J Korean Diabetes.  2013 Mar;14(1):46-53.

Association Between Blood Sugar Level, Psychological Impact, and Emotional Symptoms in Patients Newly Diagnosed with Diabetes

• Lee YM
• Lee HJ
• Kwon EJ
• Ha JY
• Kim MK
• Noh TW
• Kang S
• Park JS
• Seok JH
• Ahn CW
• Kim KR

Abstract

As the duration of diabetes mellitus (DM) increases, the risk of complications increases and the prevalence of depression becomes higher. Most studies on depression in Korean patients with DM have focused on a point 5-10 years after diagnosis, and there has not been much data reported regarding the early stages of DM, including newly developed DM. In this study, we examined whether blood glucose levels could be associated with emotional symptoms such as depression (DS) and anxiety (AS) in patients newly diagnosed with DM. Serum glucose and HbA1c were measured in 89 patients with DM. The Impact of Event Scale (IES) was used to investigate the extent of the psychological impact of a diagnosis of DM. The IES comprises four elements: hyperarousal, intrusiveness, avoidance, and sleep problems. DS and AS were investigated using the Hospital Anxiety and Depression Scales. DS was observed in 32 patients (36%) and AS was observed in 21 patients (23.6%), indicating a higher prevalence of DS and AS than in the general population. There was an inverse correlation between HbA1c and DS (Pearson's correlation coefficient: R = -0.227; P = 0.035), but no correlation was found for AS. The four elements of the IES had significant correlations with DS and AS. Logistic regression analysis showed that sleep problems (OR = 1.437) and HbA1c (OR = 0.51) were associated with DS, but only intrusiveness (OR = 0.629) showed a correlation with AS. In patients newly diagnosed with DM, DS is associated with sleep problems and low HbA1c levels. Emotional symptoms should be considered as part of glucose control, and efforts to mitigate psychological stress during the initial period of diabetes management should be made.

Keyword

Anxiety; Depression; Diabetes mellitus

MeSH Terms

Anxiety
Blood Glucose
Depression
Diabetes Mellitus
Glucose
Humans
Logistic Models
Prevalence
Stress, Psychological
Weights and Measures
Blood Glucose
Glucose

Reference

1. SKim DJ. The epidemiology of diabetes in Korea. Diabetes Metab J. 2011; 35:303–8.

2. SOkamura F, Tashiro A, Utumi A, Imai T, Suchi T, Tamura D, Sato Y, Suzuki S, Hongo M. Insulin resistance in patients with depression and its changes during the clinical course of depression: minimal model analysis. Metabolism. 2000; 49:1255–60.

3. SGavard JA, Lustman PJ, Clouse RE. Prevalence of depression in adults with diabetes. An epidemiological evaluation. Diabetes Care. 1993; 16:1167–78.

4. SNichols GA, Brown JB. Unadjusted and adjusted prevalence of diagnosed depression in type 2 diabetes. Diabetes Care. 2003; 26:744–9.

5. SAnderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001; 24:1069–78.

6. SLustman P, Carney R, Amado H. Acute stress and metabolism in diabetes. Diabetes Care. 1981; 4:658–9.

7. STesta MA, Simonson DC. Health economic benefits and quality of life during improved glycemic control in patients with type 2 diabetes mellitus: a randomized, controlled, double-blind trial. JAMA. 1998; 280:1490–6.

8. SWinokur A, Maislin G, Phillips JL, Amsterdam JD. Insulin resistance after oral glucose tolerance testing in patients with major depression. Am J Psychiatry. 1988; 145:325–30.

9. STashiro A, Hongo M, Ota R, Utsumi A, Imai T. Hyper-insulin response in a patient with depression. Changes in insulin resistance during recovery from depression. Diabetes Care. 1997; 20:1924–5.

10. SGoldman LS, Nielsen NH, Champion HC. Awareness, diagnosis, and treatment of depression. J Gen Intern Med. 1999; 14:569–80.

11. SGross R, Olfson M, Gameroff MJ, Carasquillo O, Shea S, Feder A, Lantigua R, Fuentes M, Weissman MM. Depression and glycemic control in Hispanic primary care patients with diabetes. J Gen Intern Med. 2005; 20:460–6.

12. Sde Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med. 2001; 63:619–30.

13. SNoh JH, Park JK, Lee HJ, Kwon SK, Lee SH, Park JH, Ko KS, Rhee BD, Lim KH, Kim DJ. Depressive symptoms of type 2 diabetics treated with insulin compared to diabetics taking oral anti-diabetic drugs: a Korean study. Diabetes Res Clin Pract. 2005; 69:243–8.

14. SJeon BH. The relationship of anxiety symptoms and depressive symptoms to glycemic control in diabetic patients. Korean J Psychosom Med. 2008; 16:95–102.

15. SStandards of medical care in diabetes-2010. Diabetes Care. 2010; 33(Suppl 1):S11–61.

16. SZigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67:361–70.

17. SLim HK, Woo JM, Kim TS, Kim TH, Choi KS, Chung SK, Chee IS, Lee KU, Paik KC, Seo HJ, Kim W, Jin B, Chae JH. Reliability and validity of the Korean version of the Impact of Event Scale-Revised. Compr Psychiatry. 2009; 50:385–90.

18. SOh SM, Min KJ, Park DB. A study on the standardization of the hospital anxiety and depression scale for Koreans: a comparison of normal, depressed and anxious groups. J Korean Neuropsychiatr Assoc. 1999; 38:289–96.

19. SEaton WW, Armenian H, Gallo J, Pratt L, Ford DE. Depression and risk for onset of type II diabetes. A prospective population-based study. Diabetes Care. 1996; 19:1097–102.

20. SKaton W. The epidemiology of depression in medical care. Int J Psychiatry Med. 1987; 17:93–112.

21. SAdriaanse MC, Dekker JM, Heine RJ, Snoek FJ, Beekman AJ, Stehouwer CD, Bouter LM, Nijpels G, Pouwer F. Symptoms of depression in people with impaired glucose metabolism or Type 2 diabetes mellitus: The Hoorn Study. Diabet Med. 2008; 25:843–9.

22. SSurridge DH, Erdahl DL, Lawson JS, Donald MW, Monga TN, Bird CE, Letemendia FJ. Psychiatric aspects of diabetes mellitus. Br J Psychiatry. 1984; 145:269–76.

23. SPibernik-Okanovic M, Roglic G, Prasek M, Metelko Z. War-induced prolonged stress and metabolic control in type 2 diabetic patients. Psychol Med. 1993; 23:645–51.

24. SSmith GR. The epidemiology and treatment of depression when it coexists with somatoform disorders, somatization, or pain. Gen Hosp Psychiatry. 1992; 14:265–72.

25. SGrigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. Prevalence of anxiety in adults with diabetes: a systematic review. J Psychosom Res. 2002; 53:1053–60.

26. SLloyd CE, Dyer PH, Barnett AH. Prevalence of symptoms of depression and anxiety in a diabetes clinic population. Diabet Med. 2000; 17:198–202.

27. SMaes M. Cytokines in major depression. Biol Psychiatry. 1994; 36:498–9.

28. SPickup JC. Inflammation and activated innate immunity in the pathogenesis of type 2 diabetes. Diabetes Care. 2004; 27:813–23.

29. SSaghizadeh M, Ong JM, Garvey WT, Henry RR, Kern PA. The expression of TNF alpha by human muscle. Relationship to insulin resistance. J Clin Invest. 1996; 97:1111–6.

30. SRäikkönen K, Keltikangas-Järvinen L, Adlercreutz H, Hautanen A. Psychosocial stress and the insulin resistance syndrome. Metabolism. 1996; 45:1533–8.

31. SSapolsky RM, Romero LM, Munck AU. How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocr Rev. 2000; 21:55–89.

32. SClouse RE, Lustman PJ, Freedland KE, Griffith LS, McGill JB, Carney RM. Depression and coronary heart disease in women with diabetes. Psychosom Med. 2003; 65:376–83.

33. SCiechanowski PS, Katon WJ, Russo JE, Hirsch IB. The relationship of depressive symptoms to symptom reporting, self-care and glucose control in diabetes. Gen Hosp Psychiatry. 2003; 25:246–52.