Spotlight on depression in diabetes

Recent studies analyzed depression in diabetes, including associated causes of death, the potential benefits of peer support and a plant-based diet, and strategies for screening and treatment.

Several recent studies looked at depression, and its complications and treatments, among patients with diabetes.

The first study, published in the November European Journal of Endocrinology, compared deaths from alcohol, accidents, and suicide among Finnish people with and without diabetes. The analysis included 208,148 people who had filled a prescription for insulin or an oral antidiabetic drug, matched with 226,481 people without diabetes by sex, age, and geographic area. Over a mean follow-up of 7.1 years, the patients with diabetes had increased mortality from all three causes, with the difference being greatest in those treated with insulin. The association between insulin use and mortality was most consistent in men, “but in cases of alcohol-related death female diabetic patients showed excess mortality regardless of treatment modality,” the study authors noted. The results highlight the importance of psychosocial interventions for at-risk patients, they concluded.

Another study looked at one such intervention: peer support. The trial, published by Diabetes Care on Oct. 29, included 424 patients with diabetes wanting help with self-management, mostly African-American and living in low-income rural areas. They were randomized to either usual care or a year of peer support. At baseline, about half reported mild depressive symptoms and a quarter reported moderate depressive symptoms. Patients with depressive symptoms who received peer support had a lower rate of hospitalization or acute care use (incident rate ratios for patients with mild depressive symptoms, 0.26 and 0.55, respectively) than those getting usual care. In patients without depressive symptoms, peer support was not associated with any reduction in health care utilization. The study authors concluded that peer support may be an effective strategy to improve health outcomes and patient experience in patients with depressive symptoms while managing costs.

A third study, published by BMJ Open Diabetes Research and Care on Oct. 8, looked at the effectiveness of a plant-based diet for promoting well-being in patients with type 2 diabetes. The systematic review included 11 studies with a total of 433 patients and found that “plant-based diets were associated with significant improvement in emotional well-being, physical well-being, depression, quality of life, general health, HbA1c levels, weight, total cholesterol and low-density lipoprotein cholesterol” compared to other diets, including some officially recommended ones. Three of the included studies reported on psychosocial and quality-of-life outcomes, the authors noted. Limitations include that patients' adherence to prescribed diets was unknown, the included studies had small sample sizes, and two of them were not randomized. The authors called for future research to examine the association between diet and psychological health and to determine how to support patients in following healthy dietary patterns.

Finally, an article published by the Journal of General Internal Medicine on Oct. 22 discussed the importance of addressing depression and diabetes distress in patients with type 2 diabetes. (Diabetes distress results from the emotional burden of managing diabetes and is distinct from depression, but the conditions can co-occur.) Noting that barriers make screening for depression and diabetes distress challenging, the authors reviewed existing screening recommendations and tools and offered strategies to improve screening for depression and diabetes distress. The authors also highlighted methods to improve care for patients with depression and diabetes, including collaborative care and diabetes self-management education and support.