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Depression-related hyperglycemia in type 1 diabetes: a mediational approach.
Psychosom Med. 2005 Mar-Apr; 67(2):195-9.PM

Abstract

OBJECTIVE

Depression is linked with hyperglycemia and with an increased risk for diabetes complications, but the mechanisms underlying these relationships have not been established. In this study, we applied mediational analysis methods to determine whether the hyperglycemic effect of depression could be mediated by poor diabetes self-care.

METHODS

Depression symptoms and diabetes self-care activity were assessed in a primary care sample of 188 patients with type 1 diabetes by using the Hopkins Symptom Checklist-90 (SCL-90) and the Summary of Diabetes Self-Care Activities (SDSCA). A composite score of self-care activity was formed from SDSCA ratings for diet amount, exercise, and glucose testing. Degree of hyperglycemia (level of glycosylated hemoglobin [HbA1c]), weight, insulin dose, and other clinical characteristics were obtained from electronic medical records. Ordinary least-squares regression was used to determine the effect of depression on HbA1c level controlling for weight and insulin dose. The SDSCA score was then added to the regression model to determine whether it attenuated the effect of depression symptoms on HbA1c level, thus providing suggestive evidence of mediation from these cross-sectional data.

RESULTS

Depression symptoms, poor diabetes self-care, and hyperglycemia were correlated with one another in univariate analyses (p <.05). Depression symptoms were associated with higher HbA1c after controlling for weight and insulin dose (parameter estimate for depression 0.53, t = 3.6, p <.001). Inclusion of SDSCA in the model minimally attenuated the effect of depression symptoms (adjusted parameter estimate for depression 0.50, t = 3.3, p = .001).

CONCLUSIONS

These findings do not support mediation of the depression-hyperglycemia relationship by diabetes self-care behavior. Other pathways, including psychophysiological mechanisms, should be investigated.

Authors+Show Affiliations

Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA. lustmanp@wustl.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15784783

Citation

Lustman, Patrick J., et al. "Depression-related Hyperglycemia in Type 1 Diabetes: a Mediational Approach." Psychosomatic Medicine, vol. 67, no. 2, 2005, pp. 195-9.
Lustman PJ, Clouse RE, Ciechanowski PS, et al. Depression-related hyperglycemia in type 1 diabetes: a mediational approach. Psychosom Med. 2005;67(2):195-9.
Lustman, P. J., Clouse, R. E., Ciechanowski, P. S., Hirsch, I. B., & Freedland, K. E. (2005). Depression-related hyperglycemia in type 1 diabetes: a mediational approach. Psychosomatic Medicine, 67(2), 195-9.
Lustman PJ, et al. Depression-related Hyperglycemia in Type 1 Diabetes: a Mediational Approach. Psychosom Med. 2005 Mar-Apr;67(2):195-9. PubMed PMID: 15784783.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Depression-related hyperglycemia in type 1 diabetes: a mediational approach. AU - Lustman,Patrick J, AU - Clouse,Ray E, AU - Ciechanowski,Paul S, AU - Hirsch,Irl B, AU - Freedland,Kenneth E, PY - 2005/3/24/pubmed PY - 2006/6/24/medline PY - 2005/3/24/entrez SP - 195 EP - 9 JF - Psychosomatic medicine JO - Psychosom Med VL - 67 IS - 2 N2 - OBJECTIVE: Depression is linked with hyperglycemia and with an increased risk for diabetes complications, but the mechanisms underlying these relationships have not been established. In this study, we applied mediational analysis methods to determine whether the hyperglycemic effect of depression could be mediated by poor diabetes self-care. METHODS: Depression symptoms and diabetes self-care activity were assessed in a primary care sample of 188 patients with type 1 diabetes by using the Hopkins Symptom Checklist-90 (SCL-90) and the Summary of Diabetes Self-Care Activities (SDSCA). A composite score of self-care activity was formed from SDSCA ratings for diet amount, exercise, and glucose testing. Degree of hyperglycemia (level of glycosylated hemoglobin [HbA1c]), weight, insulin dose, and other clinical characteristics were obtained from electronic medical records. Ordinary least-squares regression was used to determine the effect of depression on HbA1c level controlling for weight and insulin dose. The SDSCA score was then added to the regression model to determine whether it attenuated the effect of depression symptoms on HbA1c level, thus providing suggestive evidence of mediation from these cross-sectional data. RESULTS: Depression symptoms, poor diabetes self-care, and hyperglycemia were correlated with one another in univariate analyses (p <.05). Depression symptoms were associated with higher HbA1c after controlling for weight and insulin dose (parameter estimate for depression 0.53, t = 3.6, p <.001). Inclusion of SDSCA in the model minimally attenuated the effect of depression symptoms (adjusted parameter estimate for depression 0.50, t = 3.3, p = .001). CONCLUSIONS: These findings do not support mediation of the depression-hyperglycemia relationship by diabetes self-care behavior. Other pathways, including psychophysiological mechanisms, should be investigated. SN - 1534-7796 UR - https://www.unboundmedicine.com/medline/citation/15784783/Depression_related_hyperglycemia_in_type_1_diabetes:_a_mediational_approach_ L2 - http://dx.doi.org/10.1097/01.psy.0000155670.88919.ad DB - PRIME DP - Unbound Medicine ER -