Article Figures & Data
Figures
- Figure 1
Recruitment diagram for depression, diabetes, hypoglycemia study.
Tables
Study Variable Total Not Depressed n=3,622 (88%) Depressed n=495 (12%) P Value Any prebaseline hypoglycemic episode,a % (No.) 3.7 (153) 3.1 (113) 8.1 (40) <.001 Any postbaseline hypoglycemic episode,b % (No.) 6.9 (283) 6.4 (230) 10.7 (53) <.001 Female, % (No.) 48.1 (1,981) 46.7 (1,690) 58.8 (291) <.001 Age, mean (SD), y 63.4 (13.4) 64.0 (13.3) 59.4 (13.8) <.001 White, % (No.) 80.1 (3,299) 80.3 (2,910) 78.6 (389) .37 Married, % (No.) 65.4 (2,693) 66.8 (2,418) 55.6 (275) <.001 Some college (≥1 year), % (No.) 76.2 (3,134) 76.6 (2,774) 72.4 (360) .06 Type 2 diabetes, % (No.) 95.6 (3,933) 95.4 (3,457) 96.2 (476) .47 Duration of diabetes, mean (SD), y 9.6 (9.4) 9.6 (9.6) 9.6 (8.3) .87 Taking insulin, % (No.) 30.6 (1,259) 28.9 (1,047) 42.8 (212) <.001 RxRisk score, mean (SD)c 3,133.7 (2,441.0) 3,093.0 (2,386.3) 3,431.4 (2,793.5) .01 Hypertension diagnosis, % (No.) 74.5 (3,069) 74.3 (2,687) 75.7 (373) .54 Diabetes complications, mean (SD), No. 1.4 (1.3) 1.4 (1.3) 1.6 (1.4) <.001 Body mass index, mean (SD) 31.5 (7.3) 31.1 (6.8) 34.8 (9.3) <.001 Current smoker, % (No.) 8.4 (347) 7.6 (276) 14.3 (71) <.001 Physical activity score, mean (SD)d 2.7 (2.2) 2.8 (2.2) 1.9 (1.4) <.001 -
↵a Percentage with hypoglycemic episode in 5 years prebaseline.
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↵b Percentage with hypoglycemic episode in 5 years postbaseline.
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↵c For this study population, scored on a range from 71 to 21,950, where higher numbers indicate greater morbidity.
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↵d Scored on a range from 0 to 7, where higher numbers indicate more days per week of exercise.
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- Table 2
Hazard Ratios for Major Depression for Time to an Hypoglycemic Event or for Relative Risk for Number of Hypoglycemic Events (N=4,117)
Covariate Adjustment Time to Hypoglycemic Event HR (95% CI) Number of Hypoglycemic Events RR (95% CI) Unadjusted 1.89 (1.39–2.56) 1.91 (1.49–2.43) Adjusted Prior hypogycemic eventa 1.65 (1.21–2.25) 1.69 (1.32–2.17) Prior hypogycemic eventa and demographic characteristicsb 1.78 (1.30–2.44) 1.76 (1.37–2.26) Prior hypogycemic eventa and demographicb and clinicalc characteristics 1.41 (1.03–1.94) 1.39 (1.08–1.80) Prior hypogycemic eventa and demographic,b clinical,c and health risk behaviord characteristics 1.42 (1.03–1.96) 1.34 (1.03–1.74) -
HR=hazard ratio; RR=relative risk.
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↵a At least 1 hypoglycemic event in the 5 years before entering study.
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↵b Demographic characteristics: age, sex, race (white vs nonwhite race/ethnicity), education (some college, high school, or less), and marital status (married or partnered, single).
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↵c Clinical characteristics: diabetes duration, insulin use, RxRisk score, hypertension diagnosis, diabetes type 1 or 2, and diabetes complication score.
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↵d Health risk behavior characteristics: body mass index, current smoking, and physical activity.
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Supplemental Appendixes
Supplemental Appendix 1. Potential Cofounders; Supplemental Appendix 2. Differences Between Nonconsenting and Consenting Patients
Files in this Data Supplement:
- Supplemental data: Appendix 1-2 - PDF file, 2 pages, 106 KB
The Article in Brief
Association of Depression With Increased Risk of Severe Hypoglycemic Episodes in Patients With Diabetes
Wayne J. Katon , and colleagues
Background Psychosocial and clinical factors can be associated with hypoglycemia (low blood glucose levels) in patients with diabetes, but there has been little research into the relationship between depression and severe hypoglycemic episodes. This study examines that association.
What This Study Found Patients with diabetes and major depression are at increased risk of severe hypoglycemic episodes requiring hospitalization or a visit to the emergency room. Over a 5-year period, depressed adult patients with diabetes had a significantly higher risk of a severe hypoglycemic episode and a greater number of hypoglycemic episodes compared with nondepressed patients.
Implications
- The increased risk of severe hypoglycemic episodes in patients with depression may be due to poor self-care or psychobiologic changes associated with depression.
- The authors call for research to assess whether recognition and effective treatment of depression among diabetic patients prevents severe hypoglycemic episodes, as well as increased risk of complications and mortality.
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