Andreas Schmitt1, Jennifer McSharry2, Jane Speight3, Elizabeth Holmes-Truscott3, Christel Hendrieckx3, Timothy Skinner4, Frans Pouwer5, Molly Byrne2. 1. Diabetes Center Mergentheim, Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), Ingolstaedter Landstraße 1, 85764 Muenchen-Neuherberg, Germany. Electronic address: schmitt@diabetes-zentrum.de. 2. School of Psychology, National University of Ireland Galway, Galway, Ireland. 3. School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia. 4. Department of Psychology, University of Copenhagen, Copenhagen, Denmark; University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Melbourne, Victoria, Australia. 5. School of Psychology, Deakin University, Geelong, Victoria, Australia; Department of Psychology, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense, Denmark.
Abstract
OBJECTIVE: To examine whether symptoms of depression or anxiety predict glycaemia and incident diabetes complications four years later, and whether diabetes self-care behaviours mediate these associations, in adults with type 1 diabetes (T1DM). METHODS: Data of 205 adults with T1DM from the 2011 and 2015 Diabetes MILES-Australia surveys were analysed. Variables of interest were: baseline depression and anxiety (PHQ-8 and GAD-7, respectively) symptoms; HbA1c and incident complications at four-year follow-up; and self-care behaviours at both time points. Longitudinal associations were analysed using structural equation modelling. RESULTS: Forty-two participants (20.6%) reported incident complications. Baseline depressive symptoms predicted higher HbA1c at follow-up indirectly via less optimal self-care at follow-up (β = 0.19, P = 0.011). Baseline anxiety was not independently associated with HbA1c or self-care at follow-up (P ≥ 0.64). Neither depressive nor anxiety symptoms predicted incident complications, although depressive symptoms were associated with less optimal self-care at baseline (β = -0.67, P < 0.001), and this predicted microvascular complications (β = -0.38, P = 0.044); however, the indirect association via self-care was not significant (β = 0.25, P = 0.067). LIMITATIONS: Participants were self-selected; all study variables were assessed using self-report measures; and adjusting for baseline HbA1c was not possible. CONCLUSIONS: Depressive symptoms predicted suboptimal self-care behaviour and glycaemic outcome four years later, while anxiety symptoms did not. The findings suggest that tailored diabetes care should take the potential impact of comorbid depression into consideration to help people improve their diabetes self-care and achieve best possible health outcomes.
OBJECTIVE: To examine whether symptoms of depression or anxiety predict glycaemia and incident diabetes complications four years later, and whether diabetes self-care behaviours mediate these associations, in adults with type 1 diabetes (T1DM). METHODS: Data of 205 adults with T1DM from the 2011 and 2015 Diabetes MILES-Australia surveys were analysed. Variables of interest were: baseline depression and anxiety (PHQ-8 and GAD-7, respectively) symptoms; HbA1c and incident complications at four-year follow-up; and self-care behaviours at both time points. Longitudinal associations were analysed using structural equation modelling. RESULTS: Forty-two participants (20.6%) reported incident complications. Baseline depressive symptoms predicted higher HbA1c at follow-up indirectly via less optimal self-care at follow-up (β = 0.19, P = 0.011). Baseline anxiety was not independently associated with HbA1c or self-care at follow-up (P ≥ 0.64). Neither depressive nor anxiety symptoms predicted incident complications, although depressive symptoms were associated with less optimal self-care at baseline (β = -0.67, P < 0.001), and this predicted microvascular complications (β = -0.38, P = 0.044); however, the indirect association via self-care was not significant (β = 0.25, P = 0.067). LIMITATIONS: Participants were self-selected; all study variables were assessed using self-report measures; and adjusting for baseline HbA1c was not possible. CONCLUSIONS:Depressive symptoms predicted suboptimal self-care behaviour and glycaemic outcome four years later, while anxiety symptoms did not. The findings suggest that tailored diabetes care should take the potential impact of comorbid depression into consideration to help people improve their diabetes self-care and achieve best possible health outcomes.
Authors: Mónica Carreira; María Soledad Ruiz de Adana; Marta Domínguez; Sergio Valdés; Maria Cruz Almaraz; Gabriel Olveira; María Teresa Anarte Journal: Int J Environ Res Public Health Date: 2021-11-28 Impact factor: 3.390