Depression in patients with diabetes mellitus and its impact on diabetes self-care, medication adherence and glycemic control

Depression is an independent risk factor for the onset of type 2 diabetes. It negatively affects the course of diabetes and is associated with increased risk of complications, hyperglycemia, and mortality. Diabetes may exert its negative effect through hormonal, neuronal, or immune system changes that directly affect the body's ability to produce or use insulin or, the effect of depression may be indirect, by resulting in poor self-care behavior, such as overeating, not exercising, skipping medication, or failing to keep medical appointments. Thus, identifying and treating depression in diabetes is strongly recommended. Cross-sectional study done in ambulatory care. A total of 320 diabetic patients who have duration of diabetes more than 1 year with out-patient diagnosis of diabetes (including fasting blood glucose > 126 mg% twice in 1 year, random blood glucose > 200 mg% twice in 1 year, currently taking any anti-diabetic agent, hospital discharge diagnosis of diabetes) were identified during the study period. Multivariable logistic regression was used to estimate odds ratio (Odds Ratios) and 95% confidence intervals (CIs). Overall depression was 17.5% (95% CI: 0.13-0.22%).The mean age was 55 +/- 12 years, 138 (43%) were females. Hypertension 197(61.6%) and ischemic heart disease(IHD) (N = 68; 21.3%) were the most common co-morbidities. Factors independently associated with depression were; hypertension (OR 2.75; 95% CI: 0.99-7.37), complication of neuropathy (OR 4.56; 95% CI: 1.71-12.15) and nephropathy (OR 4.10; 95% CI: 1.26-13.33), family history of depression (OR 4.46; 95%CI: 1.50-13.26) and inadequate intake of fruit and vegetable (OR 0.32; 95% CI: 0.13-0.82). Depressed diabetics had more complications and sub-optimal self care. Coexistence of depression produced poor glycemic control.