title: Risk of suicidal ideation in diabetes varies by diabetes regimen, diabetes duration, and HbA1c level.
abstract: OBJECTIVE
  To investigate patient subgroups based on the clinical characteristics of diabetes to evaluate risk factors for suicidal ideation using a large population-based sample in South Korea.
  
  
  METHODS
  Data from the Fifth Korea National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey, were analyzed. The participants were 9159 subjects aged ≥40years. We defined patients with diabetes based on self-reported physician-diagnosed diabetes. We evaluated clinical risk factors for suicidal ideation according to diabetes regimen, diabetes duration, and glycated hemoglobin (HbA1c) level compared with no diabetes. Given the complex sample design and unequal weights, we analyzed weighted percentages and used survey logistic regression.
  
  
  RESULTS
  Diabetes per se was not associated with suicidal ideation. However, suicidal ideation was significantly more prevalent among patients who had injected insulin, had a duration of diabetes ≥5years and had HbA1c levels ≥6.5 compared with those without diabetes. Depressive symptoms were the most prominent predictor of suicidal ideation.
  
  
  CONCLUSIONS
  Insulin therapy, diabetes of long duration, and unsatisfactory glycemic control were identified as risk factors for suicidal ideation; thus, patients with these characteristics warrant special attention. Our findings suggest the need to integrate efforts to manage emotional distress into diabetes care.
authors.affiliation: Department of Social Medicine, College of Medicine, Dankook University, 201, Manghyang-ro, Dongnam-gu, Cheonan-si, Choongnam 330-714, South Korea.
authors.forename: Hoo-Yeon
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Shinchang-myun, Asan-si, Choongnam 336-745, South Korea.
authors.forename: Myung-Il
authors.initials: MI
authors.lastname: Hahm
authors.affiliation: Graduate School of Public Health, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-749, South Korea. Electronic address: LEEVAN@yuhs.ac.
authors.forename: Sang Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology*; D003920:Diabetes Mellitus / Q000097:blood / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D056910:Republic of Korea; D012306:Risk; D012307:Risk Factors; D012959:Socioeconomic Factors; D059020:Suicidal Ideation; D013997:Time Factors
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Depression; Diabetes; HbA1c; Insulin; Suicidal ideation