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Depression and anxiety symptoms in diabetic patients on continuous subcutaneous insulin infusion (CSII)

Molecular Psychiatry volume 10, pages 975–976 (2005)Cite this article

SIR—Diabetes mellitus is associated with depression, anxiety, tension, and current perceived stress.1, 2 In diabetics, symptoms of depression have been associated with increased complications. Reducing the level of psychological distress may help prevent the development of the metabolic syndrome in women.3 Several neuropeptides, neurotransmitters, metabolic products, and cytokines, including CRH, neuropeptide Y, serotonin, glucose, norepinephrine, TNFα, and IL-6 are involved in the regulation of mood, behavior, and metabolic function.4 Polymorphisms in the genes encoding factors involved in the regulation of glucose levels and energy homeostasis, such as glucagons-like peptide-1, glucocorticoid receptor, melanocortin receptor, uncoupling protein 2 and 3 (UCP2/UCP3) and β3 adrenergic receptor, are also thought to contribute to psychiatric disorders.1, 5

The secretory products of the pancreatic β cell have been identified not only as the major hormones regulating blood sugar, but also as potent neuropeptides influencing eating behavior and mood.6 Moreover, type of insulin and route of application strongly influence the perception of hypoglycemia and emotionality.7, 8 To investigate the association of psychological symptoms and intensively treated diabetes, we analyzed the psychological symptoms of depression and anxiety in patients receiving continuous insulin administration (CSII). In all, 52 type 1 diabetics (22 male, 30 female) at a mean age of 41.4 years and mean duration of diabetes mellitus of 20.9 years were enrolled in this study. Patients had been on insulin pumps for 3.8±0.89 years and reached a good level of glycemic control as documented by an HbA1c value of 7.16±0.89%. Anxiety and depression scores were analyzed using the Hospital Anxiety and Depression Score in its German version.9 Patients on CSII presented with marked symptoms of both depression and anxiety. We found severe anxiety symptoms in 25% of our patients compared to 6.8% in the healthy cohort, while mild symptoms were less frequent (13.0 vs 20.2%), and the number of patients without symptoms was lower in the diabetic group (61.5 vs 73%). Depression scores showed an even more pronounced difference. Severe symptoms were found in 19.2% of the diabetic patients vs 0.7% in the healthy cohort. Mild depression was seen in 7.7 vs 4.3%.

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References

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  2. Raikkonen K et al. Metabolism 2002; 51: 1573–1577.

  3. Bonnet F et al. J Hypertens 2005; 23: 611–617.

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  6. Sima AA, Li ZG . Diabetes 2005; 54: 1497–1505.

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Authors and Affiliations

  1. Department of Medicine, University of Dresden, Carl Gustav Carus, Dresden, Germany

    A Reichel, J Schwarz, J Schulze & S R Bornstein

  2. Center for Pharmacogenomics and Clinical Pharmacology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, CA, USA

    J Licinio

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  1. A Reichel
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  2. J Schwarz
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  3. J Schulze
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  4. J Licinio
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  5. M-L Wong
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  6. S R Bornstein
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Correspondence to S R Bornstein.

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Reichel, A., Schwarz, J., Schulze, J. et al. Depression and anxiety symptoms in diabetic patients on continuous subcutaneous insulin infusion (CSII). Mol Psychiatry 10, 975–976 (2005). https://doi.org/10.1038/sj.mp.4001726

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