Type 2 Diabetes Mellitus and Alcoholic Liver Disease: a literature review

Introduction Alcoholic liver disease (ALD) and type 2 diabetes mellitus (T2DM) are two important chronic diseases in Australia, both of which are emerging epidemics. As a result, patients presenting with both conditions may become increasingly more common. However, not much is known about how each affects the other in terms of clinical outcomes.   Methods Evidence from studies exploring the relationship between T2DM and ALD, including those pertaining to liver function tests (LFT) and hepatocellular carcinoma (HCC), was reviewed and summarised.   Results There are studies which show that high alcohol intake and chronic liver disease (CLD) are risk factors of developing T2DM. Conversely, having impaired glucose tolerance has been shown to promote progression of CLD. There is also some evidence of increased risk of HCC in patients with T2DM and who consume alcohol in the context of other liver disease. However, no studies that looked into how T2DM directly affects LFT results in ALD were found.   Discussion There seems to be a bidirectional relationship between T2DM and ALD, although it is not explicitly cause-and-effect in nature. Hence, there is a need for a comprehensive management plan that utilises a multidisciplinary approach to minimise the risk of complications for patients with either or both diseases. Currently, this is not available and both diseases are treated as separate entities. Therefore, further research must be done to elucidate the relationship between the two, so that effective strategies to manage co-existing T2DM and ALD can be developed

Management of Depression for patients with type 2 diabetes mellitus in Australia

Background: The occurrence of type 2 diabetes mellitus (T2DM) co-morbidly with depression is extremely common, with diabetic patients having more than twice the risk of developing depression, and depression being a major risk factor for T2DM. In Australia, it is estimated that half of T2DM patients currently have depression, and this prevalence is much higher than the 6.2% seen in the general population (aged  6-85). Objective: To explore the relationship between T2DM and depression, investigate management options that may reduce the risk of depression, and ways to increase awareness about these non-communicable diseases. Methods: Data was examined from the 20   Diabetes-MILES study, a postal survey sent to  5,000 randomly selected adults from the National Diabetes Services Scheme database, with 3,338 respondents. It included questions regarding demographics, existing diabetic care, and the PHQ-9 questionnaire. From the dataset, we analysed the subset of respondents with T2DM (n= 962). Depression was defined as having a PHQ-9 score greater than 8. We examined factors impacting on the prevalence of depression in this population using both odds ratio methods and log odds models. Results: Respondents who reported lower rates of receiving necessary information or teaching about managing their issues from their diabetes care team were significantly more likely to suffer from depression (OR= .89 and  .58, respectively). Similarly, lower rates of inter-appointment contact from the diabetic care team for general follow-up were associated with higher rates of depression (OR= .76). Log odds models demonstrated strongly negative linear relationships between the frequency of depression and the rates of access to information and teaching. Conclusion: Improvements in provision of information, education and inter-appointment contact result in lower rates of depression in patients with T2DM.  This highlights the importance of access to diabetes education, information and inter-appointment contact to decrease rates of depression in T2DM patients