title: Association of severe hypoglycemia with depressive symptoms in patients with type 2 diabetes: the Fukuoka Diabetes Registry.
abstract: OBJECTIVE
  Although many studies have investigated the clinical characteristics of patients with diabetes with depression in Western populations, there is a lack of information regarding other ethnicities. We studied the association between clinical characteristics and depressive symptoms in Japanese patients with type 2 diabetes.
  
  
  METHODS
  A total of 4218 Japanese patients with type 2 diabetes who were not taking antidepressants were divided into four groups according to the Center for Epidemiologic Studies Depression Scale (CES-D) score. The relationship between the severity of depressive symptoms and clinical parameters was examined cross-sectionally.
  
  
  RESULTS
  After multivariate adjustments, the severity of depressive symptoms was significantly associated with body mass index, leisure-time physical activity, current smoking, sleep duration, sucrose intake, skipping breakfast, insulin use, severe hypoglycemia, dysesthesia of both feet, history of foot ulcer, photocoagulation, ischemic heart disease, and stroke. ORs for severe hypoglycemia increased significantly with the CES-D score in 2756 sulfonylurea and/or insulin-treated patients after multivariate adjustment including age, sex, duration of diabetes, glycated hemoglobin, insulin use, self-monitoring of blood glucose, leisure-time physical activity, skipping breakfast, dysesthesia of both feet, ischemic heart disease, and stroke (CES-D score ≤9, referent; 10-15, OR 1.64; 16-23, OR 2.09; ≥24, OR 3.66; p for trend <0.01).
  
  
  CONCLUSIONS
  Severe hypoglycemia was positively associated with the severity of depressive symptoms in Japanese patients with type 2 diabetes independent of glycemic control, insulin therapy, lifestyle factors, and diabetic complications. As both severe hypoglycemia and depression are known risk factors for morbidity and mortality in patients with diabetes, clinicians should be aware of this association.
  000002627.
authors.affiliation: Department of Medicine and Clinical Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Kikuchi
authors.affiliation: Department of Medicine and Clinical Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan ; Diabetes Center, Hakujyuji Hospital , Fukuoka , Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Iwase
authors.affiliation: Division of General Internal Medicine , School of Oral Health Science, Kyushu Dental University , Kitakyushu , Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Fujii
authors.affiliation: Division of Research Management , Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ohkuma
authors.affiliation: Department of Medicine and Clinical Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan.
authors.forename: Shinako
authors.initials: S
authors.lastname: Kaizu
authors.affiliation: Department of Medicine and Clinical Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ide
authors.affiliation: Department of Medicine and Clinical Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan.
authors.forename: Tamaki
authors.initials: T
authors.lastname: Jodai
authors.affiliation: Diabetes Center, Hakujyuji Hospital , Fukuoka , Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Idewaki
authors.affiliation: Department of Medicine and Clinical Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan.
authors.forename: Udai
authors.initials: U
authors.lastname: Nakamura
authors.affiliation: Department of Medicine and Clinical Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan.
authors.forename: Takanari
authors.initials: T
authors.lastname: Kitazono
keywords: Depression; Dietary Assessment; Epidemiology; Hypoglycemia