A1C Variability Predicts Seniors' Depression in Diabetes Care Study

The study highlights the importance of Medicare's plan to launch the Diabetes Prevention Program in early 2018.

Another study connecting diabetes and depression has appeared in Diabetes Care, the journal of the American Diabetes Association.

This study from Israel, published Tuesday, involves seniors and shows the importance of Medicare’s efforts to launch the Diabetes Prevention Program starting in 2018. With diabetes already accounting for $1 of every $3 spent on the federal healthcare program, officials are concerned about the mounting evidence of diabetes’ links to depression and cognitive decline as the baby boomers age.

Researchers led by Ramit Ravona-Springer, MD, of the Joseph Sagol Neuroscience Center, Sheba Medical Center in Ramat Gan, Israel, studied 837 participants, whose average age was 72.74 years, and who had been in a diabetes registry for an average of 8.7 years. Symptoms of depression were measured with a 15-item questionnaire, the Geriatric Depression Scale.

Ten percent of the participants had a score on the depression scale low enough to signify clinically significant depression. Researchers examined both the mean glycated hemoglobin (A1C) and A1C variability, which was the standard deviation in a series of A1C scores.

While the mean A1C was not associated with the number of depressive symptoms, the standard deviation of A1C was. In fact, for each additional 1% increase in the standard deviation of A1C, the number of depressive symptoms rose by a factor of 1.31 (incidence rate ratio = 1.31 [95% confidence interval, 1.03-1.67]; P = 0.03).

Cognitive decline is known to be associated with type 2 diabetes (T2D), but only recently have researchers focused on the fact that symptoms can emerge quite early, making early treatment for T2D important. Letting clinical inertia creep into care has consequences beyond physical health, as a 2015 article in Diabetes Care noted. A history of smoking and macrovascular disease were significant risk factors.

“Type 2 diabetes typically develops insidiously and may often be undiagnosed in the early stages,” the authors of the 2015 article wrote. “Therefore, cognitive decrements may start to develop years before the actual diagnosis, even in the prediabetes stages.”

Reference

Ravona-Springer R, Heymann A, Schmeidler J, et al. Hemoglobin A1C variability predicts symptoms of depression in elderly individuals with type 2 diabetes [published online June 20, 2017]. Diabetes Care. 2017; https://doi.org/10.2337/dc16-2754.