Depressive symptoms and cerebral microvascular disease in adults with Type 1 diabetes mellitus

K. A. Nunley; J. F. Karp; T. J. Orchard; T. Costacou; H. J. Aizenstein; J. R. Jennings; C. Rosano

doi:10.1111/dme.13879

Depressive symptoms and cerebral microvascular disease in adults with Type 1 diabetes mellitus

K. A. Nunley, J. F. Karp, T. J. Orchard, T. Costacou, H. J. Aizenstein, J. R. Jennings, C. Rosano

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5 Scopus citations

Abstract

Aim: To assess the prevalence of, and risk factors for, depressive symptoms, comparing a sample of middle-aged adults with and without juvenile-onset Type 1 diabetes mellitus, and to determine if depressive symptoms were associated with white matter hyperintensity volume among those with Type 1 diabetes. Methods: Depressive symptoms and white matter hyperintensities were compared between adults (age range 30–65 years) with juvenile-onset Type 1 diabetes (n=130) and adults without Type 1 diabetes (n=133). The association of Type 1 diabetes with depression was computed before and after adjustment for white matter hyperintensities. Among the Type 1 diabetes group, the primary associations of interest were between depressive symptoms (Beck Depression Inventory score ≥10) and white matter hyperintensities (n=71), hyperglycaemia and physical activity. Associations between depressive symptoms and diabetes-related complications, cognitive impairment, smoking and self-reported disability were examined. Analyses were controlled for education, sex, age and antidepressant use. Results: Depressive symptoms were more prevalent among those with vs those without Type 1 diabetes (28% vs 3%; P<0.001). White matter hyperintensities explained 40% of the association of Type 1 diabetes with depressive symptoms, while Type 1 diabetes had a direct effect of 68% on depressive symptoms. Among those with Type 1 diabetes, depressive symptoms were related to white matter hyperintensity volume, a 16-year average HbA_1c ≥58 mmol/mol (7.5%), and lower physical activity levels. Associations with other characteristics were not significant. Conclusion: These findings suggest a cerebrovascular origin for depressive symptoms in adults with Type 1 diabetes, perhaps triggered by hyperglycaemia. Future longitudinal studies should investigate whether targeting hyperglycaemia and physical inactivity alleviates depressive symptoms, possibly by slowing the development of cerebral microvascular disease, in people with Type 1 diabetes.

Original language	English (US)
Pages (from-to)	1168-1175
Number of pages	8
Journal	Diabetic Medicine
Volume	36
Issue number	9
DOIs	https://doi.org/10.1111/dme.13879
State	Published - 2019
Externally published	Yes

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Endocrinology

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10.1111/dme.13879

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@article{2ab832dea2274327bf1d7152b067be92,

title = "Depressive symptoms and cerebral microvascular disease in adults with Type 1 diabetes mellitus",

abstract = "Aim: To assess the prevalence of, and risk factors for, depressive symptoms, comparing a sample of middle-aged adults with and without juvenile-onset Type 1 diabetes mellitus, and to determine if depressive symptoms were associated with white matter hyperintensity volume among those with Type 1 diabetes. Methods: Depressive symptoms and white matter hyperintensities were compared between adults (age range 30–65 years) with juvenile-onset Type 1 diabetes (n=130) and adults without Type 1 diabetes (n=133). The association of Type 1 diabetes with depression was computed before and after adjustment for white matter hyperintensities. Among the Type 1 diabetes group, the primary associations of interest were between depressive symptoms (Beck Depression Inventory score ≥10) and white matter hyperintensities (n=71), hyperglycaemia and physical activity. Associations between depressive symptoms and diabetes-related complications, cognitive impairment, smoking and self-reported disability were examined. Analyses were controlled for education, sex, age and antidepressant use. Results: Depressive symptoms were more prevalent among those with vs those without Type 1 diabetes (28% vs 3%; P<0.001). White matter hyperintensities explained 40% of the association of Type 1 diabetes with depressive symptoms, while Type 1 diabetes had a direct effect of 68% on depressive symptoms. Among those with Type 1 diabetes, depressive symptoms were related to white matter hyperintensity volume, a 16-year average HbA1c ≥58 mmol/mol (7.5%), and lower physical activity levels. Associations with other characteristics were not significant. Conclusion: These findings suggest a cerebrovascular origin for depressive symptoms in adults with Type 1 diabetes, perhaps triggered by hyperglycaemia. Future longitudinal studies should investigate whether targeting hyperglycaemia and physical inactivity alleviates depressive symptoms, possibly by slowing the development of cerebral microvascular disease, in people with Type 1 diabetes.",

author = "Nunley, {K. A.} and Karp, {J. F.} and Orchard, {T. J.} and T. Costacou and Aizenstein, {H. J.} and Jennings, {J. R.} and C. Rosano",

note = "Funding Information: We would like to thank Andrea Metti, PhD, from the University of Pittsburgh, for her help in analysing and presenting these data. We also thank the individuals with Type 1 diabetes from Pittsburgh's Epidemiology of Diabetes Complications Study for their continued participation in the study. Funding Information: All funding was from National Institutes of Health (NIH). C.R. is principal investigator of the neuroimaging study of the Type 1 diabetes cohort (NIH grant: R01 DK089028). T.J.O. is principal investigator of the ongoing parent study of participants with Type 1 diabetes (NIH grant: R37 DK034818). J.R.J. is principal investigator providing data for the cohort without Type 1 diabetes (NIH grant RO1 HL101959-05). The funding source had no role in the design and conduct of the study; in data collection, management, analysis, or interpretation; review or approval of manuscript, or decision of submit manuscript for publication. Publisher Copyright: {\textcopyright} 2018 Diabetes UK",

year = "2019",

doi = "10.1111/dme.13879",

language = "English (US)",

volume = "36",

pages = "1168--1175",

journal = "Diabetic Medicine",

issn = "0742-3071",

publisher = "Wiley-Blackwell",

number = "9",

}

TY - JOUR

T1 - Depressive symptoms and cerebral microvascular disease in adults with Type 1 diabetes mellitus

AU - Nunley, K. A.

AU - Karp, J. F.

AU - Orchard, T. J.

AU - Costacou, T.

AU - Aizenstein, H. J.

AU - Jennings, J. R.

AU - Rosano, C.

N1 - Funding Information: We would like to thank Andrea Metti, PhD, from the University of Pittsburgh, for her help in analysing and presenting these data. We also thank the individuals with Type 1 diabetes from Pittsburgh's Epidemiology of Diabetes Complications Study for their continued participation in the study. Funding Information: All funding was from National Institutes of Health (NIH). C.R. is principal investigator of the neuroimaging study of the Type 1 diabetes cohort (NIH grant: R01 DK089028). T.J.O. is principal investigator of the ongoing parent study of participants with Type 1 diabetes (NIH grant: R37 DK034818). J.R.J. is principal investigator providing data for the cohort without Type 1 diabetes (NIH grant RO1 HL101959-05). The funding source had no role in the design and conduct of the study; in data collection, management, analysis, or interpretation; review or approval of manuscript, or decision of submit manuscript for publication. Publisher Copyright: © 2018 Diabetes UK

PY - 2019

Y1 - 2019

N2 - Aim: To assess the prevalence of, and risk factors for, depressive symptoms, comparing a sample of middle-aged adults with and without juvenile-onset Type 1 diabetes mellitus, and to determine if depressive symptoms were associated with white matter hyperintensity volume among those with Type 1 diabetes. Methods: Depressive symptoms and white matter hyperintensities were compared between adults (age range 30–65 years) with juvenile-onset Type 1 diabetes (n=130) and adults without Type 1 diabetes (n=133). The association of Type 1 diabetes with depression was computed before and after adjustment for white matter hyperintensities. Among the Type 1 diabetes group, the primary associations of interest were between depressive symptoms (Beck Depression Inventory score ≥10) and white matter hyperintensities (n=71), hyperglycaemia and physical activity. Associations between depressive symptoms and diabetes-related complications, cognitive impairment, smoking and self-reported disability were examined. Analyses were controlled for education, sex, age and antidepressant use. Results: Depressive symptoms were more prevalent among those with vs those without Type 1 diabetes (28% vs 3%; P<0.001). White matter hyperintensities explained 40% of the association of Type 1 diabetes with depressive symptoms, while Type 1 diabetes had a direct effect of 68% on depressive symptoms. Among those with Type 1 diabetes, depressive symptoms were related to white matter hyperintensity volume, a 16-year average HbA1c ≥58 mmol/mol (7.5%), and lower physical activity levels. Associations with other characteristics were not significant. Conclusion: These findings suggest a cerebrovascular origin for depressive symptoms in adults with Type 1 diabetes, perhaps triggered by hyperglycaemia. Future longitudinal studies should investigate whether targeting hyperglycaemia and physical inactivity alleviates depressive symptoms, possibly by slowing the development of cerebral microvascular disease, in people with Type 1 diabetes.

AB - Aim: To assess the prevalence of, and risk factors for, depressive symptoms, comparing a sample of middle-aged adults with and without juvenile-onset Type 1 diabetes mellitus, and to determine if depressive symptoms were associated with white matter hyperintensity volume among those with Type 1 diabetes. Methods: Depressive symptoms and white matter hyperintensities were compared between adults (age range 30–65 years) with juvenile-onset Type 1 diabetes (n=130) and adults without Type 1 diabetes (n=133). The association of Type 1 diabetes with depression was computed before and after adjustment for white matter hyperintensities. Among the Type 1 diabetes group, the primary associations of interest were between depressive symptoms (Beck Depression Inventory score ≥10) and white matter hyperintensities (n=71), hyperglycaemia and physical activity. Associations between depressive symptoms and diabetes-related complications, cognitive impairment, smoking and self-reported disability were examined. Analyses were controlled for education, sex, age and antidepressant use. Results: Depressive symptoms were more prevalent among those with vs those without Type 1 diabetes (28% vs 3%; P<0.001). White matter hyperintensities explained 40% of the association of Type 1 diabetes with depressive symptoms, while Type 1 diabetes had a direct effect of 68% on depressive symptoms. Among those with Type 1 diabetes, depressive symptoms were related to white matter hyperintensity volume, a 16-year average HbA1c ≥58 mmol/mol (7.5%), and lower physical activity levels. Associations with other characteristics were not significant. Conclusion: These findings suggest a cerebrovascular origin for depressive symptoms in adults with Type 1 diabetes, perhaps triggered by hyperglycaemia. Future longitudinal studies should investigate whether targeting hyperglycaemia and physical inactivity alleviates depressive symptoms, possibly by slowing the development of cerebral microvascular disease, in people with Type 1 diabetes.

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JO - Diabetic Medicine

JF - Diabetic Medicine

IS - 9

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Depressive symptoms and cerebral microvascular disease in adults with Type 1 diabetes mellitus

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