Data indicate that patients with diabetes have almost double the risk of being depressed, when compared with those without the disease. Studies have assessed the link between depression and mortality among patients with diabetes, but the role of age in this association is still being explored.
Studying the Association
For a study published in the Journal of the American Geriatrics Society, Carol M. Mangione, MD, MSPH, and colleagues assessed the relationship between depression and long-term mortality among more than 3,000 patients with diabetes. Patients were divided into those aged 65 and older and those younger than 65. “It’s well known in geriatrics that people older than 65 often have less typical presentations of depression, so it can be easily missed,” says Dr. Mangione. “We felt there may be fewer depression cases diagnosed in older patients. In addition, since other investigations have shown that older patients are less likely to get treated for depression, we hypothesized that the impact of having diabetes and depression would be greater among older adults.”
The study team’s findings confirmed their suspicions. The risk for early mortality among depressed patients with diabetes was 49% higher than that of counterparts without depression. However, depressed patients aged 65 and older with diabetes had a 78% higher mortality risk than non-depressed diabetics in the same age group. “There was a trend toward higher mortality among younger diabetics with depression when compared with diabetics without depression in the same age group, but it was not statistically significant,” adds Dr. Mangione.
Putting Findings Into Practice
According to Dr. Mangione, the associations observed in the study should send a message to physicians about the importance of screening for depression for all patients with diabetes, especially older individuals. “There are many reliable depression screening tools, such as the nine-item Patient Health Questionnaire, or PHQ-9, which takes patients about 2 minutes to complete,” she says. “Incorporating these tools into routine care for people with diabetes may help prevent premature mortality in this patient population. Those who screen positive for depression should be referred to mental health providers to confirm the diagnosis and connect them with appropriate treatment.”
Dr. Mangione notes that diabetics with depression often struggle to care for their diabetes. “Providers should consider referring patients to diabetes educators or health coaches or recommend a clinical pharmacist who can simplify medication regimens,” she says. “The key is to build a team around patients so that they don’t have to rely so heavily on self-management strategies.”
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Moreno G, Mangione C. Management of cardiovascular disease risk factors in older adults with type 2 diabetes mellitus: 2002-2012 literature review. J Am Geriatr Soc. 2013;61:2027-2037.
Moreno G, Mangione C, Kimbro L, Vaisberg E. Guidelines abstracted from the American Geriatrics Society guidelines for improving the care of older adults with diabetes mellitus: 2013 update. J Am Geriatr Soc. 2013;61:2020-2026.
Kimbro L, Steers W, Mangione C, et al. The association of depression and the cardiovascular risk factors of blood pressure, HbA1c, and body mass index among patients with diabetes: results from the translating research into action for diabetes study. Int J Endocrinol. 2012;747460.