Journal List > J Korean Diabetes > v.14(1) > 1054899

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Lee, Lee, Kwon, Ha, Kim, Noh, Kang, Park, Seok, Ahn, and Kim: Association Between Blood Sugar Level, Psychological Impact, and Emotional Symptoms in Patients Newly Diagnosed with Diabetes
Original Articles & Case Reports

J Korean Diabetes 2013;14(1):46-53.

Published online: 7 January 2013

DOI: https://doi.org/10.4093/jkd.2013.14.1.46

Association Between Blood Sugar Level, Psychological Impact, and Emotional Symptoms in Patients Newly Diagnosed with Diabetes

Young Mi Lee1, Hyung Jung Lee1, Eun Jin Kwon1, Ji Yoon Ha1, Min Kyung Kim1, Tae woong Noh1, Shinae Kang1, Jong Suk Park1, Jeong Ho Seok2, Chul Woo Ahn1, Kyung Rae Kim1

1Division of Endocrinology, Department of Internal Medicine, Endocrinology and Diabetes Center, Seoul, Korea

2Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

교신저자: 유주화, 서울시 종로구 대학로 101 서울대학교병원 내분비내과 병동, E-mail: ACW@yuhs.ac

석정호, 서울시 강남구 언주로 211 연세대학교 의과대학 강남세브란스병원 정신과학교실 E-mail: JOHNSTEIN@yuhs.ac

Copyright © 2013 Korean Diabetes Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

As the duration of diabetes mellitus (DM) increases, the risk of complications increases and the prevalence of depression becomes higher. Most studies on depression in Korean patients with DM have focused on a point 5-10 years after diagnosis, and there has not been much data reported regarding the early stages of DM, including newly developed DM. In this study, we examined whether blood glucose levels could be associated with emotional symptoms such as depression (DS) and anxiety (AS) in patients newly diagnosed with DM. Serum glucose and HbA1c were measured in 89 patients with DM. The Impact of Event Scale (IES) was used to investigate the extent of the psychological impact of a diagnosis of DM. The IES comprises four elements: hyperarousal, intrusiveness, avoidance, and sleep problems. DS and AS were investigated using the Hospital Anxiety and Depression Scales. DS was observed in 32 patients (36%) and AS was observed in 21 patients (23.6%), indicating a higher prevalence of DS and AS than in the general population. There was an inverse correlation between HbA1c and DS (Pearson's correlation coefficient: R = -0.227; P = 0.035), but no correlation was found for AS. The four elements of the IES had significant correlations with DS and AS. Logistic regression analysis showed that sleep problems (OR = 1.437) and HbA1c (OR = 0.51) were associated with DS, but only intrusiveness (OR = 0.629) showed a correlation with AS. In patients newly diagnosed with DM, DS is associated with sleep problems and low HbA1c levels. Emotional symptoms should be considered as part of glucose control, and efforts to mitigate psychological stress during the initial period of diabetes management should be made.

Keywords: Anxiety, Depression, Diabetes mellitus

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Table 1.
Baseline characteristics of the subjects
Variables   Mean or n (%)
Age   49.2 ± 10.6
  20–29 3 (3.4)
  30–39 12 (13.5)
  40–49 32 (36.0)
  50–59 24 (27.0)
  60–69 18 (20.2)
Sex    
  Male 64 (72)
  Female 25 (28)
FPG (mg/dL)   166.7 ± 54.9
HbA1c (%)   8.6 ± 2.1
BMI   25.6 ± 3.5
  15–20 2 (2.2)
  20–25 42 (47.2)
  25–30 37 (41.6)
  30–35 8 (9.0)
HADS-a   5.3 ± 3.1
HADS-d   6.1 ± 3.3
Hyperarousal   11.0 ± 9.5
voidance   11.0 ± 7.3
Intrusiveness   5.9 ± 5.3
Sleep problem   5.3 ± 4.7

FPG, fasting plasma glucose; HbA1c, hemoglobin A1c; BMI, body mass index; HADS-a, average scores for anxiety subscale of the Hospital Anxiety and Depression Scale; HADS-d, average scores depression subscale of the Hospital Anxiety and Depression Scale.

Table 2.
T-test comparisons between newly diagnosed diabetic patients who have HADS-d scores of less than 8 and more than or equal to 8
  HADS-d < 8 HADS-d ≥ 8 P value
No. Sex (M:F) 57 40 : 17 32 24 : 8 0.81
Age 47.1 ± 10.8 52.9 ± 9.2 0.01
BMI 25.3 ± 2.9 26.3 ± 4.5 0.33
HbA1c (%) 8.7 ± 2.8 7.8 ± 1.5 0.002
FPG (mg/dL) 158.3 ± 74.1 155.6 ± 48.9 0.853
Hyperarousal 8.1 ± 7.5 16.1 ± 10.6 0.001
Avoidance 9.3 ± 6.2 13.9 ± 8.3 0.009
Intrusion 4.7 ± 4.5 7.9 ± 5.8 0.004
Sleep problem 3.7 ± 3.7 8.1 ± 5.1 0.001

Values are presented as mean ± SD or number (%). FPG, fasting plasma glucose; HbA1c, hemoglobin A1c; BMI, body mass index; HADS-a, average scores for anxiety subscale of the Hospital Anxiety and Depression Scale; HADS-d, average scores depression subscale of the Hospital Anxiety and Depression Scale.

Table 3.
Odds ratio for the prediction of depression symptom in logistic regression model
  β Odds ratio 95% confidence interval P value
Age 0.063 1.065 0.977-1.160 0.152
BMI 0.236 1.266 0.901-1.779 0.175
HbA1c −0.677 0.508 0.264-0.977 0.042
Hyperarousal −0.211 0.81 0.571-1.148 0.237
Avoidance 0.132 1.141 0.822-1.585 0.431
Intrusion 0.146 1.158 0.899-1.491 0.257
Sleep problem 0.363 1.437 1.020-2.025 0.038

Adjusted for age, HbA1C, BMI, hyperarousal, avoidance, intrusion and sleep problem. BMI, body mass index; HbA1c, hemoglobin A1c.

Table 4.
T-test comparisons between newly diagnosed diabetic patients who have HADS-a scores of less than 8 and more than or equal to 8
  HADS-a < 8 HADS-a > 8 P value
No. 68 21  
Sex (M:F) 48:20 16:5 0.78
Age 47.4 ± 10.3 54.9 ± 9.7 0.005
BMI 25.2 ± 3.2 27.5 ± 4.5 0.052
HbA1c (%) 8.8 ± 2.1 7.8 ± 1.8 0.053
FPG (mg/dL) 157.3 ± 72.0 157.3 + 41.1 0.99
Hyperarousal 8.8 ± 8.0 18.2 ± 10.4 0.001
Avoidance 9.8 ± 6.7 14.8 ± 7.9 0.005
Intrusion 5.1 ± 4.5 8.3 ± 6.8 0.056
Sleep problem 4.3 ± 4.2 8.6 ± 4.8 0.001

Values are presented as mean ± SD. BMI, body mass index; HbA1c, hemoglobin A1c; FPG, fasting plasma glucose; HADS-a, average scores anxiety subscale of the Hospital Anxiety and Depression Scale.

Table 5.
Odds ratio for the prediction of anxiety symptom in logistic regression model
  β Odds ratio 95% confidence interval P value
Age 0.066 1.068 0.950-1.202 0.269
BMI 0.196 1.217 0.784-1.890 0.382
HbA1c −0.01 0.99 0.571-1.718 0.972
Hyperarousal 0.624 1.866 0.943-3.693 0.073
Avoidance −0.397 0.673 0.404-1.120 0.128
Intrusion −0.463 0.629 0.400-0.991 0.046
Sleep problem 0.011 1.011 0.672-1.522 0.957

Adjusted for age, HbA1C BMI, hyperarousal, avoidance, intrusion and sleep problem. BMI, body mass index; HbA1c, hemoglobin A1c.

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