Glucose-lowering therapies, adequacy of metabolic control, and their relationship with comorbid depression in outpatients with type 2 diabetes in a tertiary hospital in Kenya
Authors Otieno CFF, Kanu JE, Karari EM, Okech-Helu V, Joshi MD, Mutai K
Received 12 October 2016
Accepted for publication 14 March 2017
Published 28 April 2017 Volume 2017:10 Pages 141—149
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Professor Ming-Hui Zou
CF Frederick Otieno,1 Joseph E Kanu,1 Emma M Karari,1 Violet Okech-Helu,2 Mark D Joshi,1 Kenn Mutai2
1Department of Clinical Medicine and Therapeutics, University of Nairobi, 2Kenyatta National Hospital, Nairobi, Kenya
Background: Depression and diabetes mellitus are important comorbid conditions with serious health consequences. When depression and diabetes are comorbid, depression negatively affects self-management activities of diabetes with serious consequences. Relationship between treatment regimens of diabetes, the adequacy of glycemic control, and occurrence of comorbid depression is not known among our patients.
Patients and methods: This was a cross-sectional descriptive study at the outpatient diabetes clinic of the Kenyatta National Hospital where 220 ambulatory patients with type 2 diabetes on follow-up were systematically sampled. Sociodemographic data and clinical information were documented. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression. Ethylenediaminetetraacetic acid-anticoagulated blood was used for glycated hemoglobin (HbA1C) assay on automated system, COBAS INTEGRA machine.
Results: Two hundred twenty patients with type 2 diabetes were enrolled. The prevalence of comorbid depression by PHQ-9 was 32.3% (95% confidence interval: 26.4%–38.6%). The majority, 69.5%, had poor glycemic control, HbA1C >7.0%, mean HbA1C was 8.9%±2.4%. Half, 50.4%, of the study subjects were on insulin-containing regimens. Over 8% (84.5%) of the participants with comorbid depression had poor glycemic control, which worsened with increasing severity of depression. There was significant correlation between comorbid depression and poor glycemic control, which is more consistent in the insulin-treated patients. However, patients on oral agents only, both with and without comorbid depression, were similar in their glycemic control.
Conclusion: Among our type 2 diabetic population with comorbid depression, a large proportion had poor glycemic control, which worsened with increasing severity of depression. The insulin treatment increased the odds of comorbid depression and poor glycemic control in patients. It is justifiable to screen for comorbid depression in patients with type 2 diabetes who are in poor glycemic control, especially the insulin-treated, and then provide specific and appropriate interventions that are necessary to optimize their metabolic outcomes.
Keywords: type 2 diabetes, comorbid depression, insulin therapy and poor glycemic control
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]