetes and nondiabetic controls. Patients and controls were matched based on age and sex alone or on age, sex and number of outpatient primary care visits. The authors then used logistic regression to compare new diagnoses of depression among patients with diabetes and controls without. The study results appear in the July/August Annals of Family Medicine.

In all groups, the likelihood of a depression diagnosis decreased as primary care visits increased. When patients and controls were matched for age and sex alone, a statistically significant association was noted between diabetes and depression risk in patients with prevalent diabetes and few primary care visits compared with controls (odds ratio [OR], 1.46; 95% CI, 0.77-1.17). This relationship was less strong, however, when patients had over 10 primary care visits (OR, 0.95; 95% CI, 0.77-1.17). When patients with prevalent diabetes were matched with controls for age, sex, and number of primary care visits, a depression diagnosis was less likely in diabetics who made at least four primary care visits compared with controls (OR, 0.99; 95% CI, 0.80-1.23) and more likely in diabetics who did not (OR, 1.32; 95% CI, 1.07-1.63). Findings were similar in patients with incident diabetes.

The authors noted that diagnoses of depression were based on the medical record rather than independent evaluations and that their results may not apply to other settings. However, they concluded that patients with diabetes seem no more likely to develop depression than patients who have other chronic diseases and frequently make outpatient visits. Future studies, they wrote, should examine why few outpatient visits seem to be associated with a higher depression risk.

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An electronic tracking system improved processes of care and some clinical markers for patients with type 2 diabetes, a Canadian study found.

The trial included 46 primary care providers and 511 of their patients who were randomized to either usual care or the electronic intervention. The intervention gave patients and physicians access to a Web-based diabetes tracker that provided monitoring values and targets for 13 diabetes risk factors and brief advice messages. Patients were also sent a color-coded tracker page by mail, and they received automated telephone reminders.

After six months, patients in the intervention group showed some (although statistically insignificant) improvement in processes of care. The patients who participated in the electronic tracking also had statistically significant declines in blood pressure and glycated hemoglobin. Physicians and patients noted difficulty accessing the Web portal as the major shortcoming of the system. The study was published in the July 7 Canadian Medical Association Journal.

The study was unusual in that it tested an electronic monitoring system outside of a large institution, so technology support was less available and the system had to work across different, non-interoperable electronic medical records. It was limited by patients' lack of access to the Web. At baseline, about half of patients used a computer. Therefore, it's difficult to isolate the effects of the computer system from those of the telephone and mail reminders, which encouraged patients to see their physicians.

Although researchers favored the creation of patient-centered electronic systems to facilitate clinical management, it's not known yet what innovations will result in durable improvements in diabetes care, concluded the accompanying editorial.

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From the National Library of Medicine (NLM)
This resource compiles content related to pregnancy and diabetes, and is intended for patients.

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If you are of African, Mediterranean, or Southeast Asian heritage, you could have a variant form of hemoglobin in your red blood cells that affects your diabetes care. Hemoglobin in red blood cells gives blood its red color and carries oxygen from your lungs to all parts of your body. Some forms of hemoglobin can cause false results for a diabetes blood test called the A1C test. If the A1C test gives a false result, your doctor may think your blood glucose level is higher or lower than it really is.

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