title: Mental health symptoms and patient-reported diabetes symptom burden: implications for medication regimen changes.
abstract: OBJECTIVE
  To examine the relative contribution of glycaemic control (HbA1C) and depressive symptoms on diabetes-related symptom burden (hypoglycaemia and hyperglycaemia) in order to guide medication modification.
  
  
  METHODS
  Secondary analysis of medical records data and questionnaires collected from a racially/ethnically diverse sample of adult patients with type 2 diabetes (n = 710) from seven outpatient clinics affiliated with an academic medical centre over a 1-year period as part of the Reducing Racial Disparities in Diabetes: Coached Care (R2D2C2) study.
  
  
  RESULTS
  Results from linear regression analysis revealed that patients with high levels of depressive symptoms had more diabetes-related symptom burden (both hypoglycaemia and hyperglycaemia) than patients with low levels of depressive symptoms (βs = 0.09-0.17, Ps < 0.02). Furthermore, results from two logistic regression analyses suggested that the odds of regimen intensification at 1-year follow-up was marginally associated with patient-reported symptoms of hypoglycaemia [adjusted odds ratio (aOR) = 1.24, 95% CI: 0.98-1.58; P = 0.08] and hyperglycaemia (aOR = 1.21, 95% CI: 1.00-1.46; P = 0.05), after controlling for patients' HbA1C, comorbidity, insulin use and demographics. These associations, however, were diminished for patients with high self-reported hypoglycaemia and high levels of depressive symptoms, but not low depressive symptoms (interaction terms for hypoglycaemia by depressive symptoms, aOR = 0.98, 95% CI: 0.97-0.99; P = 0.03).
  
  
  CONCLUSIONS
  Mental health symptoms are associated with higher levels of patient-reported of diabetes-related symptoms, but the association between diabetes-related symptoms and subsequent regimen modifications is diminished in patients with greater depressive symptoms. Clinicians should focus attention on identifying and treating patients' mental health concerns in order to address the role of diabetes-related symptom burden in guiding physician medication prescribing behaviour.
authors.affiliation: Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and dsorkin@uci.edu.
authors.forename: Dara H
authors.initials: DH
authors.lastname: Sorkin
authors.affiliation: Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and.
authors.forename: John
authors.initials: J
authors.lastname: Billimek
authors.affiliation: Department of Psychology, Rutgers University, Camden, NJ, USA.
authors.forename: Kristin J
authors.initials: KJ
authors.lastname: August
authors.affiliation: Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and.
authors.forename: Quyen
authors.initials: Q
authors.lastname: Ngo-Metzger
authors.affiliation: Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and.
authors.forename: Sherrie H
authors.initials: SH
authors.lastname: Kaplan
authors.affiliation: Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Reikes
authors.affiliation: Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Greenfield
mesh_terms: D001213:Asian / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000208:ethnology / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000208:ethnology / Q000209:etiology / Q000523:psychology*; D007003:Hypoglycemia / Q000208:ethnology / Q000209:etiology / Q000523:psychology*; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D017058:Mexican Americans / Q000706:statistics & numerical data; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014744:Vietnam / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data
chemical_list: D006442:Glycated Hemoglobin
keywords: Diabetes-related symptom burden; mental health; physician medication prescribing behaviour; type 2 diabetes.
references.citation: Diabetes Care. 1994 Jun;17 Suppl 1:32-9
references.pmid: 8088221
references.citation: Diabetes Care. 2012 Sep;35(9):1897-901
references.pmid: 22699297
references.citation: J Gen Intern Med. 2011 Jun;26(6):595-602
references.pmid: 21321793
references.citation: Diabetes Care. 1988 Sep;11(8):605-12
references.pmid: 3219966
references.citation: Diabetes Care. 2000 Jan;23(1):23-9
references.pmid: 10857963
references.citation: Mediators Inflamm. 2010;2010:573594
references.pmid: 20490354
references.citation: Arch Intern Med. 2007 Sep 24;167(17):1853-60
references.pmid: 17893306
references.citation: Semin Clin Neuropsychiatry. 1998 Apr;3(2):82-86
references.pmid: 10085195
references.citation: Psychosom Med. 2007 May;69(4):297-9
references.pmid: 17517972
references.citation: Diabetes Care. 2001 Jun;24(6):1069-78
references.pmid: 11375373
references.citation: Diabetes Care. 1999 Jun;22(6):997-8
references.pmid: 10372255
references.citation: Gen Hosp Psychiatry. 2003 Jul-Aug;25(4):246-52
references.pmid: 12850656
references.citation: Patient Educ Couns. 2002 Dec;48(3):243-52
references.pmid: 12477609
references.citation: Arch Intern Med. 2000 Nov 27;160(21):3278-85
references.pmid: 11088090
references.citation: Diabetes Care. 2009 Dec;32(12):2156-60
references.pmid: 19729522
references.citation: Ann Intern Med. 2002 May 21;136(10):765-76
references.pmid: 12020146
references.citation: Diabetes Care. 2000 Jul;23(7):934-42
references.pmid: 10895843
references.citation: Int J Psychiatry Med. 1990;20(3):259-77
references.pmid: 2265888
references.citation: J Clin Psychopharmacol. 2004 Oct;24(5):527-31
references.pmid: 15349009
references.citation: J Gen Intern Med. 2012 Apr;27(4):432-7
references.pmid: 22005941
references.citation: Womens Health Issues. 2015 Jan-Feb;25(1):6-12
references.pmid: 25442365
references.citation: Am J Med. 2008 Nov;121(11 Suppl 2):S8-15
references.pmid: 18954592
references.citation: Int J Soc Psychiatry. 1990 Winter;36(4):252-64
references.pmid: 2079396
references.citation: Value Health. 2012 Dec;15(8):1036-41
references.pmid: 23244805
references.citation: Int J Psychiatry Med. 1988;18(4):295-303
references.pmid: 3235277
references.citation: JAMA. 1999 Jun 2;281(21):2005-12
references.pmid: 10359389
references.citation: Community Ment Health J. 2003 Feb;39(1):33-46
references.pmid: 12650554
references.citation: Urology. 1999 Sep;54(3):424-9
references.pmid: 10475347
references.citation: N Engl J Med. 2010 Dec 30;363(27):2611-20
references.pmid: 21190455