title: Depression, anxiety and cognitive function in patients with type 2 diabetes: an 8-year prospective observational study.
abstract: OBJECTIVE
  Since depression, anxiety and cognitive function may be impaired in type 2 diabetes, we investigated the relationships between clinical and socioeconomic variables and these psychological dimensions.
  
  
  METHODS
  For an 8-year prospective observational study of 498 patients, 249 were not insulin-treated (NIT) and 249 were insulin-treated (IT). Demographic, socioeconomic and clinical data were monitored along with depression and anxiety (assessed by Zung questionnaire) and cognitive function by Mini Mental State Examination (MMSE).
  
  
  RESULTS
  After 8 years, 131 patients remained NIT (NIT-NIT), 179 remained IT (IT-IT), 47 switched to insulin (NIT-IT), 111 were lost to follow-up and 30 were died. In all groups, HbA1c remained stable, BMI, glucose and lipid profile improved, and foot ulcers and retinopathy worsened. Mild worsening in depression and anxiety scores was observed in the IT-IT patients only. On multivariate analysis, worsening of depression was associated with female gender, disease duration and being IT-IT, and worsening of anxiety with disease duration. Decreased MMSE was associated inversely with smoking and directly with being IT-IT.
  
  
  CONCLUSIONS
  Patients with type 2 diabetes are at relatively low risk of psycho-cognitive decline. However, being female and on long-term insulin treatment may be risk factors for psychological distress, suggesting that special attention is required for these patients.
authors.affiliation: Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM Dogliotti 14, 10126, Turin, Italy. marina.trento@unito.it.
authors.forename: Marina
authors.initials: M
authors.lastname: Trento
authors.affiliation: Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Lorena
authors.initials: L
authors.lastname: Charrier
authors.affiliation: Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM Dogliotti 14, 10126, Turin, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Salassa
authors.affiliation: Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM Dogliotti 14, 10126, Turin, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Merlo
authors.affiliation: Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM Dogliotti 14, 10126, Turin, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Passera
authors.affiliation: Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Cavallo
authors.affiliation: Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM Dogliotti 14, 10126, Turin, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Porta
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D003863:Depression / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000523:psychology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Anxiety; Cognitive function; Depression; Metabolic control; Type 2 diabetes