title: Depressive symptoms prior to and following insulin initiation in patients with type 2 diabetes mellitus: Prevalence, risk factors and effect on physician resource utilisation.
abstract: OBJECTIVE
  To study the frequency and intensity of depressive symptoms and associations with physician resource utilisation following insulin initiation in patients with type 2 diabetes mellitus.
  
  
  METHODS
  SOLVE was a 24-week observational study. In this sub-analysis of data from Poland, depressive symptoms were evaluated using the Patient Health Questionnaire (PHQ)-9.
  
  
  RESULTS
  PHQ-9 was completed by 942 of 1169 patients (80.6%) at baseline, and 751 (64.2%) at both baseline and final (24-week) visit. PHQ-9 scores indicated depressive symptoms in 45.6% (n=430) at baseline, and 27.2% (n=223) at final visit. Mean PHQ-9 change was -2.38 [95% CI -2.73, -2.02], p<0.001. Depressive symptoms at baseline (OR 6.32, p<0.001), microvascular disease (OR 2.45, p=0.016), number of physician contacts (OR 1.16, p=0.009), and change in HbA1c (OR 0.60, p=0.025) were independently associated with moderate/severe depressive symptoms at final visit. Patients with more severe depressive symptoms spent more time training to self-inject (p=0.0016), self-adjust (p=0.0023) and manage other aspects of insulin delivery (p<0.0001). Patients with persistent depressive symptoms had more telephone contacts and dose changes at final visit than those without (both p<0.05).
  
  
  CONCLUSIONS
  Depressive symptoms are common with type 2 diabetes and associated with increased healthcare utilisation, reinforcing the need for holistic interdisciplinary management approaches.
authors: Department of Internal Diseases, Medical University of Lublin, Poland. Electronic address: grzegorz.dzida@wp.pl.
authors: Grzegorz
authors: G
authors: Dzida
authors: Endocrinology, Diabetes & Metabolism, Rambam Medical Center and Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors: Eddy
authors: E
authors: Karnieli
authors: Department of Biostatistics & Epidemiology, Novo Nordisk A/S, Søborg, Denmark.
authors: Anne Louise
authors: AL
authors: Svendsen
authors: Global Medical Affairs, Novo Nordisk A/S, Søborg, Denmark.
authors: Kristine Steensen
authors: KS
authors: Sølje
authors: Diabetes Zentrum Mergentheim, Forschungsinstitut Diabetes-Akademie Bad Mergentheim (FIDAM GmbH), Bad Mergentheim, Germany.
authors: Norbert
authors: N
authors: Hermanns
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009819:Office Visits / Q000706:statistics & numerical data; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013689:Telephone / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Depression; Depressive symptoms; HbA(1c); Healthcare resource utilisation; PHQ-9; Type 2 diabetes