To explore the potential association, the team included data from 553,552 subjects extracted from a national healthcare claims database (included 44,735 patients with T1D, 152,187 with T2D, and 356,630 without diabetes). Using the Cox proportional hazards model, they determined that having CDCs increased the risk of developing MHD (hazard ratio, 1.9-2.9; P <.05), with higher hazard ratios observed in the older age range. For those aged younger than 60 years, subjects with T1D were more likely to have CDCs, and those with T2D had a greater incidence of MHDs.
According to senior authors Brian Callaghan, MD, MS, and Eva L. Feldman, MD, PhD, professor of neurology at University of Michigan (U-M) Medical School, “We wanted to see if chronic diabetes complications led to mental health disorders or if mental health disorders led to those diabetes complications—but we found that both relationships are true.”
“The findings highlight a need for clinicians to actively screen for mental health disorders in patients with diabetes in addition to screening for chronic complications, which is the recommended standard of care in diabetes. For instance, a stroke causes detrimental effects on the brain, which may directly lead to depression,” Dr. Callaghan said.
First author Maya Watanabe, MS, described why she felt their research contributed greater understanding. “Most likely, a combination of direct and indirect effects and shared risk factors drive the association we are seeing,” she said, adding, “Diabetes care providers may be able to simultaneously prevent the risk of multiple complications by providing interventions to treat these shared risk factors.” Dr. Watanable is also a biostatistician at the Harvard T.H. Chan School of Public Health and former graduate student research assistant at U-M.
According to Dr. Feldman, who is also the director of the ALS Center of Excellence at Michigan Medicine, “These systems should include mental health screening, easily accessible insurance coverage for mental health services and both physician and patient education programs. Action is needed, and our new research provides further evidence that this action needs to occur now.”
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