May 23, 2013

Depression raises diabetics’ risk of severe low blood sugar episodes

A patient with diabetes learns how to test her blood sugar levels with a glucose meter.

Clare McLean

A patient with diabetes learns how to test her blood sugar levels with a glucose meter.

Patients with diabetes who are depressed are much more likely to develop episodes of dangerously low blood sugars, or hypoglycemia, than are those who are not depressed, a new study has found.

These episodes typically occur when the drugs used to control high blood sugars drive down blood sugar levels too low.

“Severe hypoglycemia can be very dangerous for these patients. Symptoms can vary. Patients may feel shaky, sweaty and anxious. But very low blood sugar can cause loss of consciousness even coma and death and repeated episodes can lead to cognitive impairment over time,” said lead author Dr. Wayne J. Katon, professor of psychiatry and behavioral sciences at the UW School of Medicine. The episodes are also costly to the health-care system. They account for one in four emergency room visits or hospitalizations in the United States due to adverse drug reactions, he said.

In the study, researchers at the University of Washington and the Group Health Research Institute in Seattle tracked more than 4,100 patients with diabetes for five years. At the beginning of the study all the participants filled out a psychological screening questionnaire that identified those who had signs of major depression.

After analyzing data at the end of the five-year study, the researchers found that those participants who had met the criteria for major depression were 42 percent more likely to have low blood sugar episode severe enough that it required a trip to the emergency room or admission to the hospital than were participants who were not depressed..

The depressed patients were also 34 percent more likely to have a greater number of hypoglycemic episodes.

It’s not surprising that depression makes it more likely for people with diabetes to have episodes of hypoglycemia, Katon said.  Patients with diabetes have to juggle three or four diseasecontrol medications, test their blood sugar levels regularly and adjust their medication doses based on these results, and stick to special diets. “When you’re depressed, it can be very hard to do all those things,” he said.

Depression is common among people with diabete; it affects up to one in five. That’s why it’s important for health-care providers to screen their patients for depression and for patients to call it to their physician’s attention, Katon said.

“The good news is that depression is something that can be treated effectively with either psychotherapy or with antidepressant medication,” said Katon. “But it’s important that it be recognized and treated because it significantly increases the patient’s risk of this serious complication.

The study, “Association of Depression With Increased Risk of Severe Hypoglycemic Episodes in Patients With Diabetes,” appears the May/June issue of the Annals of Family Medicine.

The project was supported by funding from the National Institute of Mental Health, grant numbers: MH069741 and MH073686.

This story was written by Michael McCarthy for UW Health Sciences/UW Medicine.

 

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