diabetes Diabetes & Depression

[Guest allanopie]

1: Diabetes Care., 2005 Jan;28(1):65-70.

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Diabetes Care. 2005 Jun;28(6):1534.

The effect of chronic pain on diabetes patients' self-management.

Krein SL, Heisler M, Piette JD, Makki F, Kerr EA.

Center for Practice Management and Outcomes Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA. skrein@umich.edu

OBJECTIVE: Many adults experience chronic pain, yet little is known about the consequences of such pain among individuals with diabetes. The purpose of this study was to examine whether and how chronic pain affects diabetes self-management. RESEARCH DESIGN AND METHODS: This is a cross-sectional study of 993 patients with diabetes receiving care through the Department of Veterans Affairs (VA). Data on chronic pain, defined as pain present most of the time for 6 months or more during the past year, and diabetes self-management were collected through a written survey. Multivariable regression techniques were used to examine the association between the presence and severity of chronic pain and difficulty with diabetes self-management, adjusting for sociodemographic and other health characteristics including depression. RESULTS: Approximately 60% of respondents reported chronic pain. Patients with chronic pain had poorer diabetes self-management overall (P = 0.002) and more difficulty following a recommended exercise plan (adjusted odds ratio [OR] 3.0 [95% CI 2.1-4.1]) and eating plan (1.6 [1.2-2.1]). Individuals with severe or very severe pain, compared with mild or moderate, reported significantly poorer diabetes self-management (P = 0.003), including greater difficulty with taking diabetes medications (2.0 [1.2-3.4]) and exercise (2.5 [1.3-5.0]). CONCLUSIONS: Chronic pain was prevalent in this cohort of patients with diabetes. Even after controlling for general health status and depressive symptoms, chronic pain was a major limiting factor in the performance of self-care behaviors that are important for minimizing diabetes-related complications. Competing demands, such as chronic pain, should be considered when working with patients to develop effective diabetes self-care regimens.

Publication Types:

Multicenter Study,

PMID: 15616235 [PubMed - indexed for MEDLINE]

SOURCE:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=15616235&query_hl=8&itool=pubmed_DocSum

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1: Psychosom Med., 2005 Mar-Apr;67(2):195-9.

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Depression-related hyperglycemia in type 1 diabetes: a mediational approach.

Lustman PJ, Clouse RE, Ciechanowski PS, Hirsch IB, Freedland KE.

Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA. lustmanp@wustl.edu

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.

PMID: 15784783 [PubMed - indexed for MEDLINE]

SOURCE:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=15784783&query_hl=1&itool=pubmed_docsum

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1: Issues Ment Health Nurs., 2005 Feb-Mar;26(2):137-48.

Psychological distress is linked to gastrointestinal symptoms in diabetes mellitus.

Talley SJ, Bytzer P, Hammer J, Young L, Jones M, Horowitz M.

Department of Medicine, University of Sydney, Nepean Hospital, NSW, Australia.

OBJECTIVE: Gastrointestinal (GI) symptoms are common in patients with long-standing diabetes mellitus, but the pathogenesis is controversial. We aimed to determine if GI symptoms are linked to psychological distress in diabetes. METHODS: A consecutive sample of outpatients with diabetes mellitus (n = 209) and a random sample of community diabetics (n = 892) completed a validated questionnaire measuring GI symptoms, the Hospital Anxiety and Depression (HAD) Scale for anxiety and depression, and the Eysenck short neuroticism scale. RESULTS: Overall, 42% reported one or more GI symptoms: bloating, abdominal pain, loose stools, and urgency were most common. The mean HAD and neuroticism scores were significantly higher for most GI symptoms (11 of 14, all p < 0.05), and a dose-response relationship was observed. GI symptoms were, in general, approximately twice as frequent in cases with anxiety or depression (HAD > or = 11). Anxiety, depression, and neuroticism were each independently associated with the number of GI symptoms, adjusting for age, gender, duration and type of diabetes, and self-reported glycemic control. CONCLUSIONS: Increased levels of state anxiety and depression and neuroticism are associated with upper and lower GI symptoms in diabetes mellitus. It is uncertain whether psychological distress is causally linked to symptoms, or whether GI symptoms per se increase levels of anxiety and depression.

PMID: 11316143 [PubMed - indexed for MEDLINE]

SOURCE:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=11316143&query_hl=1&itool=pubmed_DocSum

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1: Pharmacoeconomics., 2003;21(15):1123-34.

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Reductions in individual work productivity associated with type 2 diabetes mellitus.

Lavigne JE, Phelps CE, Mushlin A, Lednar WM.

Department of Community and Preventive Medicine, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 644, Rochester, New York 14642, USA. Jill_Lavigne@urmc.rochester.edu

BACKGROUND: Chronic diseases and their treatments may cause symptoms that impair performance but are too mild to affect outcome measures such as absences and workforce exit. OBJECTIVE: To assess the effect of type 2 diabetes mellitus on individuals' productivity when working, absences from work and the value of any lost work time. METHODS: Subjects were identified from claims data and enrolled over the phone. A telephone survey was used to elicit information about productivity at work, absences, diabetes history, comorbidities, job characteristics, employment history, demographics and healthcare utilisation. The sample consisted of 472 employed residents of New York state, USA, of whom, 445 worked at one major US corporation. Of the 472 participants, 78 had type 2 diabetes. All participants agreed to release their claims data for this study; participants with diabetes also consented to the release of clinical records. All data were linked at the individual level. Tobit regression was used to model work efficiency losses, the total productivity time lost and the value of that time. Absences were modelled using Poisson regression. Productivity was measured using absences from work and work efficiency. Work efficiency was assessed using the Osterhaus model. MAIN OUTCOME MEASURES AND RESULTS: Using the Osterhaus model of work productivity, type 2 diabetes was associated with a reduction in productivity at work. These productivity losses increased with the length of exposure to diabetes. Surprisingly, higher productivity losses among employees with diabetes did not translate into significantly higher productivity costs because the group with diabetes earned less. This likely reflects the prevalence of diabetes in populations. Among salaried people, very few reported working extra hours to make up for reduced productivity. Self-report biases may have been a factor in this finding. Type 2 diabetes was not associated with more frequent absences. Other factors that have strong effects on work efficiency are depression and colds, and job satisfaction. CONCLUSIONS: People with type 2 diabetes appear to experience incremental decrements in work performance that may affect their current and future health and performance. Lower incomes of participants with diabetes suggest that both people with diabetes and their employers bear the cost of any work efficiency losses.

PMID: 14596631 [PubMed - indexed for MEDLINE]

SOURCE:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=14596631&query_hl=1&itool=pubmed_DocSum

[sbrewer]

Thanks Allan for this information. You know he does have that chronic toe pain that seems to have no solution.

Maybe that has something to do with his diabetes, none of the 3 drs. so far that he has seen for this has said anything about that.

Again thanks so much,

sbrewer