Depressed diabetes patients at higher risk of comorbidities

Diabetic patients who also suffer from depression face an increased risk of renal and cardiovascular disease, according to new research conducted on millions of U.S. veterans.

Miklos Zsolt Molnar, MD, PhD, FEBTM, FERA, FASN, associate professor of medicine specializing in nephrology at University of Tennessee Health Science Center, says no paper has been published on his research yet, but preliminary data indicates a need for additional studies to find out if interventions to treat depression in patients with diabetes could prevent other adverse clinical outcomes. Molnar presented his findings at the American Society of Nephrology’s Kidney Week 2015 in San Diego in early November.

Molnar and his team studied more than three million veterans with baseline estimated glomerular filtration rates (eGFR) of at least ≥60 ml/min/1.73m2. They found that 933,211 of those patients had diabetes mellitus. Within that cohort, 340,806 patients-mostly males in their mid-60s-were also suffering from depression.

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After following those cases for about seven years, the research team identified a 20% higher risk in patients with diabetes and depression of chronic kidney disease (CKD), as well as a 35% higher risk of stroke, a 24% higher risk of coronary heart disease, and a 25% higher risk of general mortality..

Due to the observational nature of the study, researchers could not determine that the negative clinical outcomes were caused by diabetes and depression, but did show an association between the comorbidities. This observation is supported by previous research indicating that patients with diabetes who are also depressed employ suboptimal self-care and face worse clinical outcomes as a result of neglectful medication adherence and preventive care.

The National Institute of Mental Health says depression and diabetes are definitely linked, but it’s unclear whether one causes the other. Research indicates that both causal relationships are possible, and the agency says diabetes certainly exacerbates the symptoms of depression, particularly as diabetes worsens.

Additionally, a number of comorbidities are already associated with diabetes, due to the effect of elevated glucose in the blood. The American Association of Clinical Endocrinologists (AACE) estimates that only 14% of patients with diabetes have no other comorbidities such as hypertension, renal problems, and hyperlipidemia. AACE says 46% of patients with diabetes mellitus have elevated lipid levels, 67% have hypertension, and 40% have chronic kidney disease-a condition that AACE says doubles the risk of cardiovascular disease. Cardiovascular disease, including coronary artery disease and coronary heart disease, is the leading cause of death in diabetic patients, according to AACE. The association also links depression to diabetes, citing decreased medication adherence and self-care, as well as poor glycemic control as negative outcomes in diabetic patients with depression. AACE recommends routine screening for depression in patients with diabetes.