title: Differential associations between depressive symptoms and glycaemic control in outpatients with diabetes.
abstract: OBJECTIVE
  Depression is common in people with diabetes, and related to higher HbA(1c) levels. Depression, however, is a heterogeneous construct that involves a variety of symptoms. As little is known about the associations of individual depressive symptoms with HbA(1c), we explored these associations in outpatients with diabetes.
  
  
  METHODS
  The study was conducted in three tertiary diabetes clinics in the Netherlands. At baseline, the presence of the nine depressive symptoms that are listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition was assessed with the nine-item Patient Health Questionnaire (PHQ-9). At baseline and after a 1-year follow-up, HbA(1c) was derived from the medical charts.
  
  
  RESULTS
  A total of 288 out of 646 subjects with diabetes (45%) reported one or more depressive symptom(s). Depressed mood (β = 0.11, P = 0.005), sleeping difficulties (β = 0.16, P < 0.001), appetite problems (β = 0.15, P < 0.001) and suicidal ideation (β = 0.14, P = 0.001) were significantly related to higher baseline HbA(1c) values. Furthermore, depressed mood (β = 0.09, P = 0.03) sleeping difficulties (β = 0.12, P = 0.004), appetite problems (β = 0.11, P = 0.01) and psychomotor agitation/retardation (β = 0.09, P = 0.04) were significantly related to higher HbA(1c) values at 1-year follow-up. Associations were more pronounced in Type 1 diabetes than in Type 2 diabetes. None of the depressive symptoms were related to change in HbA(1c) over time, except suicidal ideation.
  
  
  CONCLUSIONS
  In people with diabetes, several individual depressive symptoms were related to higher HbA(1c) levels. These associations persisted over time. More research is needed to investigate potential mechanistic pathways.
authors.affiliation: CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands. m.bot@uvt.nl
authors.forename: M
authors.initials: M
authors.lastname: Bot
authors.forename: F
authors.initials: F
authors.lastname: Pouwer
authors.forename: P
authors.initials: P
authors.lastname: de Jonge
authors.forename: C J
authors.initials: CJ
authors.lastname: Tack
authors.forename: P H L M
authors.initials: PH
authors.lastname: Geelhoed-Duijvestijn
authors.forename: F J
authors.initials: FJ
authors.lastname: Snoek
mesh_terms: D000553:Ambulatory Care; D003430:Cross-Sectional Studies; D003863:Depression / Q000097:blood / Q000209:etiology*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology*; D005221:Fatigue / Q000209:etiology; D001068:Feeding and Eating Disorders / Q000209:etiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011595:Psychomotor Agitation / Q000209:etiology; D012189:Retrospective Studies; D012649:Self Concept; D012893:Sleep Wake Disorders / Q000209:etiology; D059020:Suicidal Ideation
chemical_list: D006442:Glycated Hemoglobin