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Diabetes Care. 2018 Mar;41(3):446-452. doi: 10.2337/dc17-1566. Epub 2017 Dec 18.

The Bidirectional Association Between Depression and Severe Hypoglycemic and Hyperglycemic Events in Type 1 Diabetes.

Author information

1
Division of Research, Kaiser Permanente, Oakland, CA paola.gilsanz@kp.org.
2
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
3
Division of Research, Kaiser Permanente, Oakland, CA.
4
Icahn School of Medicine at Mount Sinai, New York, NY.
5
The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel.

Abstract

OBJECTIVE:

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.

RESEARCH DESIGN AND METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
29255060
PMCID:
PMC5829958
DOI:
10.2337/dc17-1566
[Indexed for MEDLINE]
Free PMC Article

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