Depression ups risk of death in type 2 diabetes

Among patients with type 2 diabetes mellitus (T2DM), those with depression are at increased risk of death, as reported in a study.

The study followed 3,923 individuals with T2DM. A diagnosis of depression was established by a physician, according to the MINI 5.0.0 questionnaire, or following at least 2 months of antidepressant therapy.

At baseline, 867 patients (22.1 percent) had depression. They were more likely to be older and female, less likely to be married, had a longer duration of T2DM, had a higher proportion of never-smokers, and were less likely to be physically active. Additionally, most of them had a history of cardiovascular events, renal failure, and neuropathy as compared with patients without depression.

Over a median follow-up of 8.1 years, 1,104 patients died (28.0 percent), yielding an overall mortality rate of 430.3 per 10,000 patient-years. Significantly more deaths occurred among patients with vs without depression (31.9 percent vs 26.9 percent; p=0.003). Depression was associated with a significantly poorer survival (median, 7.4 vs 7.8 years; p<0.001).

Cox proportional hazard analysis confirmed that depression conferred an increased risk of mortality (hazard ratio [HR], 1.40, 95 percent confidence interval [CI], 1.20–1.65; p<0.001). Other predictive factors included age >75 years (HR, 6.04, 95 percent CI, 4.62–7.91; p<0.001), insulin use (HR, 2.37, 95 percent CI, 1.86–3.00; p<0.001), lower limb amputation (HR, 1.99, 95 percent CI, 1.28–3.11; p=0.002), heart failure (HR, 1.94, 95 percent CI, 1.63–2.30; p<0.001), and male gender (HR, 1.90, 95 percent CI, 1.59–2.27).

The findings highlight the need for more efforts to minimize the influence of depression on mortality in people with T2DM and to implement measures that allow its early diagnosis and effective treatment.