Depression is linked to hyperglycaemia via suboptimal diabetes self-management: A cross-sectional mediation analysis.
To analyse if the association between depressive symptoms and hyperglycaemia is mediated by diabetes self-management.



430 people with diabetes (57.7% type 1, 42.3% type 2) were cross-sectionally assessed using validated self-report scales for depressive symptoms (Center for Epidemiologic Studies Depression Scale (CES-D)) and diabetes self-management (Diabetes Self-Management Questionnaire (DSMQ)); HbA1cwas analysed simultaneously in a central laboratory. Structural equation modelling was used to test if the association between depressive symptoms and hyperglycaemia (HbA1c) was mediated by suboptimal self-management in people with type 1 and type 2 diabetes.



The hypothesised model of depressive symptoms, diabetes self-management and hyperglycaemia fit the data well for both diabetes types (SRMR≤0.04, TLI≥0.99, CFI>0.99, RMSEA≤0.02 for both models). In both the type 1 and type 2 diabetes group, higher depressive symptoms were associated with lower self-management (P<0.001) and lower self-management was associated with higher HbA1c(P<0.001). Results indicated that the association between depressive symptoms and hyperglycaemia was significantly mediated by suboptimal diabetes self-management in both type 1 and type 2 diabetes patients (P<0.001). Significant direct associations between depressive symptoms and hyperglycaemia, not mediated by self-management, could not be observed.



This study provides good evidence supporting that depression is linked to hyperglycaemia via suboptimal diabetes self-management in both major diabetes types.
Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany. Electronic address: schmitt@diabetes-zentrum.de.
Andreas
A
Schmitt
Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany. Electronic address: reimer@diabetes-zentrum.de.
André
A
Reimer
Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany; Otto-Friedrich-University of Bamberg, Department for Psychology, Markusplatz 3, 96047 Bamberg, Germany. Electronic address: hermanns@diabetes-zentrum.de.
Norbert
N
Hermanns
Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany; Otto-Friedrich-University of Bamberg, Department for Psychology, Markusplatz 3, 96047 Bamberg, Germany. Electronic address: kulzer@diabetes-zentrum.de.
Bernhard
B
Kulzer
Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany. Electronic address: ehrmann@diabetes-zentrum.de.
Dominic
D
Ehrmann
Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany. Electronic address: krichbaum@diabetes-zentrum.de.
Michael
M
Krichbaum
Centre for Health Research, University of Brighton, Falmer, BN1 9PH, United Kingdom. Electronic address: J.Huber@brighton.ac.uk.
Jorg
J
Huber
Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany. Electronic address: haak@diabetes-zentrum.de.
Thomas
T
Haak
D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D012648:Self Care; D011795:Surveys and Questionnaires
Depressive symptoms; Diabetes self-care; HbA(1c); Hyperglycaemia; Mediation; Mood disorder