Type 1 diabetes

Depression leads to poor self-care and worse glycaemia in people with T1D

People with type 1 diabetes who have co-morbid depression – but not anxiety – are more likely to have poor self-care behaviour and subsequent poor glycaemic outcomes, an Australian study has shown.

In a four year follow up of 205 adults with T1DM enrolled in the Diabetes MILES–Australia, those with depressive symptoms at baseline were less likely to practice good self management such as missing insulin doses and self-monitoring of blood glucose (SMBG), as well as not maintaining a healthy diet, exercise and weight management.

And poor self care was found to predict higher HbA1c at the four year follow-up (β = 0.19, P = 0.011), according to results published in the Journal of Affective Disorders.

Having sub-optimal self-care at baseline also predicted microvascular complications (β = -0.38, P = 0.044); but a significant indirect association with depression via self-care was not seen

However, having anxiety symptoms was not associated with self-care behaviour or glycaemia outcomes independently from depression, noted the researchers, who included Professor Jane Speight from the Australian Centre for Behavioural Research in Diabetes, Victoria.

The investigators said depression and anxiety much more common among people with T1D than in the general population, and might be explained by the distress associated with the need for ongoing insulin treatment, adaption of activities around glycaemia, social stigma and risks of complications.

However the relationship between depression, anxiety and diabetes outcomes was not so clear-cut.

The results confirmed previous findings of a link between depression and poor outcomes in diabetes but also showed that the effect was mediated by poor self care behaviours, they said.

And the lack of an association between anxiety and poor outcomes might be because anxiety has a protective role in prompting people to perform self care behaviours such as blood glucose checks, they suggested.

“Thus, glycaemia and health outcomes in adults with T1DM may be primarily affected by depressive symptoms, rather than anxiety,” they concluded.

“The findings suggest that tailored diabetes care, including psychological treatment where required, should take the potential impact of comorbid depression into consideration to help people improve their diabetes self-care and achieve best possible health outcomes,” they wrote.

Meanwhile, a separate Western Australia study involving people with T1D has suggested that interventions to identify and improve coping skills may lessen the impact from diabetes-related distress and deliver better glycaemic outcomes.

The WA study which involved 105 adults patients attending the diabetes outpatients clinic at the Fiona Stanley Hospital found that those with less ‘psychological inflexibility’ had higher self-efficacy and less diabetes distress. This in turn correlated with lower glycaemia levels, with a 10-point (one standard deviation) higher psychological flexibility score corresponding to a 0.5% lower HbA1c.

“Psychological flexibility/inflexibility is potentially modifiable via behavioural intervention, and may reduce the negative impact of diabetes distress and improve psychological adjustment and coping with the burden and self-management demands of living with type 1 diabetes,” the authors concluded

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