Background: Asians are at higher risk of diabetes, though risk associations of depression and diabetes complications were reported mainly in the Western population. This is the first prospective study reporting association between depression and clinical outcomes in Asian patients with type 2 diabetes (T2D), adjusted for patient report outcomes (PRO) including lifestyle behaviours, self-care and health-related quality of life (HRQoL).
Methods: We performed a retrospective analysis of 4525 Chinese patients with T2D utilizing the Hong Kong Diabetes Register medical records and PRO data collected between 2013 and 2019. Hazard ratios (HR) of depression for the following diabetes complications were estimated: cardiovascular disease (CVD) including ischemic heart disease (IHD), stroke, chronic kidney disease (CKD) and all-cause mortality adjusted for PRO with Cox regression models.
Results: At baseline, 537 patients reported depressive symptoms with a PHQ-9 score≥7. Depression was significantly associated with CVD (HR 1.90 [1.20-3.01]) particularly for IHD (HR 2.21 [1.21-4.02]) after adjusting for conventional risk factors and PRO. Depression was significantly associated with all-cause mortality (HR 1.87 [1.16-3.03]) before adjusting for HRQoL. Patient Health Questionnaire (PHQ-9) Q4 (feeling tired or having little energy) was significantly associated with all-cause mortality (HR 1.76 [1.38-2.24]), indicating a potential single screening item for all-cause mortality in Asian patients with T2D.
Conclusion: Depression is reported to have significant associations with diabetes complications considering PRO. PHQ-9 Q4 can be used as a single item tool in identifying patients with T2D who are at high risk of all-cause mortality, for early counselling and behaviour modifications.
J.N.M.Lui: None. H.Yeung: None. K.Loo: None. R.Ozaki: None. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer Inc., Celltrion, Boehringer Ingelheim and Eli Lilly Alliance, Sanofi, Research Support; AstraZeneca, Servier Laboratories, Viatris Inc., Hua Medicine, Merck KGaA, Applied Therapeutics Inc., Lee Powder, Pfizer Inc., Speaker's Bureau; Novartis, Stock/Shareholder; GemVCare Ltd. E.S.H.Lau: None. Y.Yeung: None. K.Lee: None. T.Yung: None. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Speaker's Bureau; Abbott, AstraZeneca, Lilly, Bayer Inc., Boehringer Ingelheim Inc. A.Luk: Research Support; Novo Nordisk, Boehringer-Ingelheim, Bayer Inc., Speaker's Bureau; Eli Lilly and Company. E.Chow: Research Support; Medtronic, Merck KGaA, Speaker's Bureau; Novartis, Bayer Inc., Sanofi. R.C.Ma: Advisory Panel; AstraZeneca, Merck & Co., Inc., Other Relationship; Bayer Inc., Boehringer-Ingelheim, Research Support; Tricida, Inc., Roche Diagnostics, Novo Nordisk.
