title: The relationship between depressive symptoms and diabetic complications in elderly patients with diabetes: Analysis using the Diabetes Study from the Center of Tokyo Women's Medical University (DIACET).
abstract: OBJECTIVE
  To investigate the association between likelihood or severity of depression and symptoms associated with diabetic complications in elderly Japanese patients with diabetes.
  
  
  METHODS
  This single-center cross-sectional study included 4283 patients with diabetes, 65 years and older (mean age was 73 ± 6 years, 38.7% were women, 3.9% had type 1 diabetes). Participants completed a self-administered questionnaire including items on subjective symptoms associated with diabetic microangiopathy, frequency of clinical visits due to vascular diseases (heart diseases, stroke, or gangrene), hospitalization, and the Patient Health Questionnaire-9 (PHQ-9), a simple but reliable measure of depression. The associations between severity of depression and diabetic complications were examined using logistic regression analysis.
  
  
  RESULTS
  According to the PHQ-9 scores, patients were classified into the following 3 categories: 0-4 points (n=2975); 5-9 points (n=842); and 10 or more points (n=466). Higher PHQ-9 scores were associated with increased odds ratios for retinopathy, symptoms related to peripheral polyneuropathy and autonomic neuropathy, and end-stage renal disease requiring dialysis after adjustment for age, gender, smoking status, and HbA1c (all p<0.05).
  
  
  CONCLUSIONS
  Significant relationships were found between depression severity and chronic diabetic complications among elderly Japanese patients with diabetes.
authors.affiliation: Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Electronic address: ishizawa.dmc@twmu.ac.jp.
authors.forename: Kaya
authors.initials: K
authors.lastname: Ishizawa
authors.affiliation: Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Electronic address: babazono.dmc@twmu.ac.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Babazono
authors.affiliation: Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Electronic address: horiba.yu.dmc@twmu.ac.jp.
authors.forename: Yu
authors.initials: Y
authors.lastname: Horiba
authors.affiliation: Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Electronic address: shiotsu.dmc@tmwu.ac.jp.
authors.forename: Junko
authors.initials: J
authors.lastname: Nakajima
authors.affiliation: Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Electronic address: takasaki.dmc@twmu.ac.jp.
authors.forename: Keiko
authors.initials: K
authors.lastname: Takasaki
authors.affiliation: Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Electronic address: jmiura.dmc@twmu.ac.jp.
authors.forename: Junnosuke
authors.initials: J
authors.lastname: Miura
authors.affiliation: Department of Medicine, Medical Center East, Tokyo Women's Medical University School of Medicine, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-0011, Japan. Electronic address: sakuragm@dnh.twmu.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sakura
authors.affiliation: Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Electronic address: uchigata.dmc@twmu.ac.jp.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Uchigata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000523:psychology*; D003925:Diabetic Angiopathies / Q000150:complications / Q000523:psychology*; D003928:Diabetic Nephropathies / Q000150:complications / Q000523:psychology*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D012720:Severity of Illness Index; D012737:Sex Factors; D014504:Urban Health
keywords: Depression; Elderly patients with diabetes; Macroangiopathy; Microangiopathy; PHQ-9