Impaired glucose regulation, depressive symptoms, and health-related quality of life

Abstract

Introduction: This study aims to investigate whether the associations between impaired glucose regulation and health-related quality of life are modified by severity or type of depressive symptoms.

Research design and methods: For this cross-sectional study, we included 1939 individuals (mean age 61.5 years) from the Helsinki Birth Cohort Study. Between 2001 and 2004, a standard 2-hour 75 g oral glucose tolerance test was applied to define normoglycemia, pre-diabetes, and newly diagnosed diabetes. Information on previously diagnosed diabetes was collected from national registers and questionnaires. Pre-diabetes was defined as having either impaired fasting glucose or impaired glucose tolerance. The Mental and Physical Component Scores of health-related quality of life were assessed with Short Form-36. Beck's Depression Inventory was employed to investigate the severity of depressive symptoms and to define minimal (depression score <10), non-melancholic, and melancholic types of depression. We analyzed data with general linear models adjusted for sex, age, lifestyle factors, comorbidities, and body mass index.

Results: Glucose regulation subgroups, especially previously known diabetes, were associated with lower Physical Component Score (p=0.001) and higher depression score (p=0.015), but not with the Mental Component Score (p=0.189). Non-melancholic depression was associated with lower Physical and Mental Component Scores compared with those with depression score <10 and melancholic depression (p<0.001), independently of glucose regulation status (p for glucose regulation status by depression type interaction >0.54).

Conclusions: Non-melancholic type of depression and previously known diabetes are independently associated with lower health-related quality of life. This should be appraised in long-term treatment of diabetes and when treating non-melancholic depressive symptoms to maintain a higher health-related quality of life.

Keywords: depression; diabetes mellitus; insulin resistance; quality of life; type 2.

Figure 1

Flow chart of the data screening process.

Figure 2

Adjusted differences of non-melancholic and melancholic depression types from the Beck’s Depression Inventory (BDI) <10 group in the Physical Component Score (PCS) and Mental Component Score (MCS) of health-related quality of life (HRQoL) among subgroups of glucose regulation. Analyses are adjusted for sex, age, smoking status, alcohol consumption, socioeconomic status, leisure-time physical activity, comorbidities, and body mass index. Error bars indicate 95% CIs.; ALL, all groups; NDD, newly diagnosed diabetes; NGT, normal glucose tolerance; PD, pre-diabetes; PKD, previously known diabetes.