Depression is Associated with Increased Risk for Metabolic Syndrome in Latinos with Type 2 Diabetes

doi:10.1016/j.jagp.2017.02.017

The American Journal of Geriatric Psychiatry

Volume 25, Issue 6, June 2017, Pages 646-653

https://doi.org/10.1016/j.jagp.2017.02.017 Get rights and content

Objective

Latino adults are 66% more likely to have diabetes relative to non-Latino white adults. Prior research identifies depression as a significant risk factor for metabolic syndrome (MetS), but research examining this among Latinos is lacking. This study sought to examine the links between depression and MetS and clinically significant elevations in cardiovascular disease risk markers of MetS in a sample of community-dwelling older Latinos with type 2 diabetes.

Methods

Participants were 332 community-dwelling older (≥60 years) Latinos with type 2 diabetes who completed the nine-item Patient Health Questionnaire and received a health checkup assessing body mass index (BMI), triglyceride and high-density lipoprotein (HDL) cholesterol levels, and blood pressure. Logistic regression analysis compared MetS rates of those meeting criteria for depression with those who did not. Secondary analyses examined the associations between depression and individual MetS components. All analyses controlled for demographic (e.g., income, age) and other potential MetS risk factors (e.g., smoking status, physical activity, alcohol level consumption).

Results

Depression was significantly associated with an increased risk of MetS (OR: 5.79; 95% CI: 1.32–25.42) and clinically significant elevations in triglycerides (OR: 2.71; 95% CI: 1.15–6.42) and reduced (HDL) cholesterol (OR: 2.46; 95% CI: 1.11–5.45). A significant association was not observed between depression and either BMI or hypertension.

Conclusion

Depression is significantly linked to MetS, and most notably dyslipidemia, in older Latinos with diabetes. Causation, however, cannot be inferred from these analyses given the cross-sectional nature of the study. Future research should prospectively examine the directionality of this effect.

Section snippets

Participants

Participants were 332 Latino, community-dwelling older adults recruited from two primary care facilities in San Diego County, California. All 332 participants were enrolled in the Salud Program, an evaluation study examining the implementation of two evidenced-based psychosocial interventions in patients with diabetes and concurrent depression/high risk of depression. Assessments for both clinics were administered approximately 2 weeks before initiating the respective interventions. Potential

Sample Characteristics

Characteristics of the sample can be found in Table 1. Of the 332 participants, 256 (77.1%) met criteria for MetS, which is similar to other studies reporting the prevalence of MetS in individuals with diabetes.6, 7 For each of the specific MetS criteria, 288 participants (86.7%) met criteria for hypertension, 168 (50.6%) met criteria for obesity, 199 (59.9%) met criteria for elevated triglycerides, and 90 (27.1%) for low HDL-C. Mean ± standard deviation (SD) systolic blood pressure for

Discussion

MetS is a known risk factor for developing CVD,⁷ particularly among Latinos.⁴ The current study sought to understand the relationship between depression and MetS in older Latinos with diabetes. We found that compared with nondepressed diabetics, the presence of major depression was related to significantly higher risk for MetS (odds ratio: 5.79; 95% confidence interval: 1.32–25.42) in an older Latino sample. These effects remained significant after controlling for age, sex, years residing in

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Depression and diabetes are co-occurring epidemics. This article explores the association between depression and diabetes in a cohort of Latinx patients with diabetes from low-income households. Data were gathered in Albuquerque, New Mexico (U.S.) between 2016 and 2020 as part of a patient-engaged comparative effectiveness trial comparing two culturally appropriate diabetes self-management programs—the Chronic Care Model (CCM) and the standard of care, Diabetes Self-Management Support Empowerment Model (DSMS). We proposed that the program most culturally and contextually situated in the life of the patient would have the greatest impact on diabetes self-management. Participants were enrolled as dyads—226 Latinx diabetes patient participants (PPs) from low-income households and 226 social support participants (SSPs). Data gathered at baseline, 3, 6, and 12 months included a measure of depression and A1c testing. Outcomes between programs were analyzed using longitudinal linear mixed modeling, adjusted for patient demographic characteristics and other potential confounding covariates. Patient A1c had an initial slight decrease at 3 months in both programs. At CCM, patients with a very high A1c (greater than 10%) demonstrated a clinically meaningful decrease in A1c over time. Patients at CCM experienced a large initial decrease in depression and continued to decrease throughout the study, while patients at DSMS showed a slight initial decrease through 6 months, but depression increased again by 12 months, nearly rebounding to baseline levels. A subgroup analysis revealed that a higher baseline A1c was associated with higher depression, and patients with higher A1c achieved greater reductions in depression at CCM than at DSMS. CCM scored higher on Consumer Assessment of Healthcare Providers and Systems cultural competence (CAHPS-CC). Interpretation of results suggests that the more culturally, contextually situated program, CCM, had better outcomes. This study demonstrates that culturally and contextually situating a diabetes intervention can deliver improved benefits for Latinx patients.
Association between symptoms of depression, diabetes complications and vascular risk factors in four European cohorts of individuals with type 1 diabetes – InterDiane Consortium
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Citation Excerpt :
To our knowledge, the association between depression and metabolic syndrome has not been investigated in other populations of type 1 diabetes. In a group of elderly participants with type 2 diabetes, however, depression was significantly associated with an increased risk of metabolic syndrome and, comparable to the current observations, dyslipidaemia in particular [29]. Moreover, as seen in the current study, depression was not associated with either BMI or hypertension.
To investigate the association between depressive symptomatology and health markers in type 1 diabetes.
Four countries from the InterDiane Consortium had adopted the Finnish Diabetic Nephropathy Study protocol, including the Beck Depression Inventory (BDI). Associations between depression symptomatology, diabetes complications (diabetic nephropathy, proliferative retinopathy, major adverse cardiovascular events [MACE]) and vascular risk factors (metabolic syndrome, body mass index, glycaemic control) were investigated.
In a sample of 1046 participants (Croatia n = 99; Finland n = 314; Latvia n = 315; Lithuania n = 318), 13.4% displayed symptoms of depression (BDI score ≥ 16) with no statistically significant difference in the prevalence of depression among the cohorts. The highest rates of diabetic nephropathy (37.1%) and proliferative retinopathy (36.3%) were observed in Lithuania. The rates of MACE and metabolic syndrome were highest in Finland. In joint analyses, individuals exhibiting depression symptomatology had higher HbA_1c (79 vs. 72 mmol/mol, p < 0.001) and higher triglyceride concentration (1.67 vs. 1.28 mmol/l, p < 0.001), than those without. In the multivariable model, BDI score was positively associated with the presence of diabetic nephropathy, proliferative retinopathy, MACE, and metabolic syndrome and its triglyceride component. Moreover, BDI score was positively associated with the number of metabolic syndrome components, triglyceride concentration, and HbA_1c.
Comorbid depression should be considered a relevant factor explaining metabolic problems and vascular outcomes. Causality cannot be inferred from this cross-sectional study.
Psychological factors involved in metabolic control in patients with type 2 diabetes mellitus
2017, Anuario de Psicologia
La diabetes mellitus de tipo 2 (DM2) es una enfermedad metabólica crónica con repercusiones importantes en la vida de los pacientes que la presentan; su control metabólico es fundamental para disminuir los índices de morbimortalidad, que dependen de factores fisiológicos, económicos, sociales y psicológicos. El objetivo de este estudio fue determinar la asociación entre los factores psicológicos y el control metabólico de pacientes con DM2.
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Estos resultados indican que existe una relación entre los factores psicológicos y el control metabólico; sin embargo, desde el punto de vista clínico se resalta la importancia de tener en cuenta la depresión y los síntomas somáticos, como variables comórbidas, las cuales influyen en un adecuado control metabólico y en la disminución de la morbimortalidad en este grupo de pacientes.
Diabetes mellitus type 2 (DM2) is a chronic metabolic disease with important repercussions in the life of the patients who suffer it. Its metabolic control is essential to reduce morbidity and mortality rates, which depends on physiological, economic, social and psychological factors. The objective of this study was to determine the association between psychological factors and metabolic control of patients with DM2.
The methodological approach was descriptive cross-sectional, with analysis of cases and controls, in a group of 60 participants with diagnosis of DM2, 30 with controlled diabetes (DC) and 30 with uncontrolled diabetes (DNC); defined by the serum levels of glycosylated hemoglobin.
Correlational analysis was performed using the Spearman test, to establish the relationship between glycosylated hemoglobin and psychological variables, showing significant correlations of <0.01 for somatic symptoms and <0.05 for depression and family support, for the group with DNC.
These results suggest that there is a relationship between psychological factors and metabolic control. However, from the clinical point of view, the importance of taking into account depression and somatic symptoms, as comorbid variables, which influence an adequate metabolic control and the decrease of morbidity and mortality in this group of patients is highlighted.
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Depression is Associated with Increased Risk for Metabolic Syndrome in Latinos with Type 2 Diabetes

Objective

Methods

Results

Conclusion

Section snippets

Participants

Sample Characteristics

Discussion

Gen Hosp Psychiatry

J Psychosom Res

Am J Clin Nutr

Prev Med

Am J Geriatr Psychiatry

Changes in the leading cause of death: recent patterns in heart disease and cancer mortality

Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies

BMJ

Impact of diabetes on coronary artery disease in women and men: a meta-analysis of prospective studies

Diabetes Care

Heart disease and stroke statistics—2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee

Circulation

Definition, diagnosis, and classification of diabetes mellitus and its complications: report of a WHO consultation. Part 1: diagnosis and classification of diabetes mellitus

WHO and ATPIII proposals for the definition of the metabolic syndrome in patients with Type 2 diabetes

Diabet Med

NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older

Diabetes

Dietary patterns and risk of incident type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)

Diabetes Care

Heart disease and stroke statistics—2011 update: a report from the American Heart Association

Circulation

Prevalence of diabetes among Hispanics/Latinos from diverse backgrounds: the Hispanic community health study/study of latinos (HCHS/SOL)

Diabetes Care

Depression as a risk factor for diabetes: a meta-analysis of longitudinal studies

J Clin Psychiatry

Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis

PLoS ONE

Bidirectional association between depression and metabolic syndrome: a systematic review and meta-analysis of epidemiological studies

Diabetes Care

Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey

JAMA

Prevalence of psychiatric illnesses in older ethnic minority adults

J Am Geriatr Soc