Print Article for : Effects Of Diabetes Mellitus

Your Online Guide » Guide to Medical » Diabetes Treatment

[E144]Effects Of Diabetes Mellitus

by Ibrahim Machiwala, Ibr

Introduction:
The relationship between Diabetes and clinical depression is a subject of growing interest. The diabetic population has a 2-fold risk of depression1 compared to general population, 10-15% meeting the criteria for clinical depression2 and as high as 40% prevalence of sub-clinical depressive symptomatology3. Depression can severely impact medical management of Diabetes in terms of higher symptom burden4, increased functional impairment4,5, poorer glycemic control6 and more diabetic complications 7,8.

The course of depression is more chronic and severe in people with Diabetes9. 20% recover completely for 5 years and on average this population suffers 4.2 episodes in 5 years10. Symptoms of depression and diabetes may exacerbate each other at neuroendocrine level11. Depression in this population also remains under-diagnosed and under-treated12, 13 because of symptom overlaps14 and it commonly viewed as secondary to medical condition hence not independently important.

Compliance to medication5, diet15 and exercise4 is central to prognosis in this chronic illness. Depression has been most commonly associated with non-adherence in foreign16,17,18 and local literature19. Depressed mood leads to increased pessimism with respect to perceived benefits and reduced self-efficacy, both being crucial motivating factors for self-care and compliance 20.

Local literature shows high non-compliance21,22 and majority of diabetics having poor glycemic control23,24,25,26. Previous studies27,28,29,30 show various reasons for non-compliance, most being forgetfulness, belief of immediate cure and financial constraint. This study aims to find an association between depression and treatment compliance in the diabetic population of a tertiary care hospital in Karachi. Operational definitions are attached as Annexure 1.

Objectives:
1.To find the prevalence of depressive disorders in the diabetic population coming to a tertiary care hospital of Karachi.
2.To observe the effect of depression on glycemic control in the same population.

Hypothesis:
The group of diabetics having depression will have poorer glycemic control as compared to those who do not have depression.

Material and Methods:
Study Design: Cross-sectional observational study
Study Setting: The Aga Khan University Hospital is a 500-bedded tertiary care hospital

catering to middle and upper socio-economic strata suffering from Diabetes Mellitis. At the hospital there are 16 clinics every week specific to Diabetes and Endocrinology. American Diabetic Association recommendations of diet, exercise, glycemic monitoring and investigations are followed on all patients.

Duration Of Study: 6 months after protocol approval.

Sample Size: Sample size calculated by the formula for binomial variables in two groups:
h'= [zÎ±âˆš(C+1)P(1-P) + zÎ²âˆšCP1(1-P1)+P2(1-P2)]2
C(P2-P1)2
is 280 keeping p-value of 0.05 and power of the study 80%.

Sampling Technique: Non-probability convenience sampling will be done.

Sample Selection:

Inclusion Criteria:
1.Patients having Type II Diabetes and its related complications (Annexure 1)
2.Age between 18 and 60 (Adult population only)
3.Patients who have at least taken one appointment at the endocrinology clinic before

Exclusion Criteria:
1.Patients having history of psychiatric illnesses other than depressive disorders (Annex 1)
2.Patients having history of use of psychotropic drugs
3.Patients unable to give informed consent

Data Collection Procedure:

Outcome Variables:

Dependent variable:
1.HbA1c level (poor glycemic control 7%) done 3 months after the recruitment time
2.Number of diabetes-related complications (Coded in Annex1)

Independent variable:
Score on Hospital Anxiety and Depression Scale (Depression Subscale with cut-off â‰¥8)

Method of Data Collection:
Informed consent after nursing assessment will take place for those fulfilling the criteria; those agreeing will undergo a semi-structured clinical interview of 10 minutes before consultation with endocrinologist including demographic details, history of psychiatric illness or exposure to psychotropic, family history of diabetes and depression and self-care activities. The same sample will be followed on next visit in 6 months for HbA1c level measured using few drops of blood on High-Protein Liquid Chromatography method (HPLC).

Data Collection Tools:
1.Measurement of Depression: The Urdu Translation of Hospital Anxiety and Depression Scale31-depression subscale has been used in various studies. It has good sensitivity, specificity and receiver operating characteristics when compared to other measures of depression32,33. It will screen for case-ness of depression in this study (Annex2) with a cut-off score of â‰¥8
2.Measurement Of Compliance: A proxy measure of compliance will be used Glycosylated Hemoglobin (7% poor compliance).

Self-care activities will be part of the interview. Weight, blood pressure and diabetes-related complications that develop will be followed in case records for change indicating treatment compliance.

Data Analysis Procedure:
Statistical Software
Statistical Package for Social Sciences Version 13.0 (SPSS 13.0)
Statistical Tests
A 2x2 table will be constructed as follows:
DISEASE / HbA1c>7%

Exposure: Good Glycemic control: Depressed: a:b
HbA1c<7%: Poor Glycemic Control: Not Depressed: c: d
Odds Ratio (ad/bc) will be calculated and Chi-square test of significant applied to primary variables of HAD-D score and HbA1c level.

Stepwise logistic regression will be applied using glycemic control and diabetes-related complications as dependent variables, controlling for demographic details and duration of illness. A bivariate analysis for depression and different self-care behaviors asked during the interview will be conducted to find the most effected self-care behavior.

The most common short-term effect is sudden dips and spikes in blood sugar. These can cause dizziness, confusion, upset stomach, and other problems. While some diabetics seldom have this problem, most will occasionally experience mild episodes. Routine self-care can help minimize episodes.

Monitoring is vital. Pricking your finger three times a day is wearisome, but worth the effort. Some new glucose monitoring devices don't require painful pricks.

The newer devices may have a laser which makes a hole in the skin from which to obtain blood; these are painless, producing a gentle tingling sensation. Another monitoring device can measure the glucose level by sending an infrared beam through the skin, drawing no blood.

The aim is to maintain a normal or near normal glucose-insulin balance. A fasting glucose level of under 99mg/dL is normal in non-diabetics. After a heavy meal, glucose may increase to over 200 mg/dL, but in non-diabetics released insulin will bring the level down within two hours. So keeping a proper glucose level means maintaining a balance, rather than keeping the glucose level at a steady number.

Part of a long-term glucose monitoring strategy should encompass regular physician visits with a quarterly A1C test. Several tests exist to measure blood glucose level at a given time. The A1C test provides a picture averaged over a period of months. The name comes from HbA1c, an abbreviation for glycated hemoglobin.

Hemoglobin molecules in the red blood cells carry oxygen to tissues. The extra glucose in the bloodstream of a diabetic causes that hemoglobin to get glycated. That effect persists and allows an A1C test to measure the accumulated result.

The effects of diabetes continue over the long-term. In the past, many diabetics would suffer from kidney damage, blindness, nerve damage and ills within a decade or so of the condition's onset. Luckily this need not occur. Modern medical knowledge enables most diabetics to lead nearly normal lives, with few ill effects.

Much of this management is disciplined exercise and diet. Many diabetics can keep their glucose-insulin balance nearly normal through diet and exercise, without medicine.

Because diet and exercise help keep body fat low, the effects of diabetes are minimized. Body fat plays a role in hormone production and release and it also interferes with the body's reaction to glucose levels. Several studies show a definite correlation between the degree of diabetes and the degree of body fat, but the mechanisms for this are unclear.

One part of the puzzle is role lowering body fat plays in lowering the blood pressure. Chronic hypertension (high blood pressure) is a major contributor to the cardiovascular and nerve problems experienced by some diabetics.

With diligence a diabetic can lead a normal life, one very much like those fortunate enough not to have the condition. A little attention a few times a day can lead to not having to pay too much attention at all.

Article Source : Pg. 22

About Author

Both Ibrahim Machiwala & Julia Hanf.. are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Ibrahim Machiwala has sinced written about articles on various topics from Quit Smoking, Menopause and Quit Smoking. Dr. D.S. Merchant is a Gold Medalist in (Anatomy & Histology), He has written many articles on the related topic of , Control in type I. Ibrahim Machiwala's top article generates over 5400 views. to your Favourites.

Julia Hanf.. has sinced written about articles on various topics from . Julia Hanf author of the book How To Play the Diabetes Diet Game and Win Through a real life crisis Julia figured out how to live diabetes free. Visit