How 25 years of psychosocial research has contributed to a better understanding of the links between depression and diabetes

This narrative review of the literature provides a summary and discussion of 25 years of research into the complex links between depression and diabetes. Systematic reviews have shown that depression occurs more frequently in people with type 1 or type 2 diabetes compared with people without diabetes. Currently, it remains unclear whether depression is also more common in people with impaired glucose metabolism or undiagnosed type 2 diabetes compared with people without diabetes. More prospective epidemiological research into the course of depression and an exploration of mechanisms in individuals with diabetes are needed.Depression in diabetes is associated with less optimal self-care behaviours, suboptimal glycaemic control, impaired quality of life, incident micro- and macrovascular diseases, and elevated mortality rates. Randomized controlled trails concluded that depression in diabetes can be treated with antidepressant medication, cognitive–behavioural therapy (individual, group-based or web-based), mindfulness-based cognitive therapy and stepped care. Although big strides forward have been made in the past 25 years, scientific evidence about depression in diabetes remains incomplete. Future studies should investigate mechanisms that link both conditions and test new diabetes-specific web- or app-based interventions for depression in diabetes. It is important to determine whether treatment or prevention of depression prevents future diabetes complications and lowers mortality rates

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

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

Self-Monitoring of Blood Pressure in Hypertension: A UK Primary Care Survey

This study aimed to determine the prevalence of Self-Monitoring Blood Pressure amongst people with hypertension using a cross-sectional survey. Of the 955 who replied (53%), 293 (31%) reported that they self-monitored blood pressure. Nearly 60% (198/331) self-monitored at least monthly. Diabetic patients monitoring their blood glucose were five times more likely than those not monitoring to monitor their blood pressure. Self-monitoring is less common in the UK than internationally, but is practiced by enough people to warrant greater integration into clinical practice

Population-specific use of the same tool-assisted alarm call between two wild orangutan populations (Pongopygmaeus wurmbii) indicates functional arbitrariness

This study was financially supported by Fundação para a Ciência e Tecnologia (SFRH/BD/44437/2008), Wenner-Gren Foundation for Anthropological Research, Dr. J.L. Dobberke voor Vergelijkende Psychologie, Lucie Burgers Foundation for Comparative Behaviour Research, Schure-Beijerinck-Popping Fonds, Ruggles-Gates Fund for Anthropological Scholarship of the Royal Anthropological Institute of Great Britain and Ireland, and Fundação Calouste Gulbenkian. KN and ET were financially supported by Pongo Foundation. Orangutan fieldwork at Cabang Panti was supported by grants to CDK from the 16 National Science Foundation (0936199), the National Geographic Society, the Leakey Foundation and the US Fish and Wildlife Service.Arbitrariness is an elementary feature of human language, yet seldom an object of comparative inquiry. While arbitrary signals for the same function are relatively frequent between animal populations across taxa, the same signal with arbitrary functions is rare and it remains unknown whether, in parallel with human speech, it may involve call production in animals. To investigate this question, we examined a particular orangutan alarm call - the kiss-squeak - and two variants - hand and leaf kiss-squeaks. In Tuanan (Central Kalimantan, Indonesia), the acoustic frequency of unaided kiss-squeaks is negatively related to body size. The modified variants are correlated with perceived threat and are hypothesized to increase the perceived body size of the sender, as the use of a hand or leaves lowers the kiss-squeak's acoustic frequency. We examined the use of these variants in the same context in another orangutan population of the same sub-species and with partially similar habitat at Cabang Panti (West Kalimantan, Indonesia). Identical analyses of data from this site provided similar results for unaided kiss-squeaks but dissimilar results for hand and leaf kiss-squeaks. Unaided kiss-squeaks at Cabang Panti were emitted as commonly and showed the same relationship to body size as in Tuanan. However, at Cabang Panti, hand kiss-squeaks were extremely rare, while leaf-use neither conveyed larger body size nor was related to perceived threat. These findings indicate functional discontinuity between the two sites and therefore imply functional arbitrariness of leaf kiss-squeaks. These results show for the first time the existence of animal signals involving call production with arbitrary function. Our findings are consistent with previous studies arguing that these orangutan call variants are socially learned and reconcile the role of gestures and calls within evolutionary theories based on common ancestry for speech and music.Publisher PDFPeer reviewe

The bidirectional longitudinal association between depressive symptoms and HbA 1c : a systematic review and meta‐analysis

Aim To investigate whether there is a bidirectional longitudinal association of depression with HbA1c. Methods We conducted a systematic literature search in PubMed, PsycINFO, CINAHL and EMBASE for observational, longitudinal studies published from January 2000 to September 2020, assessing the association between depression and HbA1c in adults. We assessed study quality with the Newcastle-Ottawa-Scale. Pooled effect estimates were reported as partial correlation coefficients (rp) or odds ratios (OR). Results We retrieved 1,642 studies; 26 studies were included in the systematic review and eleven in the meta-analysis. Most studies (16/26) focused on type 2 diabetes. Study quality was rated as good (n=19), fair (n=2) and poor (n=5). Of the meta-analysed studies, six investigated the longitudinal association between self-reported depressive symptoms and HbA1c and five the reverse longitudinal association, with a combined sample size of n=48,793 and a mean follow-up of 2 years. Higher levels of baseline depressive symptoms were associated with subsequent higher levels of HbA1c (partial r=0.07;[95%CI0.03,0.12]; I238%). Higher baseline HbA1c values were also associated with 18% increased risk of (probable) depression (OR=1.18;[95%CI1.12,1.25]; I20.0%). Conclusions Our findings support a bidirectional longitudinal association between depressive symptoms and HbA1c. However, the observed effect sizes were small and future research in large-scale longitudinal studies is needed to confirm this association. Future studies should investigate the role of type of diabetes and depression, diabetes distress and diabetes self-management behaviours. Our results may have clinical implications, as depressive symptoms and HbA1c levels could be targeted concurrently in the prevention and treatment of diabetes and depression

Exercise to preserve β-cell function in recent-onset Type 1 diabetes mellitus (EXTOD) - a randomized controlled pilot trial

AIM: Residual β-cell function is present at the time of diagnosis with Type 1 diabetes. Preserving this β-cell function reduces complications. We hypothesized that exercise preserves β-cell function in Type 1 diabetes and undertook a pilot trial to address the key uncertainties in designing a definitive trial to test this hypothesis. METHODS: A randomized controlled pilot trial in adults aged 16-60 years diagnosed with Type 1 diabetes within the previous 3 months was undertaken. Participants were assigned to control (usual care) or intervention (exercise consultation every month), in a 1 : 1 ratio for 12 months. The primary outcomes were recruitment rate, drop out, exercise adherence [weeks with ≥ 150 min of self-reported moderate to vigorous physical activity (MVPA)], and exercise uptake in the control group. The secondary outcomes were differences in insulin sensitivity and rate of loss of β-cell function between intervention and control at 6 and 12 months. RESULTS: Of 507 individuals who were approached, 58 (28 control, 30 intervention) entered the study and 41 completed it. Participants were largely white European males, BMI 24.8 ± 3.8 kg/m2 , HbA1c 75 ± 25 mmol/mol (9 ± 2%). Mean level of objectively measured MVPA increased in the intervention group (mean 243 to 273 min/week) and 61% of intervention participants reached the target of ≥ 150 min/week of self-reported MVPA on at least 42 weeks of the year. Physical activity levels fell slightly in the control group (mean 277 to 235 min of MVPA/week). There was exploratory evidence that intervention group became more insulin sensitive and required less insulin. However, the rate of loss of β-cell function appeared similar between the groups, although the change in insulin sensitivity may have affected this. CONCLUSION: We show that it is possible to recruit and randomize people with newly diagnosed Type 1 diabetes to a trial of an exercise intervention, and increase and maintain their exercise levels for 12 months. Future trials need to incorporate measures of greater adherence to exercise training targets, and include more appropriate measures of β-cell function

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

The comparative and degree pluralities

Quantifiers in phrasal and clausal comparatives often seem to take distributive scope in the matrix clause: for instance, the sentence John is taller than every girl is is true iff for every girl it holds that John is taller than that girl. Broadly speaking, two approaches exist that derive this reading without postulating the (problematic) wide scope of the quantifier: the negation analysis and the interval analysis of than-clauses. We propose a modification of the interval analysis in which than-clauses are not treated as degree intervals but as degree pluralities. This small change has significant consequences: it yields a straightforward account of differentials in comparatives and it correctly predicts the existence of hitherto unnoticed readings, viz. cumulative readings of clausal comparatives. Finally, this paper also makes the case that using degree pluralities is conceptually appealing: it allows us to restrict the analysis of comparatives by mechanisms that are postulated independently in the semantics of pluralities