22 de enero de 2012

Which Comes First: Diabetes or Depression?


Johns Hopkins Health Alert
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The link between diabetes and depression has long been recognized; many studies have shown that depression is twice as likely to occur in people with diabetes as in the general population. What's more, the connection is said to be "bidirectional," meaning that not only do people with diabetes have a greater risk of being depressed, but those with depression are at higher risk for developing diabetes -- although the latter association is not as strong.

What's the key to this connection? Researchers are still trying to tease it out, but both biological and lifestyle factors appear to be involved. Depressed people have elevated levels of cortisol, also known as the "stress hormone." Cortisol is a key player in blood glucose metabolism and insulin sensitivity, and high levels are also associated with increased fat deposits within the abdomen, a risk factor for type 2 diabetes.

Certain lifestyle factors also go hand-in-hand with both illnesses -- including obesity, inactivity, smoking and poor eating habits. And the stress of managing a chronic condition has been shown to lead to depression.

What the Research Shows A major study in the Journal of the American Medical Association by Johns Hopkins researchers recently examined the two-way association. The investigators analyzed data from more than 6,000 people age 45 to 84 from the Multi-Ethnic Study of Atherosclerosis (MESA). The first part of the study, which analyzed participants without type 2 diabetes, found that those who displayed depressive symptoms were 42 percent more likely to develop type 2 diabetes within three years than those who weren't depressed. However, the increased risk was no longer statistically significant after adjusting for diet, physical activity, smoking status and alcohol use, illustrating that lifestyle factors play a larger role in developing diabetes than depression itself.

The second part of the study looked at subjects without depression who had prediabetes, untreated diabetes or treated diabetes. Researchers found that people with treated diabetes were 54 percent more likely to develop depressive symptoms over three years than those with normal glucose, and the same risk persisted after controlling for other factors. (Surprisingly, the risk was 21 percent lower for those with prediabetes and 25 percent lower for those with untreated diabetes than those with normal glucose, though it is unclear why.)

Important, the researchers point out that treated diabetes may lead to depression because simply being aware of your diagnosis creates psychological stress, sometimes called the "illness burden," which can lead to depression.

Posted in Diabetes on January 19, 2012


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