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Old 01-04-2008, 08:54 PM
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Default Depression More Deadly for Diabetics




Treating some diabetic patients for depression may help prolong their lives, according to new research.
Investigators at the University of Pennsylvania divided 600 older patients with depression, including 123 who also had diabetes, into two groups. One group received care from primary care doctors, including drug therapy, counseling or both. The other group received a more focused treatment coordinated by a depression case manager.
Five years later, 110 patients had died. The leading cause was heart attack; only one patient had committed suicide. Notably, the researchers found that treatment of depression did not influence death rates among the otherwise healthy patients. But death rates among the diabetic patients were affected: the group who had received care from case managers were half as likely to die as those who had received less intensive care, the researchers discovered. The report appears in the current issue of Diabetes Care.
Although previous studies have demonstrated a link between depression and diabetes, this research is the first to show that aggressive treatment of depression can prolong the lives of diabetic patients. Dr. Hillary Bogner, assistant professor of family medicine at the university and the study’s lead author, says that even though both groups were under the care of a primary care doctor, the depression case managers likely were instrumental in helping their patients remember to take medications and attend therapy, and in monitoring side effects and advising doctors on patients’ progress.
Other studies have linked depression and heart attack risk. Among the more than 93,000 women participating in the Women’s Health Initiative, depressed women were found to have a 50 percent greater risk of developing or dying from cardiovascular disease than women without signs of depression. Depression also has been associated with a greatly increased chance of dying in the months after a heart attack.
Nobody knows why depression seems to take such a toll on physical health. It may be that people who are depressed don’t take care of themselves, exercising less and eating poorly. Some researchers believe depression may increase stress hormones or affect the inflammatory process, raising the odds of cardiovascular problems.
In patients with diabetes, depression may cause even more harm by interfering with a patient’s self-care, which requires regular glucose monitoring, medications, dietary changes and exercise.
“We know that patients who are depressed and have diabetes do worse,'’ said Dr. Bogner. “More resources are needed in the primary care setting to treat depression.”
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