Study Links Depression With Diabetes Development

By Brian McCurdy, Senior Editor

Can depression spur the development of diabetes? A recent study in the Archives of Internal Medicine concludes that older patients who are depressed have a higher risk of developing type 2 diabetes.    The 10-year study consisted of 4,681 patients over the age of 65 who did not have diabetes at the beginning of the study in 1989. Researchers performed annual screenings and assessed the patients for symptoms of depression related to mood, concentration, sleep and other symptoms.    The study concluded that each measure of depressive symptoms had a significant association with diabetes. Elderly people who reported a higher number of symptoms of depression were 60 percent more likely to develop diabetes, according to the study, although the researchers caution that the association is not fully explained by diabetes risk factors.    Guy Pupp, DPM, has a practice with a disproportionate number of patients with diabetes, over 75 percent of whom have type 2 diabetes and many of whom are over the age of 60. He says many patients convey symptoms of depression like sleep disturbances, problems with concentration, abrupt mood swings and occasional irritability.    “Many of these patients seem not to tend to their physical well being and fitness,” says Dr. Pupp, the Clinical Director of the Kern Foot and Ankle Clinic at Southeast Michigan Surgical Hospital in Warren, Mich. “Frequently, they are not physically active and tend to gain weight, a high risk factor for diabetes.”    How can depression lead to diabetes in older patients? Dr. Pupp notes that researchers have suggested that depressed patients have higher levels of the stress hormone cortisol. He says cortisol may decrease insulin sensitivity with the subsequent high levels of blood glucose that occur among patients with diabetes.    Kathleen Satterfield, DPM, says there can be a “mix of denial and depression” among patients with diabetes in terms of how the disease impacts daily function and whether patients can continue working or enjoying leisure activities without worrying about shoes and other concerns of disease.    Dr. Satterfield recalls two patients, both of whom were security guards with uncontrolled diabetes and Charcot. With an exacerbation of the disease, neither could care for his family, according to Dr. Satterfield.

Averting The Risks Of Diabetes Complications

How can DPMs spur patients to care for themselves and avert the potential complications of diabetes? Dr. Pupp cites patient education, which he reinforces at each visit. However, getting patients to care for themselves can be a challenge. “I have long fought to try to get patients to take ‘ownership’ of their disease but often to no avail,” says Dr. Satterfield.    Dr. Pupp makes frequent referrals to appropriate healthcare practitioners such as internists, endocrinologists, cardiologists, peripheral vascular specialists, counselors, diabetes educators and dieticians. Dr. Satterfield concurs with the importance of a multidisciplinary approach.    “I think that even more important is the need for DPMs to recognize depression and then make appropriate referrals,” says Dr. Satterfield, a Clinical Associate Professor in the Department of Orthopaedics/Podiatry Service at the University of Texas Health Science Center at San Antonio. “Sometimes, we think our responsibility ends at the ankle and that is just not the case. We have to think about the entire patient.”

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