Recurrent hypoglycaemia tied to suicidal ideation in T2D patients with depression

Depression appears to be prevalent among type 2 diabetes (T2D) patients, especially among those who are younger, female, with lower socioeconomic status, and experiencing hypoglycaemic episodes, among others, according to data from the DEPDIAB study. Moreover, frequent episodes of hypoglycaemia heighten the risk of suicidal ideation among patients with depression.

DEPDIAB included 1,371 consecutive T2D patients (60.9 percent male) from Eastern India. All patients completed the 9-item Patient Health Questionnaire and Beck Depression Inventory questionnaires. Their socioeconomic status was evaluated using the Revised Kuppuswamy and B G Prasad socioeconomic scales for 2016, a validated scoring system for Indian patients.

A total of 56 patients (4.1 percent) met the criteria for major depression, and 494 (36.16 percent) for minor depression. There were no signs of depression detected in 816 patients (59.74 percent).

Depression in T2D showed strong associations with younger age (18–40 vs >60 years: odds ratio [OR], 2.09, 95 percent confidence interval [CI], 1.11–3.96), female sex (OR, 1.31, 95 percent CI, 1.11–2.01), low socioeconomic status (OR, 2.69, 95 percent CI, 1.34–3.79), poor treatment compliance (OR, 5.05, 95 percent CI, 2.79–8.13), hypoglycaemia (hazard ratio [HR], 1.466, 95 percent CI, 1.076–1.999), and difficulty managing day-to-day activities (HR, 4.648, 95 percent CI, 3.450–6.262).

Suicidal ideation was seen in 201 patients (14.8 percent). This was more common among patients who had repeated attacks of hypoglycaemia (>1 episode per month) than among those who had not experienced such episodes (22 percent vs 12 percent; p<0.0001).

Accordingly, patients with HbA1C ≤7 percent experienced significantly lesser suicidal ideation compared with those who had a higher HbA1C (12 percent vs 16.8 percent; p=0.016).

Suicidal ideation was not associated with body mass index, fasting plasma glucose, or insulin usage.