Diabetes distress, depressive, and anxiety symptoms in people with type 2 diabetes: a network analysis approach to understanding comorbidity

Objective This study aimed to explore interactions between diabetes distress, depressive, and anxiety symptoms in a cohort of adults with type 2 diabetes using network analysis. Research design and methods Participants (N = 1,796) were from the Evaluation of Diabetes Insulin Treatment (EDIT) study from Quebec, Canada. A network of diabetes distress symptoms was estimated using the 17 items of the Diabetes Distress Scale (DDS-17). A second network was estimated using the 17 items of the DDS-17, the 9 depressive items of the Patient Health Questionnaire (PHQ-9), and the 7 anxiety items of the Generalized Anxiety Disorder Assessment (GAD-7). Network analysis was used to identify central symptoms, clusters of symptoms, and symptoms that may bridge between diabetes distress, depressive, and anxiety symptoms. Results Regimen-related and physician-related diabetes distress symptoms were amongst the most influential (most positive connections to others) in the diabetes distress network. Feeling like a failure (depression) was identified as a potential bridge between depression and diabetes distress, being highly connected to symptoms of diabetes distress. The anxiety symptoms of worrying too much and being unable to stop worrying were found to be bridge symptoms between both anxiety and depression symptoms, and anxiety and diabetes distress symptoms, respectively. Conclusions These findings suggest individual symptoms that might be influential to the development and maintenance of diabetes distress and mental health comorbidity in diabetes and warrant further investigation. Study limitations and potential for clinical applicability are discussed

Subunit a of cytochrome o oxidase requires both YidC and SecYEG for membrane insertion

The Escherichia coli YidC protein belongs to the Oxa1 family of membrane proteins that facilitate the insertion of membrane proteins. Depletion of YidC in E. coli leads to a specific defect in the functional assembly of major energy transducing complexes such as the F1F0 ATPase and cytochrome bo(3) oxidase. Here we report on the in vitro reconstitution of the membrane insertion of the CyoA subunit of cytochrome bo(3) oxidase. Efficient insertion of in vitro synthesized pre-CyoA into proteoliposomes requires YidC, SecYEG, and SecA and occurs independently of the proton motive force. These data demonstrate that pre-CyoA is a substrate of a novel pathway that involves both SecYEG and YidC.</p

Prediabetes and the risk of type 2 diabetes: investigating the roles of depressive and anxiety symptoms in the Lifelines Cohort Study

Background Depression and anxiety may increase the risk of progressing from prediabetes to type 2 diabetes. The present study examined the interactions between prediabetes status and elevated depressive and anxiety symptoms with the risk of type 2 diabetes. Methods Participants (N=72,428) were adults aged 40 years and above without diabetes at baseline from the Lifelines Cohort Study (58% female; mean age=51.4 years). The Mini-International Neuropsychiatric Interview screened for elevated symptoms of major depressive disorder and generalized anxiety disorder. Glycated hemoglobin A1c (HbA1c) levels determined prediabetes status at baseline (2007-2013), and HbA1c and self-reported diabetes diagnoses determined diabetes status at follow-up (2014-2017). Groups were formed for elevated depressive and anxiety symptoms, respectively, and prediabetes status at baseline (elevated depressive/anxiety symptoms with prediabetes, elevated depressive/anxiety symptoms alone, and prediabetes alone), and compared to a reference group (no prediabetes or anxiety/depression) on the likelihood of developing diabetes during the follow-up period. Findings N=1,300 (1.8%) participants developed diabetes. While prediabetes alone was associated with incident diabetes (OR=5.94; 95% CI=5.10-6.90, p<.001), the group with combined prediabetes and depressive symptoms had the highest likelihood of developing diabetes over follow-up (OR=8.29; 95% CI=5.58-12.32, p<.001). Similar results were found for prediabetes and anxiety symptoms (OR=6.57; 95% CI=4.62-9.33, p<.001), compared to prediabetes alone (OR=6.09; 95% CI=5.23-7.11, p<.001), though with a smaller effect. The interaction between depressive symptoms and prediabetes was synergistic in age-and-sex adjusted analyses. Conclusion Individuals with elevated depressive, and to some extent anxiety, symptoms in combination with prediabetes may represent a high-risk subgroup for type 2 diabetes

Measurement invariance testing of the patient health questionnaire-9 (PHQ-9) across people with and without diabetes mellitus from the NHANES, EHMS and UK Biobank datasets

Background: The prevalence of depression is higher among those with diabetes than in the general population. The Patient Health Questionnaire (PHQ-9) is commonly used to assess depression in people with diabetes, but measurement invariance of the PHQ-9 across groups of people with and without diabetes has not yet been investigated. Methods: Data from three independent cohorts from the USA (n=1,886 with diabetes, n=4,153 without diabetes), Quebec, Canada (n= 800 with diabetes, n= 2,411 without diabetes), and the UK (n=4,981 with diabetes, n=145,570 without diabetes), were used to examine measurement invariance between adults with and without diabetes. A series of multiple group confirmatory factor analyses were performed, with increasingly stringent model constraints applied to assess configural, equal thresholds, and equal thresholds and loadings invariance, respectively. One-factor and two-factor (somatic and cognitive-affective items) models were examined. Results: Results demonstrated that the most stringent models, testing equal loadings and thresholds, had satisfactory model fit in the three cohorts for one-factor models (RMSEA = .063 or below and CFI = .978 or above) and two-factor models (RMSEA = .042 or below and CFI = .989 or above). Limitations: Data were from Western countries only and we could not distinguish between type of diabetes. Conclusions: Results provide support for measurement invariance between groups of people with and without diabetes, using either a one-factor or a two-factor model. While the two-factor solution has a slightly better fit, the one-factor solution is more parsimonious. Depending on research or clinical needs, both factor structures can be used

A cross-sectional study of depressive symptoms and diabetes self-care in African Americans and Hispanics/Latinos with diabetes: the role of self-efficacy

Purpose The purpose of this study is to examine the relationship between depressive symptoms and diabetes self-care in African American and Hispanic/Latino patients with type 2 diabetes and whether the association, if any, is mediated by diabetes-related self-efficacy. Methods The sample included self-report baseline data of African American and Hispanic/Latino patients with type 2 diabetes who were aged ≥18 years and enrolled in a diabetes self-management intervention study. Depressive symptoms were assessed with the 9-item Patient Health Questionnaire. The Summary of Diabetes Self-care Activities measured engagement in healthy eating, physical activity, blood glucose checking, foot care, and smoking. The Diabetes Empowerment Scale–Short Form assessed diabetes-related psychosocial self-efficacy. Indirect effects were examined with the Baron and Kenny regression technique and Sobel testing. Results Sample characteristics (n = 250) were as follows: mean age of 53 years, 68% women, 54% African American, and 74% with income <$20 000. Depressive symptoms showed a significant inverse association with the self-care domains of general diet, specific diet, physical activity, and glucose monitoring in the African American group. In Hispanics/Latinos, depression was inversely associated with specific diet. Self-efficacy served a significant mediational role in the relation between depression and foot care among African Americans. Conclusions Self-efficacy mediated the relationship between depression and foot care in the African American group but was not found to be a mediator of any self-care areas within the Hispanic/Latino group. In clinical practice, alleviation of depressive symptoms may improve self-care behavior adherence. Diabetes education may consider inclusion of components to build self-efficacy related to diabetes self-care, especially among African American patients

Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: systematic review and meta-analysis

Objective To provide an estimate of the effect of interventions on comorbid depressive disorder (MDD) or subthreshold depression in type 1 and type 2 diabetes. Methods Systematic review and meta-analysis. We searched PubMed, Psychinfo, Embase and the Cochrane library for randomized controlled trials evaluating the outcome of depression treatments in diabetes and comorbid MDD or subthreshold symptoms published before August 2019 compared to Care As Usual (CAU), placebo, waiting list (WL), or active comparator treatment as in a comparative effectiveness trial (CET). Primary outcomes were depressive symptom severity and glycaemic control. Cohen’s d are reported. Results Forty-three randomised controlled trials (RCTs) were selected and 32 RCTs comprising 3543 patients were included in the meta-analysis. Our meta-analysis showed that, compared to CAU, placebo or WL, all interventions showed a significant effect on combined outcome 0,485 (95%CI 0,360;0,609). All interventions showed a significant effect on depression. Pharmacological treatment, group-therapy, psychotherapy and collaborative care had a significant effect on glycaemic control. High baseline depression score was associated with a greater reduction in HbA1c and depressive outcome. High baseline HbA1c was associated with a greater reduction in HbA1c. Conclusion All treatments are effective for comorbid depression in type 1 diabetes and type 2 diabetes. Over the last decade, new interventions with large effect sizes have been introduced, such as group-based therapy, online treatment and exercise. Although all interventions were effective for depression, not all treatments were effective for glycaemic control. Effective interventions in comorbid depressive disorder may not be as effective in comorbid subthreshold depression. Baseline depression and HbA1c scores modify the treatment effect. Based on the findings, we provide guidance for treatment depending on patient profile and desired outcome, and discuss possible avenues for further research

F1F0 ATP synthase subunit c is a substrate of the novel YidC pathway for membrane protein biogenesis

The Escherichia coli YidC protein belongs to the Oxa1 family of membrane proteins that have been suggested to facilitate the insertion and assembly of membrane proteins either in cooperation with the Sec translocase or as a separate entity. Recently, we have shown that depletion of YidC causes a specific defect in the functional assembly of F(1)F(0) ATP synthase and cytochrome o oxidase. We now demonstrate that the insertion of in vitro–synthesized F(1)F(0) ATP synthase subunit c (F(0)c) into inner membrane vesicles requires YidC. Insertion is independent of the proton motive force, and proteoliposomes containing only YidC catalyze the membrane insertion of F(0)c in its native transmembrane topology whereupon it assembles into large oligomers. Co-reconstituted SecYEG has no significant effect on the insertion efficiency. Remarkably, signal recognition particle and its membrane-bound receptor FtsY are not required for the membrane insertion of F(0)c. In conclusion, a novel membrane protein insertion pathway in E. coli is described in which YidC plays an exclusive role

An Experimental Investigation Into the Performance of a Flush Water-Jet Inlet

An experimental investigation of the flow within a generic flush type water-jet inlet has been carried out to identify the principal flow features and provide a basis for development of computational fluid dynamics (CFD) models. Tests were performed in a cavitation tunnel with the model inlet fitted to the test section ceiling, and effects of thickening the ingested tunnel wall boundary layer were investigated. The model was fitted with a range of instrumentation to investigate the ramp pressure distribution and boundary layer development, lip incidence, and pump face flow properties. Observations of lip and duct cavitation inception and behavior were also made. The results showed the inlet performance to be generally improved with the ingestion of a thicker boundary layer. The thickened boundary layer significantly reduced ramp boundary layer separation and distortion of flow at the notional pump face. However, a greater range of lip incidence occurred with the thickened boundary layer with consequent greater likelihood of lip separation and cavitation occurrence. Ideal lip incidence and pump face flow uniformity occurred at flow parameters significantly different from those for ideal pump face pressure recovery. Large developed cavities on the inlet lip were observed for a range of conditions typical of conventional high-speed vessel operation

Comment on Young-Hyman et al. Psychosocial care for people with diabetes: A position statement of the American Diabetes Association. Diabetes Care 2016;39:2126–2140

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