New study highlights link between depression, diabetes

A new study by researchers at the UW and Seattle’s Group Health Research Institute has found a link between depression and episodes of low blood sugar among diabetes patients.

UW psychiatry professors Dr. Wayne Katon and Dr. Paul Ciechanowski have been studying the adverse impacts of diabetes and depression for more than a decade. Because previous studies indicated that both low blood sugar and depression increased a patient’s risk for dementia, they were interested in investigating whether or not depression increases a series of hypoglycemic episodes.

“Our epidemiological work shows these diseases … adversely affect each other,” Katon said. “People with diabetes and depression have worse diabetes outcomes and worse depression outcomes.”

The study found that patients with diabetes and depression suffer more frequently from severe low blood sugar levels, also known as hypoglycemia, than patients who only have diabetes.

Researchers know depression is associated with a lack of adherence to lifestyle changes and a lower willingness to routinely take medicine. Katon said depressive symptoms like poor sleep, feelings of hopelessness, and a lack of motivation often make it more difficult for diabetes patients to follow their health regimens.

“People with diabetes and depression are more likely to not interact with physicians, to eat the wrong foods, not refill their medications, and not communicate with healthcare providers,” Ciechanowski said.

Consequently, the researchers hypothesized that, compared to patients with only diabetes, patients with both depression and diabetes would have an increased risk of hypoglycemic episodes.

Katon and Ciechanowski formed a multidisciplinary team of researchers and, with funding from the National Institute of Mental Health, followed a cohort of 4,117 diabetes patients over a five-year period.

The researchers found that depressed diabetes patients were at a greater risk of hypoglycemic episodes that led to hospitalization than non-depressed diabetes patients. The number of episodes the depressed patients were susceptible to also increased.

For depressed patients with poorly controlled diabetes, heart disease, or both, health care costs are also more expensive.

However, according to Katon and Ciechanowski’s study published in 2010, collaborative care enhances quality of life and quality of care for depression and diabetes patients, as well as cutting down health care costs. Katon also believes collaborative care may potentially decrease hypoglycemic episodes, though a study has yet to be conducted.

Most depression and diabetes patients are treated by usual care, in which typically one physician works independently. However, for collaborative care, an intervention group consists of a medically supervised nurse, a psychiatrist, and a primary care physician who work together to control risk factors associated with the multiple health conditions.

“To take care of diabetes and depression and other chronic conditions … it’s very difficult for a solo practitioner to do that effectively,” Ciechanowski said. “And that’s why we built this [intervention] team.”

Katon and Ciechanowski’s own intervention group found that, compared to usual care, collaborative care improved blood sugar levels, blood pressure levels, cholesterol levels, and depression outcomes for patients with diabetes.

“The icing on the cake for all the better outcomes and the patients’ health is that we were able to save costs,” Ciechanowski said. “We saved about $600 for every patient in the system during those two years.”

Reach reporter A. Jion Kim at news@dailyuw.com. Twitter: AJionKim

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