A study within the PREDIMED-Plus project supports the association between the presence of type 2 diabetes and the severity of depressive symptoms in older adults with obesity and metabolic syndrome. This work also suggests a worse metabolic control from mild levels of depressive symptomatology presented in the short-medium term, influenced by body mass index and lifestyle habits related to diabetes care. The results have been published in the Journal of Endocrinological Investigation.
“Type 2 diabetes and affective problems are highly comorbid, with shared underlying factors and a mutual influence on their clinical course and treatment, including adherence to diet and physical activity or the control of diabetes-related complications” explain Isabel Baenas and Lucía Camacho-Barcia, researchers at IDIBELL, Bellvitge University Hospital and CIBEROBN who have led the research. “This leads to an increase in morbidity and mortality and a reduction in the quality of life of these individuals, which is especially important for middle-aged and older adults, who are a vulnerable group due to the frequent coexistence of metabolic and affective disorders” add the researchers.
The work has been coordinated by the group led by Dr. Susana Jiménez-Murcia and Dr. Fernando Fernández-Aranda, from the University Hospital of Bellvitge and IDIBELL, and has involved the participation of all CIBEROBN groups participating in PREDIMED-Plus. The study has analysed more than 6,000 participants to investigate the cross-sectional relationship between depressive symptomatology and the presence of type 2 diabetes, in addition to exploring its association with metabolic control through glycosylated haemoglobin, which measures blood glucose, and other metabolic variables. Likewise, the prospective relationship between depressive symptoms and glycosylated haemoglobin levels in the blood was examined after one year of follow-up. “We evaluated the predictive capacity of baseline depressive symptoms on glycosylated haemoglobin at one-year follow-up, and the possible mediating role of different characteristics such as duration of diabetes, physical activity, adherence to the Mediterranean diet and body mass index” explains Dr Fernández-Aranda, also Professor at the University of Barcelona and coordinator of the Eating Disorders Unit at Bellvitge University Hospital.
An integrative therapeutic approach for patients with type 2 diabetes
The study is part of the PREDIMED-Plus project, whose sample is composed of older adults with overweight/obesity and metabolic syndrome who adopted a multimodal strategy based on Mediterranean diet and calorie restriction, accompanied by the promotion of leisure-time physical activity and psychosocial support.
“We observed that the presence of type 2 diabetes increased the likelihood of higher levels of depressive symptoms, and in turn, the higher the levels of depressive symptoms, the higher the prevalence of type 2 diabetes” say Dr Baenas and Dr Camacho-Barcia.
Analyses conducted in the study showed that the greater the severity of depressive symptoms at baseline, the greater the likelihood of obtaining glycosylated haemoglobin levels at annual follow-up which reflected poorer metabolic control. The researchers add that “greater severity of depressive symptoms at baseline and duration of diabetes predicted higher levels of glycosylated haemoglobin, higher body mass index, lower energy expenditure in leisure-time physical activity and a lower likelihood of adherence to the Mediterranean diet at the one-year follow-up”.
The results highlight the need to ensure screening for depressive symptoms as well as an integrative and multidisciplinary therapeutic approach in patients with type 2 diabetes, that takes into account both metabolic control and depressive symptoms in this population, as symptomatic improvement of one will influence the other.
The Bellvitge Biomedical Research Institute (IDIBELL) is a biomedical research center created in 2004. It is participated by the Bellvitge University Hospital and the Viladecans Hospital of the Catalan Institute of Health, the Catalan Institute of Oncology, the University of Barcelona and the City Council of L’Hospitalet de Llobregat.
IDIBELL is a member of the Campus of International Excellence of the University of Barcelona HUBc and is part of the CERCA institution of the Generalitat de Catalunya. In 2009 it became one of the first five Spanish research centers accredited as a health research institute by the Carlos III Health Institute. In addition, it is part of the “HR Excellence in Research” program of the European Union and is a member of EATRIS and REGIC. Since 2018, IDIBELL has been an Accredited Center of the AECC Scientific Foundation (FCAECC).