Objective : Depression in Type 2 Diabetes (T2D) not only affects quality of life (QOL) but also affects adherence to treatment. There are several studies but data for asian-indian population are scarce. Aim of this study was to estimate prevalence of depression in asian-indians with T2D & its association with duration of T2D, number of medications, insulin use & presence of complications.
Our cross-sectional study included 430 T2D cases & 120 non-diabetic controls. Patients with history of depression before the onset of T2D, malignancy or other endocrine disorders were excluded. The Hamilton Depression Rating Scale (HAMD scale) was used to measure severity of depression: no depression (score 0-7), mild (score 8-13), moderat e(score 14-18) & severe (score 19-22). Glycemic control was graded according to HbA1C levels: 8.5 gm/dL poor glycemic control.
Prevalence of depression was 37.2% in T2D subjects compared to 16.1% controls (pdL respectively. Mean duration of T2D was 9.36 yrs in patients with depression and 4.46 yrs in sujects with no depression (p<.001, OR=3). Poor glycemic control correlated with the severity of depression:mean HbA1C values for those with no depression, with mild, moderate & severe depression were 7.20, 8.74, 10.35 & 10.86 gm/dL respectively. Mean duration of T2D was 9.36 yrs in patients with depression and 4.46 yrs in sujects with no depression (p<.001).Patients with complications had higher mean HAMD score (13.05) to compared to those without complications (6.07). Patients taking ≥3 anti-diabetic drugs had higher mean HAMD score (statistically insignificant). Patients on insulin as compared to those treated with oral drugs were having higher rate/severity of depression (mean HAMD score 13.67 vs. 6.69, p <.001).Mean HAMD scores for treatment adherents & non-adherents were 6.22 & 13.67 respectively.
Studies have reported the prevalence of depression in T2D ranging from 15-56%. In the current study prevalence was 52.56% indicating that T2D Indian patients are at higher risk. Long duration of T2D, poor glycemic control probably leads to low self-esteem & depression. Depression was associated with poor adherence to treatment leading to poor glycemic control thus creating a vicious cycle.
In the current study T2D patients had three times increased risk of depression.Severity of depression correlated with the duration of T2D, glycemic control, pill burden, use of insulin, & complications. Adherence to treatment was also much less in the depressed subjects.We recommend annual screening of T2D patients for depression, as timely intervention will improve QOL & probably glycemic control.
Sandeep Tak– Professor, SN Medical College, Jodhpur, India, Jodhpur, Rajasthan, India
Ravi Mangalia– Senior Resident, Dr S N Medical College, Jodhpur, Rajasthan, India
Rajkumar Rathore– Medical Officer, RMC MCI, Nagaur, Rajasthan, India
Banshi Saboo– Chief Diabetologist, Diacare- Diabetes Care & Hormone Clinic
SN Medical College, Jodhpur, India
Jodhpur, Rajasthan, India
Consultant Diabetologist Physician & Professor of Medicine
Dr S N Medical College
Jodhpur, Rajasthan, India
Dr Ravi Mangalia, finished degree in internal medicine and currently working as senior resident in the department of internal medicine at the Dr S N Medical college, Jodhpur .
Nagaur, Rajasthan, India
Practicing medicine in a goverment hospital