Older adults with type 2 diabetes may be twice as likely as peers without diabetes to develop depression

Older adults with type 2 diabetes may be twice as likely as peers without diabetes to develop depression, according to an article in the June 11 issue of Archives of Internal Medicine.

Doctors have known for some time that depression appears to be more common among patients with the disease, but researchers are still debating the cause-and-effect relationship. People with diabetes may suffer hormonal imbalances that predispose them to depression. Depression is associated with physical and behavioral factors such as obesity and poor diet that may be enough to trigger diabetes in the elderly.

"This is the first study to evaluate diabetes as a risk factor for the onset of depression in older persons," said study author Matteo Cesari, MD, PhD, a geriatrician in the University of Florida Institute on Aging. "It's likely we are looking at a vicious, self-feeding cycle: Diabetes causes depression, which may reduce adherence to diabetic treatment, therefore worsening the diabetic condition, and so on."

The researchers evaluated 2,500 healthy patients aged 70 to 79 over a six-year period to determine if type 2 diabetes is a risk factor for depression. Patients were enrolled in the Health, Aging and Body Composition study, an ongoing program sponsored by the National Institute on Aging.

Investigators found that people with diabetes were twice as likely to develop recurrent depression. The risk was slightly higher for patients did not adhere to recommended diet and treatment regimens.

About 23 percent of participants had diabetes, and nearly two thirds of those patients had elevated blood sugar levels. Furthermore, diabetics with high blood sugar also had elevated levels of the inflammatory marker interleukin-6, which has been associated with depression.

"There may be a direct biological link between diabetes and depression,"
said Marco Pahor, MD, director of the Institute on Aging. "We know that depression is linked to proinflammatory cytokines, for one. Diabetes may be one of the triggers that causes depression."

"Obesity and physical performance are the most important mediators in the relationship between diabetes and depression reported in the study," Cesari said. "It is noteworthy that both are related to poor health status and poor quality of life."

"The research showing that diabetes has an independent effect on the onset of new depression is an important finding," said Jack Guralnik, MD, PhD, chief of the laboratory of epidemiology, demography and biometry at the National Institute on Aging. "Physicians caring for older diabetic patients need to be particularly observant to identify the onset of depression so that they can initiate early treatment."

 


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