Interferences between depression and life quality on patients suffering of type 2 diabetes

First Author : Madalina CrisanCoauthors: Madalina Salagean

Barsan IoanaCoordinators : Gabriela Buicu MD,PhD

Livia Taran MD,PhD

Introduction

• The incidence and frequency of depression is 2 times higher in the diabetics than in general population.

• Symptoms of depression can not be separated from the symptoms of diabetes as well as environmental factors which are in inseparable interdependence.

• For prevention of depression in diabetes is important not only the patient but also as early detection of depressive symptoms.

• It is reasonably stated and assumed that depression will interfere with all aspects of diabetes and will have a negative impact on the patient itself and on disease progression.

The purpose and objectives of this research

• Finding effective forms of treatment to act bilaterally to reduce the level of depression and have effects on quality of life is the main goal of this research.

Objectives: • Theoretical documentation of depressive disorders associated

with diabetes in parallel with the analysis of socio-demographic parameters

• Statistical analysis of descriptive and analytical epidemiological data on our study, the purpose of a clinical correspondent

• Investigate the relationship between depression and quality of life in patients with type 2 diabetes

Material and methods:

• Prospective study, conducted on a number of 256 patients with type 2 diabetes admitted at the MediaBase Center from Targu Mures in collaboration with specialized outpatient Psychiatric Clinic No. 1, in September 2011 to 2013.

• Inclusion criteria signing informed consent, age 18-80 years• Diagnosis of depression according to DSM IV TR set. The 17-

item Hamilton scale was used to assess the severity of depression.

• diagnosis of type 2 diabetes based upon criteria

Material and methods:

Patients were divided into two subgroups: 128 patients who were to receive duloxetine 60 mg and 128 patients who were receiving SSRIs.

Short form questionnaire was administered for assessing quality of life for patients with diabetes, the requirement being to indicate their quality of life in the last month. The questionnaire was administered at the beginning of antidepressant therapy, and 1 year of therapy.

ResultsOf the 1486 patients in evidence of the diabetes doctor, diagnosed with type 2 diabetes, 256 patients, representing 14.7% were diagnosed with depression associated with diabetes.

Results

In terms of area of origin in patients with depression and diabetes group, 56 (21.88%) were in rural areas and 200 (78.12%) in urban areas. In terms of gender, in the group of patients with depression and diabetes, 170 (66.41%) were female and 86 (33.59%) men.

Results

In the group of patients suffering from depression and diabetes, consisting of 256 patients: 170 female and 86 male, mean age overall per sample was Mage = 59.75 years.

Results

The data presented show that, of all patients with depression associated with diabetes, the majority are in retirement.

Results

As antidiabetic treatment in patients with depression and diabetes group, 136 women and 18 men were on oral agents and 68 men and 34 women had both insulin and oral antidiabetic

Results

As antidepressant treatment 80 women and 48 men had duloxetine 60 mg and 90 women and 38 men were treated with SSRIs.

Results

3 8 ,0

3 6 ,0

3 4 ,0

3 2 ,0

3 0 ,0

2 8 ,0

2 6 ,0

QOL 1, Duloxetina

Fre

cv

en

ta

6 0

5 0

4 0

3 0

2 0

1 0

0

Std . De v = 2 ,5 7

Me a n = 3 1 ,6

N = 1 2 8 ,0 0

3 4 ,0

3 3 ,0

3 2 ,0

3 1 ,0

3 0 ,0

2 9 ,0

2 8 ,0

2 7 ,0

2 6 ,0

QOL 1, SSRI

Fre

cv

en

ta

3 0

2 0

1 0

0

Std . De v = 2 ,1 7

Me a n = 3 0 ,5

N = 1 2 8 ,0 0

We obtained high scores in all quality of life questionnaire items, average scores stood at around 31.6 in the group who received duloxetine and 30.5 in the group who received SSRI.

Results• After one year, patients continued treatment with antidiabetic and

antidepressant (duloxetine and SSRI) have reviewed the impact of diabetes on quality of life and depression mean scores were 8.4 in the group receiving duloxetine and 13.3 in the group receiving SSRI

1 7 ,51 5 ,01 2 ,51 0 ,07 ,55 ,0

QOL 2, Duloxetina

Frec

vent

a

6 0

5 0

4 0

3 0

2 0

1 0

0

Std . De v = 2 ,3 1

Me a n = 8 ,4

N = 1 2 8 ,0 0

1 8 ,01 6 ,01 4 ,01 2 ,01 0 ,08 ,0

QOL 2 , SSRI

Frec

vent

a

5 0

4 0

3 0

2 0

1 0

0

Std . De v = 1 ,7 9

Me a n = 1 3 ,3

N = 1 2 8 ,0 0

Conclusions• Treatment with antidepressants increases the quality of life in

patients with type 2 diabetes• Duloxetine treatment is superior to SSRIs in improving the quality

of life in patients with type 2 diabetes-related depression• Coexisting depressive symptoms and chronic diabetes-based

diseases contributes to reduced quality of life. More attention to identifying and treating these coexisting psychiatric conditions is needed to reduce the negative impact on their quality of life.

• Diabetes associated depression is correlated with reduced quality of life.

• The impact of type 2 diabetes on quality of life may be due in part to its effect on the development of mental health problems, like depression.

Conclusion

• Using dual antidepressants (duloxetine) and selective serotonin reuptake inhibitors (SSRIs) appear to be an auspicious pharmacological intervention in this context.

• Treatment with duloxetine is superior to SSRIs in improving the quality of life in patients with type 2 diabetes-related depression.

• Diabetes doctor and psychiatrist collaboration is necessary in order to identify affective disorders in patients with diabetes to increase the quality of services offered to these patients.