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Seniors Beware: Diabetes and Depression Can Be a
Fatal Mix
Oct. 27, 2005 - Diabetics (type 2) suffering even minor depression are
more likely to die than those not experiencing depression, a new study
reports. The researchers also say a sedentary lifestyle is an important,
independent predictor of mortality from diabetes. Senior citizens and
baby boomers should be particularly aware of the depression-diabetes
mix, since they are the most likely to have both type 2 diabetes and
depression.
Researchers at the University of Washington (UW)
and at Group Health Cooperative, a large, Seattle-based health plan,
conducted the study over a three year period. They surveyed and followed
up 4,154 patients with type 2 diabetes. The patients filled out written
questionnaires. With patients' consent, automated diagnostic,
laboratory, and pharmacy data were collected from Group Health
Cooperative. The researchers also reviewed Washington state mortality
data to analyze diabetes complications and deaths.
Depression is common among people who have type 2
diabetes. This high prevalence can have unfortunate repercussions. Both
minor and major depression among people with diabetes are strongly
linked with increased mortality.
Depression may be associated with increased
mortality in patients with diabetes because of both behavioral and
biological factors, the researchers noted in their article. More work,
they added, is needed to untangle the cause-and-effect relationships
among depression, behavior, diabetes complications, and mortality.
Dr. Wayne Katon, professor and vice chair of the UW
Department of Psychiatry and Behavioral Sciences, led the recent study.
He is a noted researcher on the associations between depression, aging,
and chronic diseases, and on the medical costs and personal toll from
untreated or inadequately treated depression. The research team included
Drs. Carolyn Rutter, Greg Simon, Elizabeth Lin, Evette Ludman, and
Michael Von Korff from the Group Health Cooperative Center for Health
Studies; Dr. Paul Ciechanowski, UW assistant professor of psychiatry and
behavioral sciences; Dr. Leslie Kinder from the Veterans Affairs Puget
Sound Health Care System; and Dr. Bessie Young from the UW Department of
Medicine.
Previous studies by Katon's research group have
shown that patients with depression and diabetes are less likely to
follow diet and exercise guidelines or to check their blood glucose
levels, and to have more lapses in filling their prescriptions for oral
hypoglycemic, lipid-lowering, and high blood pressure medications.
People with depression and diabetes were also more
likely to have three or more heart disease risk factors, such as
smoking, obesity, and a sedentary lifestyle, compared to people with
diabetes alone.
Patients with both depression and diabetes are also
significantly more likely to have cardiovascular and cerebrovascular
complications.
Depression may increase complications, not only
because of poor self-care, but possibly through the brain chemistry and
nervous system abnormalities that accompany depression, the researchers
noted. They added that people may also become depressed in response to
changes in their ability to function or because of physical symptoms,
such as chronic pain from nerves damaged by diabetes.
In the UW and Group Health study, patients with
diabetes accompanied by minor depression were less educated and were
less likely to be Caucasian, in comparison to the diabetes patients
without depression.
Patients with diabetes and major depression were
significantly younger, less likely to be married, and more likely to be
female than were diabetes patient without depression.
Both those with major and minor depression were
more likely to have two or more diabetes complications, and were more
likely to have another medical condition in addition to diabetes.
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Related Research |
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Women may be
twice as likely as men to report experiences of anxiety and
depression. Women, too, especially older women, are more likely
to suffer from chronic disease.
-
Of the 10.3 million
Americans with diagnosed diabetes, 8.1 million are women.
The prevalence of diabetes is 2 to 4 times higher
among black, Hispanic, American Indian, Asian, and Pacific
Islander women than among white women.
-
Osteoporosis, characterized
by the thinning and increasing brittleness of bones, affects
more than 25 million Americans, 80% of whom are women. More
than half of all women over age 65 suffer from this
condition.
-
An estimated 4 million
people in the United States are victims of Alzheimers
disease, the most common cause of dementia for people older
than 65. In 1995, more than 13,600 women died of the
disease. It also takes a heavy toll on the quality of life
of the caregivers (primarily women) of people with
Alzheimers.
-
Nearly 26.4 million of the
42.7 million Americans with arthritis are women. It is the
most common and disabling chronic condition reported by
women.
From Centers for
Disease Control, Chronic Disease Notes & Reports, Winter,
2003. |
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They were also more likely to smoke, to be
sedentary, to have obesity, and to have been treated with insulin.
Compared to diabetes patients with minor depression, those with major
depression were more likely to be younger, female, and unemployed.
The researchers pointed out that a sedentary
lifestyle was an important, independent predictor of mortality from
diabetes. Earlier studies have shown that lack of exercise and physical
activity can predict depression, and, conversely, that depression can
predict the development of a sedentary lifestyle. Other studies have
shown that improvements in treating depression in diabetes patients can
lead to the patients exercising more and to better physical functioning.
The findings on diabetes, depression and higher
mortality rates are similar to results seen in several studies on heart
disease and depression, and may eventually point to important
correlations. In people with coronary artery disease, depression is
associated with about a two-fold increase in risk of death.
Moreover, cardiovascular illness is a leading cause
of death among people with diabetes. Some 70 percent to 80 percent of
people with diabetes die from coronary artery disease.
Among the biological factors that might account for
the link between depression and the heightened risk of heart attack or
stroke are increases in the ability of platelet cells to clump together
inside of blood vessels, an increase in inflammatory markers, and
changes in heart rhythms.
The results appear in the November 2005 edition of
Diabetes Care, published by the American Diabetes Association.
Grants from the National Institute of Mental Health
Services Division funded the study.
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What American Diabetes Association says
about senior citizens and diabetes |
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June 2005 - Diabetes is the fifth-deadliest disease in
the United States. This year, more than 213,000 will die from
the disease and its related complications. The total annual
economic cost of diabetes in 2002 was estimated to be $132
billion, or one out of every 10 health care dollars spent in the
United States.
There are 18.2 million people in the United
States, or 6.3% of the population, who have diabetes. While an
estimated 13 million have been diagnosed, unfortunately, 5.2
million people (or nearly one-third) are unaware that they have
the disease.
Studies indicate that diabetes is generally
under-reported on death certificates, particularly in the cases
of older persons with multiple chronic conditions such as heart
disease and hypertension. Because of this, the toll of diabetes
is believed to be much higher than officially reported.
Prevalence
> Diabetes prevalence increases with
age.
> Approximately half of all diabetes cases occur in people
older than 55 years of age.
> The risk for type 2 diabetes increases with age.
Approximately 18.3% (8.6 million) of the United States
population age 60 and older have diabetes.
Seniors and diabetes-related complications
The complications of diabetes include heart
disease, stroke, vision loss/blindness, amputations and kidney
disease.
> Heart disease and stroke. More than
65% of people with diabetes will die of heart disease or stroke,
and they are likely to die younger that people who do not have
diabetes. People with diabetes have the same cardiovascular risk
as if they have already had a heart attack. People with diabetes
are 2 to 4 times more likely to have heart disease (more than
77,000 deaths due to heart disease annually). Heart disease
death rates are also 2 to 4 times as high as adults without
diabetes. And, people with diabetes are 2 to 4 times more likely
to suffer a stroke.
> Blindness due to diabetic retinopathy. Each year 12,000 to
24,000 people lose their sight because of diabetes. Diabetes is
the leading cause of new blindness in people 20-74 years of age.
> Kidney disease due to diabetic nephropathy. Ten to 21% of
all people with diabetes develop kidney disease. Diabetic
nephropathy is the leading cause of end-stage renal disease
(kidney failure), accounting for 43% of new cases. In 2000,
41,046 people with diabetes initiated treatment for end-stage
renal disease, and 129,183 people with diabetes underwent
dialysis or kidney transplantation. People with diabetes who are
over 65 years of age are twice as likely to be hospitalized for
kidney infections compared with those without diabetes.
> Nerve disease and amputations. About 60-70% of people with
diabetes have mild to severe forms of diabetic nerve damage,
which, in severe forms, can lead to lower limb amputations. In
fact, diabetes is the most frequent cause of non-traumatic lower
limb amputations. The risk of a leg amputation is 15-40 times
greater for a person with diabetes. Each year, 82,000 people
lose their foot or leg to diabetes. |
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Medicare Helps with Diabetes |
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To learn more about the
diabetes benefits under the Medicare Modernization Act please visit
the following links:
For Consumers:
http://www.medicare.gov/ Health/Diabetes.asp
For Health Care Providers:
http://www.cms.hhs.gov/medlearn/ |
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An
NDEP article on Medicare benefits for diabetes,
including the new prevention benefits, benefits for people
with diabetes, and the drug benefit that begins next year.
Available as both one comprehensive article and in three
topical installments. |
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