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Wednesday, September 21, 2022

Depression is a Direct Consequence of Diabetes Mellitus? - Juniper Publishers

Juniper Online Journal of Public Health - Juniper Publishers

Abstract

Diabetes mellitus increases by four times the risk of presenting depressive symptoms in the patient who is with poor glycemic control, so, our goal was confirmed the relationship between the hyperglycemic measures and the presentation of depressive symptoms in two groups of patients with diabetes in appropriate control against poor glycemic control in the first level services of health. If the depressive symptoms appear, then the interest of the patient in the disease decreases, allowing more complications. In consequence, the monthly controls based on tools that detects depressive symptoms in the patient with diabetes mellitus are necessary.

Keywords: Depression; Diabetes mellitus; Hemoglobin; Glycosylated; Beck test

Abrevation: HbA1c: Glycosylated Hemoglobin A1c; BDI-II: Beck Depression Inventory

Introduction

Diabetes mellitus increases by four times the risk of presenting depressive symptoms in the patient who is in poor glycemic control, decreasing the therapeutic attachment. Introducing the patient to a cycle in which the depressive symptoms decrease their interest in the disease and its management, allowing more complications to occur [1-5]. Therefore, it is necessary to establish more strict therapeutic goals and monthly controls based on tests or tools that detect depressive symptoms in the patient. In Mexico the Family Medicine Units has a group of intervention in patients with diabetes mellitus, this group is confirmed by a Family Doctor, a nurse and a nutriologist. They give education, consultancy, emotional relief and follow up the progress of the selectionated patients for about one year. This program is called diabetIMSS.

Objective

To describe the prevalence of depression in two groups of patients with diabetes in good control against poor glycemic control in the groups of the diabetIMSS program of a Family Medicine Unit.

Material and Methods

An observational, cross-sectional and descriptive study was conducted in patients older than 18 years of the diabetIMSS program in The Family Medicine Unit Number 34 in Jalisco, Mexico. After that our Project was accepted and evaluated by the Local Committee of Investigation in Health 1306 with register number 13 CI 14 039 165 and in the Local Committee in Bioethics with the number 14 CEI 002 2018 102 (Global Register Number R-2019-1306-044) [6-10]. We proposed the methodology to the patients, then, after signing the informed consent, the identification file and Beck test was applied. Determining criteria for inclusion, non-inclusion and exclusion until the sample size of 154 patients per group.

Results

The file and data collector instrument were applied to 380 patients in the consultation of the diabetIMSS program assigned to the Family Medicine Unit Number 34 of Guadalajara, Jalisco. Observing predominance of the feminine gender with ages between 51 and 60 years, with Body Mass Index in the range of overweight (25 to 29.9kg/m2), without finding significant difference between the two groups. In regard to the glycosylated hemoglobin, sufficient control (range 6 to 8%) was found for 52.27% of the patients in the sample. Through the Beck test in its BDI-II version in relation to HbA1c, 39 patients with depressive symptoms were found, representing 12.66% of the total sample. Collecting 10.38% of subjects with depressive symptoms for the group with HbA1c less than or equal to 6.4% and 14.93% for the HbA1c group greater than or equal to 6.5%. Confirming elevation in the presence of depressive symptoms in the group of patients with HbA1c greater than or equal to 6.5%

Discussion

Previous research had confirmed the relationship of hyperglycemia (HbA1c greater than 7%) and the appearance of depressive symptoms. In the present study we uses the current cut-off point of glycosiled hemoglobin stablished by The American Diabetes Association in 2017 to establish this relationship but with hyperglycemia represented by an HbA1c greater than or equal to 6.5% (cut-off point for the diagnosis of diabetes mellitus), confirming this relationship [11-15]. It would be advisable to conduct a new study using a cohort that would involve the Beck test throughout the patient’s progress through the diabetIMSS program to confirm the quality of the intervention.

Conclusions

There is a clear need to use tests and tools that evaluate the psychological health of patients during their progress in the program since the quality of follow-up and adherence of individuals depends on it. Therefore, it is reiterated that psychology personnel are needed to support the program, which would increase the Like lihood that patients will follow the treatment properly [16-23]. In addition to facilitating the detection of diverse psychological conditions from the order of suicidal ideation to cognitive deterioration. Even the exclusion of at least 72 patients was due to various psychological factors such as the use of antidepressants, the presence of some mourning-effect for a recent diagnosis of diabetes, or for the very same inclusion in a program aimed to diabetes. Adding these last patients to the 39 who present symptoms of the depressive spectrum, gives a total of 111 subjects that may require support by mental health personnel, that is, 29.21% of the 380 subjects surveyed.