title: Improvement of Glycemic Control in Insulin-Dependent Diabetics with Depression by Concomitant Treatment with Antidepressants.
abstract: BACKGROUND It is still disputable whether negative effects of comorbid depression in diabetics can be diminished by successful treatment of depression. The primary aim of this study was to assess whether addition of antidepressants to existing insulin treatment would further improve glycemic control in these patients. A secondary objective was to assess whether such treatment impairs their lipid and inflammatory status. MATERIAL AND METHODS Total of 192 patients with poorly controlled diabetes (defined as HbA1c ≥8%) in the absence of any uncontrolled medical condition entered the 6-month run-in phase with optimization of diabetic therapy. Depression status was screened at the end of this phase by BDI-II depression testing. Patients with BDI-II ≥14 and psychiatric confirmation of depression (58 patients) entered the 6-month interventional phase with SSRI class antidepressants. RESULTS Fifty patients completed the study. During the run-in phase, HbA1c dropped from 10.0±1.8% to 8.5±1.2% (p<0.001), and during the interventional phase it dropped from 8.5±1.2% to 7.7±0.7% (p<0.001). BDI-II scores improved significantly from 30.4±13.2 to 23.5±11.0 (p=0.02) during the interventional phase. A positive linear correlation between improvement in depression scale and improvement in glycemic control was observed (R²=0.139, p=0.008). Lipid profile and inflammatory status did not change significantly during the interventional phase. CONCLUSIONS Patients with poorly controlled diabetes and comorbid depression might benefit from screening and treatment of depression with SSRI antidepressants by achieving an incremental effect on glycoregulation. This therapy did not have any adverse effects on lipid profile or inflammatory status.
authors.affiliation: Department of Clinical Endocrinology, Clinical Center "Dr Dragisa Misovic", Belgrade, Serbia.
authors.forename: Jana
authors.initials: J
authors.lastname: Radojkovic
authors.affiliation: Department of Clinical Psychiatry, Clinical Center "Dr Dragisa Misovic", Belgrade, Serbia.
authors.forename: Natasa
authors.initials: N
authors.lastname: Sikanic
authors.affiliation: Department of Medical Statistics, University School of Medicine, Belgrade, Serbia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Bukumiric
authors.affiliation: Department of Internal Medicine, University School of Medicine, Belgrade, Serbia.
authors.forename: Marijana
authors.initials: M
authors.lastname: Tadic
authors.affiliation: Department of Clinical Endocrinology, Clinical Center "Dr Dragisa Misovic", Belgrade, Serbia.
authors.forename: Nada
authors.initials: N
authors.lastname: Kostic
authors.affiliation: Department of Internal Medicine, University School of Medicine, Belgrade, Serbia.
authors.forename: Rade
authors.initials: R
authors.lastname: Babic
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D015897:Comorbidity; D003863:Depression / Q000188:drug therapy* / Q000378:metabolism* / Q000523:psychology; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism* / Q000523:psychology; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D038321:Glycemic Index / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D017367:Selective Serotonin Reuptake Inhibitors