Neuropathy and Presence of Emotional Distress and Depression in Longstanding Diabetes: Results From the Canadian Study of Longevity in Type 1 Diabetes

• Published in: Journal of diabetes and its complications Vol. 31; no. 8; pp. 1318 - 1324
• Main Authors: Bai, Johnny-Wei, Lovblom, Leif E, Cardinez, Marina, Weisman, Alanna, Farooqi, Mohammed A, Halpern, Elise M, Boulet, Genevieve, Eldelekli, Devrim, Lovshin, Julie A, Lytvyn, Yuliya, Keenan, Hillary A, Brent, Michael H, Paul, Narinder, Bril, Vera, Cherney, David Z.I, Perkins, Bruce A
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2017; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Aging; Canada - epidemiology; Cardiovascular disease; Cohort Studies; Complications; Cost of Illness; Cross-Sectional Studies; Depression; Depressive Disorder, Major - complications; Depressive Disorder, Major - epidemiology; Depressive Disorder, Major - mortality; Depressive Disorder, Major - psychology; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - mortality; Diabetes Mellitus, Type 1 - psychology; Diabetic Neuropathies - complications; Diabetic Neuropathies - mortality; Diabetic Neuropathies - psychology; Diabetic neuropathy; Distress; Emotions; Endocrinology & Metabolism; Female; Geriatrics; Humans; Kidney diseases; Longevity; Male; Mental depression; Mental health; Middle Aged; Neuropathy; Older people; Pain; Poisson Distribution; Prevalence; Psychiatric Status Rating Scales; Psychological aspects; Psychology; Quality of Life; Questionnaires; Risk; Stress, Physiological; Survival Analysis; Type 1 diabetes; Canada; distress; neuropathy; depression; complications; psychology; Type 1 diabetes; Depression; Distress; Neuropathy; Complications; Psychology
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2017.05.002

Abstract Aim To determine the association of neuropathy and other complications with emotional distress and depression among patients with longstanding type 1 diabetes (T1DM). Methods Canadians with ≥ 50 years of T1DM completed a questionnaire including assessment of distress and depression by the Problem Areas in Diabetes Scale (PAID) and Geriatric Depression Scale (GDS), respectively. Complications were determined using the Michigan Neuropathy Screening Instrument (Questionnaire Component), fundoscopy reports, renal function tests, and self-reported peripheral-(PVD) and cardiovascular (CVD) disease. Associations were analyzed by Poisson regression. Results Among 323 participants, 137(42.4%) had neuropathy, 113(36.5%) nephropathy, 207(69.5%) retinopathy, 95(29.4%) CVD, and 31(9.8%) PVD. The neuropathy subgroup had higher prevalence of distress (13(9.5%) vs. 6(3.3%),p = 0.029) and depression (34(24.9%) vs. 12(6.5%),p < 0.001). Adjusting for diabetes complications, neuropathy was associated with higher PAID (adjusted RR 1.44(95% CI 1.14–1.82),p = 0.003) and GDS scores (adjusted RR1.57 (1.18–2.11),p = 0.002). Independent of potential confounders, neuropathy remained associated with higher PAID (adjusted RR 1.39(1.10–1.76),p = 0.006) and GDS scores (adjusted RR 1.37(1.03–1.83),p = 0.032). Associations with neuropathy were not fully explained by neuropathic pain. Conclusion Compared to other complications, neuropathy had the greatest association with distress and depression in longstanding T1DM, independent of pain. Strategies beyond pain management are needed to improve quality of life in diabetic neuropathy.