Geriatric Conditions Develop in Middle-Aged Adults with Diabetes

BACKGROUND  

Geriatric conditions, collections of symptoms common in older adults and not necessarily associated with a specific disease, increase in prevalence with advancing age. These conditions are important contributors to the complex health status of older adults. Diabetes mellitus is known to co-occur with geriatric conditions in older adults and has been implicated in the pathogenesis of some conditions.     

Diabetes and Depression

Diabetes and depression occur together approximately twice as frequently as would be predicted by chance alone. Comorbid diabetes and depression are a major clinical challenge as the outcomes of both conditions are worsened by the other. Although the psychological burden of diabetes may contribute to depression, this explanation does not fully explain the relationship between these 2 conditions. Both conditions may be driven by shared underlying biological and behavioral mechanisms, such as hypothalamic-pituitary-adrenal axis activation, inflammation, sleep disturbance, inactive lifestyle, poor dietary habits, and environmental and cultural risk factors. Depression is frequently missed in people with diabetes despite effective screening tools being available. Both psychological interventions and antidepressants are effective in treating depressive symptoms in people with diabetes but have mixed effects on glycemic control. Clear care pathways involving a multidisciplinary team are needed to obtain optimal medical and psychiatric outcomes for people with comorbid diabetes and depression.     

Diabetes und Depression

Background

One of four patients with type 2 diabetes mellitus (T2DM) has clinically relevant depression. On the other hand, depression increases the risk for T2DM as well as micro- and macrovascular complications.

Objectives

This association may reflect a shared pathophysiology consisting of complex bidirectional interactions, which may influence therapy and prognosis.

Materials and methods

Recent findings, reviews and basic literature are analysed and an update is presented and discussed.

Results

Overall, accumulating evidence indicates a metabolic–mood syndrome with a linkage that includes stress sensitivity, insulin resistance (IR), neurohormonal dysregulation and inflammation. IR alters dopamine turnover and causes depression-like behaviour. Furthermore IR is associated with worse memory performance. Metabolic risk influences neurodevelopment. However, cross-sectional data do not support a genetic association between T2DM and depression.

Conclusions

T2DM may promote depression and interact with neurodevelopment and neurodegeneration. Comorbidity seems to be particularly toxic. Both prevention of T2DM in depressed patients and treatment of depression in T2DM are of considerable significance. Serotonin reuptake inhibition (SSRI) and psychotherapy are effective in the treatment of depression.

     

Diabetes und Depression

Compared with the general population diabetic patients have a significantly increased risk of suffering from depressive symptoms (subclinical form) or to suffer from depression (according the ICD-10 or DSM IV criteria). Depressive patients have a higher risk for developing type 2 diabetes. Depression has a negative impact on the diabetic patients disease management, quality of life, glycemic control, risk for secondary complications and mortality. Neuroendocrine disturbance as well as poor approach to the disease and its therapy are both discussed as causal factors. A major problem in terms of effective management of depression in diabetes patients is the early identification of depression. Depression screening for diabetic patients in primary care settings is recommended. Intervention studies indicate that structured therapy concepts for diabetes patients suffering from depression are effective in reducing depression and improving therapy management and outcome.     

Depression bei Diabetes

There is a bidirectional interrelationship between diabetes and depression. Depressive patients have a higher risk for manifestation of type 2 diabetes and diabetic patients have a higher risk for depression compared to the general population. The prognosis for diabetes is negatively influenced by the additional presence of depression in an accumulative manner, which equally affects patients with a clinically manifest depression as those with a subthreshold depression. This is true for the self-treatment behavior, glycemic control, quality of life, late complications and mortality. A regular screening for depression is therefore recommended for diabetes patients in order to detect depression as early as possible. The reduction of depressive symptoms, the increase of well-being and a better self-treatment behavior and glycemic control are the main goals of depression therapy.     

Diabetes und Depression

Compared with the general population diabetic patients have a clearly increased risk of suffering from depressive symptoms (subclinical form) or to develop depression (according the ICD or DSM criteria), which can represent a significant barrier to achieving the goals of diabetes therapy. The co-morbidity of depression and diabetes has a negative impact on the patient’s disease management, quality of life, glycaemic control, risk for late complications and mortality. Neuroendocrine alterations, disease-specific impact, direct and indirect effects on glycaemic control as well as impaired coping ability and strategies are all discussed as possible causes. Although effective interventions for the management of depression in diabetic patients exist, in clinical practise, patients with depression remain to a large extent unrecognised and untreated.