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- Title
The Bidirectional Association Between Depression and Severe Hypoglycemic and Hyperglycemic Events in Type 1 Diabetes.
- Authors
Gilsanz, Paola; Karter, Andrew J.; Beeri, Michal Schnaider; Quesenberry Jr., Charles P.; Whitmer, Rachel A.; Quesenberry, Charles P Jr.
- Abstract
<bold>Objective: </bold>Severe hyperglycemia and hypoglycemia ("severe dysglycemia") are serious complications of type 1 diabetes (T1D). Depression has been associated with severe dysglycemia in type 2 diabetes but has not been thoroughly examined specifically in T1D. We evaluated bidirectional associations between depression and severe dysglycemia among older people with T1D.<bold>Research Design and Methods: </bold>We abstracted depression and severe dysglycemia requiring emergency room visit or hospitalization from medical health records in 3,742 patients with T1D during the study period (1996-2015). Cox proportional hazards models estimated the associations between depression and severe dysglycemia in both directions, adjusting for demographics, micro- and macrovascular complications, and HbA1c.<bold>Results: </bold>During the study period, 41% had depression and 376 (11%) and 641 (20%) had hyperglycemia and hypoglycemia, respectively. Depression was strongly associated with a 2.5-fold increased risk of severe hyperglycemic events (hazard ratio [HR] 2.47 [95% CI 2.00, 3.05]) and 89% increased risk of severe hypoglycemic events (HR 1.89 [95% CI 1.61, 2.22]). The association was strongest within the first 6 months (HRhyperglycemia 7.14 [95% CI 5.29, 9.63]; HRhypoglycemia 5.58 [95% CI 4.46, 6.99]) to 1 year (HRhyperglycemia 5.16 [95% CI 3.88, 6.88]; HRhypoglycemia 4.05 [95% CI 3.26, 5.04]) after depression diagnosis. In models specifying severe dysglycemia as the exposure, hyperglycemic and hypoglycemic events were associated with 143% (HR 2.43 [95% CI 2.03, 2.91]) and 74% (HR 1.75 [95% CI 1.49, 2.05]) increased risk of depression, respectively.<bold>Conclusions: </bold>Depression and severe dysglycemia are associated bidirectionally among patients with T1D. Depression greatly increases the risk of severe hypoglycemic and hyperglycemic events, particularly in the first 6 months to 1 year after diagnosis, and depression risk increases after severe dysglycemia episodes.
- Subjects
HYPERGLYCEMIA; HYPOGLYCEMIA; DIABETES complications; MENTAL depression risk factors; TYPE 1 diabetes; DISEASE risk factors; HYPERGLYCEMIA treatment; HYPOGLYCEMIA treatment; CONFIDENCE intervals; MENTAL depression; RESEARCH funding; PROPORTIONAL hazards models; RETROSPECTIVE studies; DESCRIPTIVE statistics; ODDS ratio; DISEASE complications
- Publication
Diabetes Care, 2018, Vol 41, Issue 3, p446
- ISSN
0149-5992
- Publication type
journal article
- DOI
10.2337/dc17-1566