MUNICH — New research presented at the European Association for the Study of Diabetes (EASD) 2016 Annual Meeting shows high rates of depressive disorder (10%) in patients with type 2 diabetes, but with wide variations between countries.

Depression affected almost 30% of type 2 diabetes patients assessed in Bangladesh, with Mexico, Russia, and Poland also scoring highly, reported Catherine Lloyd, PhD, a medical epidemiologist at the Open University in Milton Keynes, United Kingdom.

Her research, reported as a poster here, details the International Prevalence and Treatment Study (INTERPRET-DD), which "to our knowledge is the first study to look at this issue outside of the US and UK, where most prior studies into diabetes and depression have been conducted," Dr Lloyd told Medscape Medical News.

"Our aim was to take a look in as many countries worldwide as we could," she said.

Rates of depression in diabetes patients from some countries participating in INTERPRET-DD

INTERPRET-DD is following 3000 patients in 15 countries — Argentina, Bangladesh, China, Germany, India, Italy, Kenya, Mexico, Pakistan, Poland, Russia, Serbia, Thailand, Uganda, and Ukraine.

In each, patients are being assessed by a team comprising a diabetologist and a psychiatrist, she noted.

Endocrinologists Can Help Diabetes Patients With Depression

Research has indicated that the prognosis of both diabetes and depression in terms of severity of disease, complications, treatment resistance, and mortality is worse for either disease when they are comorbid than when they occur separately, Dr Lloyd explained.

But knowledge and understanding of the relationship between the two conditions remains extremely poor internationally, where health systems differ and treatment and referral patterns vary.

Consequently, in many of the countries, detection — in terms of a recorded diagnosis of depression and prescribed medication or therapy — is "extremely poor or nonexistent," she said.

Improving the identification of depression and other mental disorders and ensuring affected diabetes patients gain access to subsequent treatments, such as talking therapies, "can lead to better quality of life, improved management of diabetes, and better clinical outcomes," she observed.

However, endocrinologists often do not ask patients about depressive symptoms because "they feel that there is a challenge of what to do next," she explained.

"But it's about asking patients. If you don't ask, you can't help, and doctors can help if they know how to refer patients," she said.

In many of the countries studied, there are a wide range of treatments available for depression if endocrinologists seek advice about how they can help, she stressed.

World Network of Centers Collaborating on Diabetes/Depression

INTERPRET-DD has recruited about 200 patients with type 2 diabetes in each of the countries that are involved.

Data such as HbA1c, presence of complications, etc, were collected from medical records, and each participant completed the Patient Health Questionnaire (PHQ-9), as well as the Problem Areas in Diabetes (PAID) and the WHO Well-being (WHO-5) scales. Demographic information was collected, and patients underwent a psychiatric interview.

Nearly half (45%) the participants were male, with mean duration of diabetes of 9 years and mean age 54 years.

Overall, 10.3% received a diagnosis of major depressive disorder (MDD), with rates differing widely between countries. Uganda, Kenya, and India had the lowest proportion diagnosed at interview (1.0%, 2.7%, and 2.0%, respectively) and Bangladesh had the highest proportion (29.9%).

Other rates included: Argentina 11.8%; China 10.8%; Germany 4.3%; Italy 3.9%; Mexico 18.2%; Pakistan 11.6%; Poland 14.7%; Russia 17.0%; Serbia 9.5%; Thailand 6.2%; and Ukraine 6.1%.

A more sophisticated analysis of the data demonstrated that being female, having a lower level of education, no regular income, and urban living were all independently associated with major depressive disorder, along with angina, higher PAID score, family history of depression and prior history of major depressive disorder.

This is "the first study of its kind to focus on these comorbid conditions and brings with it future opportunities to collaborate and share data," said Dr Lloyd, noting that a paper about the protocol of the study was published last year (Diabet Med. 2015; 32: 925–934).

By examining between-country variations, "We will be able to identify the gaps and commonalities in successful treatment and care, leading to recommendations for both future research (for example, randomized controlled trials) and practice," she and her colleagues observe in that paper.

"We will produce appropriate screening and assessment instruments and create the world's largest network of centers collaborating in the effort to address the problem of comorbidity and identify the most beneficial ways of treating depression in people with diabetes," they conclude.

Dr Lloyd receives grants from the Association for the Improvement of Mental Programmes.

Follow Lisa Nainggolan on Twitter: @lisanainggolan1. For more diabetes and endocrinology news, follow us on Twitter and on Facebook.

European Association for the Study of Diabetes 2016 Annual Meeting; September 14, 2016; Munich, Germany. Poster 817


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