Depression in Chinese patients with type 2 diabetes: Associations with hyperglycemia, hypoglycemia, and poor treatment adherence

Abstract

Background: We hypothesize that depression in type 2 diabetes might be associated with poor glycemic control, in part due to suboptimal self-care. We tested this hypothesis by examining the associations of depression with clinical and laboratory findings in a multicenter survey of Chinese type 2 diabetic patients. Method: 2538 patients aged 18-75 years attending hospital-based clinics in four cities in China underwent detailed clinical-psychological-behavioral assessment during a 12-month period between 2011 and 2012. Depression was diagnosed if Patient Health Questionnaire-9 (PHQ-9) score ≥10. Diabetes self-care and medication adherence were assessed using the Summary of Diabetes Self-care Activities and the 4-item Morisky medication adherence scale respectively. Results: In this cross-sectional study (mean age: 56.4±10.5[SD] years, 53% men), 6.1% (n=155) had depression. After controlling for study sites, patients with depression had higher HbA1c (7.9±2.0 vs. 7.7±2.0%, P=0.008) and were less likely to achieve HbA1c goal of <7.0% (36.2% vs 45.6%, P=0.004) than those without depression. They were more likely to report hypoglycemia and to have fewer days of being adherent to their recommended diet, exercise, foot care and medication. In logistic regression, apart from young age, poor education, long disease duration, tobacco use, high body mass index, use of insulin, depression was independently associated with failure to attain HbA1c target (Odds Ratio [OR]=1.56, 95%CI:1.05-2.32, P=0.028). The association between depression and glycemic control became non-significant after inclusion of adherence to diet, exercise and medication (OR=1.48, 95% CI 0.99-2.21, P=0.058). Conclusion: Depression in type 2 diabetes was closely associated with hyperglycemia and hypoglycemia, which might be partly mediated through poor treatment adherence.