Finland: Type 1 diabetes (T1D) patients having depression are at increased risk of diabetic nephropathy progression, a recent study has found. According to the study, published in the journal Diabetes Care, the purchase of antidepressants and diagnosed depression are associated with progression of nephropathy in T1D.
Aila J. Ahola, Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland, and colleagues investigated the relationship between depression and diabetic nephropathy progression in type 1 diabetes.
The study included data from 3,730 participants without end-stage renal disease (ESRD) at baseline. The patients were the participants of the Finnish Diabetic Nephropathy Study. Depression was assessed in three ways. Depression diagnoses were obtained from the Finnish Care Register for Health Care. Through the use of the, Drug Prescription Register, antidepressant agent purchase data were obtained. Depression symptoms were assessed using the Beck Depression Inventory (BDI). On the basis of urinary albumin excretion rate (AER), the participants were classified as those with normal AER, microalbuminuria, and macroalbuminuria. During the follow-up period, progression from normal AER to microalbuminuria, macroalbuminuria, or ESRD; from microalbuminuria to macroalbuminuria or ESRD; or from macroalbuminuria to ESRD was investigated.
Key findings of the study include:
Over a mean follow-up period of 9.6 years, renal status deteriorated in 18.4% of the participants.
Diagnosed depression and antidepressant purchases before baseline were associated with 53% and 32% increased risk of diabetic nephropathy progression, respectively.
Diagnosed depression assessed during follow-up remained associated with increased risk of disease progression (32%).
BDI-derived symptoms of depression showed no association with the progression, but the total number of antidepressant purchases modestly reduced the risk (hazard ratio 0.989).
With the sample divided based on median age, the observations followed those seen in the whole group.
Symptoms of depression additionally predicted progression in those age ≤36.5 years.
"Diagnosed depression and antidepressant purchases are associated with diabetic nephropathy progression in type 1 diabetes. Whether successful treatment of depression reduces the risk needs to be determined," concluded the authors.
The study, "Depression Is Associated With Progression of Diabetic Nephropathy in Type 1 Diabetes," is published in the journal Diabetes Care.
DOI: https://care.diabetesjournals.org/content/early/2020/11/10/dc20-0493