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Several studies observed higher rates of depression in patients with diabetes and tried to demonstrate the association between the presence of depressive symptoms and an increased prevalence of clinical complications of the DM. Anderson et al. conducted a meta-analysis of 42 studies investigating the association between depression and diabetes . The authors found that the presence of diabetes doubles the odds of having depression. This risk remained even after controlling for both types of diabetes or different diagnostic methods for depression across studies.
O’Connor et al. followed a retrospective cohort of patients with diabetes to investigate the prevalence of depression . The authors observed an increase prevalence of depression in patients with diabetes compared to a non-diabetic sex- and age-matched control group.Furthermore, several authors found an association between depression and a poor metabolic control of Type 2 Diabetes.
In a meta-analytic review of the literature, Lustman et al. investigated the association between depression and diabetes glycemic control . The authors observed that depression was significantly associated with hyperglycemia in patients with type 1 and type 2 diabetes (z = 5.4; p < 0.0001). In the same line, de Groot et al., conducted a meta-analysis examining the association between depression and diabetes outcomes .
Twenty-seven studies were included and the authors found a significant association between depression and clinical complications of diabetes (p < 0.00001; z = 5.94). Despite of individual, family and social stress that elevate eating disorders there are some other factors for people with diabetes. The diabetes patients needs to focus on food, fundamental in controlling the disease, places diabetic patients at increased risk of developing Eating Disorders (ED). Frequently a ED will be manifested only as a change in the eating pattern of diabetic patients .
Reports present in the literature are largely in agreement over the high rates of EDs, reporting generally higher rates of EDs in diabetic patients compared to the general population [9, 10, 11, 12, 13, 14]. Within the range of specific EDs in insulin-treated diabetic patients, insulin manipulation is of particular interest. The restriction or omission of insulin to control body weight is considered a form of purging available solely to diabetic patients, compromises control of the metabolism.
Some of the more commonly observed alarm signals, which may point to the presence of insulin manipulation, include: persistently high glycosylated hemoglobin levels. In view of the relevance of EDs in diabetic subjects and the associated health risks, the need for further in-depth studies to be conducted on an extended clinical sample of diabetic patients, both children and adults, with both type 1 and type 2 diabetes using specific questionnaires of demonstrated validity and reliability, should be underlined.
Taking into account the high prevalence and implications of comorbidity between diabetes and EDs, and the singular means of manifestation of EDs in diabetic subjects, the availability of specific screening tools of proven validity is crucial in facilitating the development of timely and effective multidisciplinary interventions aimed at minimizing the short and long-term risk of complications.
Elevated rates of depression have consistently been associated with diabetes (15), indicating depression is twice in people with diabetes than people without diabetes (16). It has been proposed that depressive symptoms may be a risk factor for the development of diabetes (17). Comorbid depressive symptoms or depression among persons with diabetes have been associated with adaptation to the illness (18), diabetic-related complications (15), unemployment (19), and illness intrusiveness, a construct defined as the degree to which diabetes disrupts valued activities and interests (20).
As is true in the general population, depression was more prevalent among women than among men with diabetes (16,21) and among younger adults (21). Depressive symptoms are more likely to persist among persons with multiple diabetic-related complications and those with less than a high school education (15). In a prospective community-based study, baseline depressive symptoms were positively associated with fasting insulin levels and physical inactivity (22).
A diagnosis of diabetes and self-reported depression were positively associated with sedentariness in both bivariate and multivariate analyses (23). Compared with their nondepressed peers, patients with diabetes who were diagnosed with depression were more likely to report frequent overeating of sweets and high-fat foods and were less satisfied with their ability to adhere to a diabetic diet away from home (24).
Despite the availability of measures to screen for depression, it is estimated that less than 25% of those with depression are diagnosed and treated (25). This is particularly disconcerting because the treatment of depression appears to be associated with improved glycemic control (26). Furthermore, because depression is associated with diabetic complications (27), the diabetes related issues can also be reduces through treatment of depression.
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