Depressed? Glass Always Half Empty? Well, you’re at risk for a footulcer. #diabetes #ada2012

Terrific data from Loretta V and friends from Manchester at this years’ American Diabetes Association Symposium.


Abstract: Prior diabetic foot ulceration (DFU) does not increase risk for depression. However, depression is associated with increased DFU risk. We re-examined these relationships substituting depression (Hospital and Anxiety Depression Scale; HADS-D) with a measure of foot problem-Specific Emotional Distress (NeuroQoL-SED). Data from an 18-month prospective cohort study of 333 patients with diabetic peripheral neuropathy, DPN (71% male; age 62yrs; 73% type 2 diabetes; Neuropathy Disability Score 7.4) showed that those with prior DFU had significantly (p < .001) greater NeuroQoL-SED (M = 2.70, SD = 1.19) at baseline than those without (M = 2.00, SD = 1.10). This difference persisted (p = .003) in multivariate regression models controlling for demographics, comorbidities, DPN-severity, symptoms and functional impairment, and was enhanced, rather than attenuated, when HADS-D was controlled for (p < .001). However, longitudinal multivariate models showed that NeuroQoL-SED did not predict DFU over time. Controlling for NeuroQoL-SED did not attenuate previously reported association between HADS-D and DFU risk. Item-level analyses showed HADS-D items assessing positive affect were not significantly associated with DFU risk. Only ‘feeling slowed down’ (p = .030) and ‘losing interest in appearance’ (p = .003) were significantly associated with increased risk of DFU. Controlling for DPN-related DFU risk factors and subjective health ratings (general or DPN-specific) did not attenuate the relationship between HADS-D and DFU risk. These results suggest that while prior DFU is associated with increased specific emotional distress and not depression, it is depression, particularly negative affect, that is associated with increased risk for the development of new DFU over time. While the mechanism for this relationship is unclear, it does not appear to be accounted for by confounding with specific emotional distress or with objective or subjective indicators of poor health.

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