Depression and/or diabetes-related distress in the cross-national DAWN MIND study: the importance of understanding different needs

SNOEK F; DE WIT M; HERMANNS N; MCGUIRE BE; PIBERNIK-OKANOVIC M; KOKOSZKA A; GAGLIARDINO JJ; MATTHEWS DR; RODRIGUEZ-SALDANA J; CLEIJNE W; SKOVLUND SF

Montreal, Canadá

Congreso; IDF 20th World Diabetes Congress; 2009

International Diabetes Federation

Backgound: The prevalence of uni-polar depression (DEP) is twice as high among people with Type 1 and Type 2 diabetes relative to the general population, affecting approximately 10-20% of the patients. DEP is associated with suffering, poor clínical outcomes and high costs. It is unclear to what extent DEP is related to high diabetes-specific distress (DSD) and if antidepressant treatment should address DSD. In the context of the cross-national DAWN MIND (Monitoring of Individual Needs in Diabetes) study, patients are screened for DEP and DSD using validated self-report measures as part of ongoing diabetes care, along with socio-demographic and clinical parameters. Aims: To explore the relationship between DEP and DSD and differentiate between different subgroups on the basis of the existence or absence of DEP and/or DSD. Such differentiation may help to clarify the relevance of perceived diabetes-specific burden in the etiology and management of DEP in people with diabetes. Methods: Cross-sectional data were collected in 1131 diabetes patients from diabetes care centres in 9 countries. Frequencies of DEP and DSD were tested using established cut-off scores of the World Health Organisation-5 item Wellbeing Index (WHO-5 score -<29) and the Problem Areas In Diabetes (PAID score > 39) scale, as measures of DEP and DSD respectively. Group differences on demographic and c1inical variables were tested for 4 sub-groups:a) No DEP and No DSD, b) DEP, no DSD,J c) DEP and DSD, and d) No DEP, DSD. Results: Correlation between WHO-5 and PAID was -.443 (p-< 0 .01)) confirming they are relatedbut not interchangeable. Both measures showed weak but significant associations (r - .077 and .122 resp.) with HbAlc, in the expected direction, Over 1/4 (26.2%) n=296) of the patients reported to be depressed and/or distressed. 15.6% had DSD but no DEP 5.5. % had DEP alone (n=62)) 5.1% combined DEP with DSD (n=S8). Comparing DEP with and without DSD revealed that the combined DEP/DSD group comprised more females, but no other striking differences. DEP/DSD had poorest glycemic control of all groups and significantly worse than those with no DEP nor DSD (8.6% ± 2.1 vs. 7.9%± 1.5) p-< .05). Discussion/Conclusion: Approximately 1: 4 diabetes patients has serious psychological issues that warrant c1inical attention. Questionnaires such as WHO-5 and PAID can help clinicians distinguish between those affected by depression or diabetes-related distress only) and those with a combined problem. Those affected by depresion and diabetes distress had the worst glycemic control, suggesting they have the greatest difficulty self-managing their diabetes. Addressing diabetes distress in treating their depression would seem essential. Our findings underscore the importance of assessing patients' individual needs to help tailor psychological services in the context of diabetes care. No conflict of interest