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Posted: November 18, 2008

Controlling Diabetes Tougher for Older Diabetics Battling Depression

Depression can cause older diabetes patients to have a more difficult time controlling their diabetes and suffer from higher glucose levels over time, compared to those who are not depressed, according to a study of aging veterans with the metabolic disease.

“Our study shows that depression is a major and important comorbidity [associated condition] in people with type 2 diabetes,” said study co-author Dr. Leonard Egede, of the Center for Health Disparities Research at the Medical University of South Carolina.

Through a combination of diet, exercise and medication, people with type 2 diabetes work to keep their blood glucose levels within a certain range. Past research has shown that those who are also depressed have a tougher time doing so. About 30% of adults with diabetes have depression and the combination is linked to poor glucose control, higher complication rates, decreased quality of life and increased risk of death. 

The current study appears in the November/December issue of the journal General Hospital Psychiatry.

Egede and his colleagues analyzed data from 11,525 veterans (98% of them men) with type 2 diabetes who received medical care at a Veterans Administration facility. The participants’ average age was 66 years, and 48% were white, 27% were African-American and 25% were of other races.

Researchers evaluated each participant at three-month intervals from 1997 to 2006, for a total of 36 intervals. At each three-month interval, clinicians checked their HbA1c level, a blood test that measures long-term glucose control. Experts recommend a target level of less than 7%.

Six percent of the participants had depression, researchers determined.

In their analysis, they found that over the four-year period, the HbA1c values in the veterans who were depressed averaged 0.13% higher than the veterans who were not depressed. Egede said the difference is quite significant -- enough to raise people with diabetes above the desirable range for glucose control, putting them at higher risk.

“The fact that the difference persisted over time and that the depressed group had higher mean HbA1c at all 36 time points was surprising,” Egede said.

The researchers also found that the change in HbA1c among the depressed participants did not differ based on race or age.

Evette Joy Ludman, Ph.D., senior research associate at the Group Health Center for Health Studies in Seattle, said that although the link between depression and diabetes complications might seem daunting, it is possible for adults to follow treatment orders for their depression while also managing their diabetes.

“I think it is a reasonable expectation that health care teams can help patients who have both depression and diabetes manage both conditions,” she said. “I don’t think patients see themselves as a collection of different illnesses, and if we take a more proactive, integrated approach to caring for them, it is likely they can benefit. Research currently in the field is addressing that exact question.”

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