Depressed Mood Is a Factor in Glycemic Control in Type 1 Diabetes
, MSN, J
, MD, M
The diabetes literature contains conflicting evidence on the relationship between depression and
glycemic control. This may be due, in part, to the fact that past studies failed to distinguish between patients with
type 1 and type 2 diabetes. Because these are actually completely different diseases that are often treated differently
and consequently make different demands on patients, the relationship between glycemic control and depressed
mood in type 1 and type 2 diabetes was examined separately.
The relationship between Beck Depression
Inventory (BDI) scores and HbA
, as an index of long-term glycemic control, was measured in samples of 30
patients with type 1 and 34 patients with type 2 diabetes.
Groups of patients with type 1 and type 2 diabetes
did not differ in mean BDI score or HbA
level. Correlation analysis revealed a significant positive relationship
between BDI scores and HbA
in the type 1 group (
in the type 2 group (
.05). This relationship was evident throughout the entire range of BDI scores and was not restricted to scores
indicative of clinical depression. Patients with type 1 diabetes who had higher HbA
and BDI scores reported a
lower frequency of home blood glucose monitoring.
Variations in depressive mood, below the level of
clinical depression, are associated with meaningful differences in glycemic control in type 1 but not type 2 diabetes.
Preliminary data analysis suggests that this effect may be mediated, at least in part, by decreased self-care behaviors
in patients with more depressed mood.
depression, type 1 diabetes, type 2 diabetes, glycemic control.
self-monitored blood glucose; BMI
body mass index.
Diabetes is a chronic metabolic disorder that affects
almost 14 million Americans (1). Many patients with
diabetes eventually develop severe complications, in-
cluding amputations, blindness, kidney failure, and
cardiovascular disease. The main goal of treatment is
the control of blood sugar. Patients must follow rigor-
ous daily dietary, exercise, and medication regimens
for the remainder of their lives. Because successful
diabetes management depends on the behavior of the
patient, biopsychosocial factors are thought to contrib-
ute to clinical outcomes. One important factor is de-
pression. Diabetes mellitus is a significant risk factor
for depression. Recent prevalence studies suggest that
approximately 15% of all patients with diabetes suffer
from clinical depression, and even a greater percentage
(about 30%) suffer from some sort of psychiatric dis-