ABSTRACT
Background: Depression is a common comorbid condition found in chronic medical illnesses in general and diabetes mellitus (DM) in particular. Worldwide, more than 365 million people are estimated to have Type 2 DM (T2DM), and almost 300 million people have major depression. Depression can be viewed as a Modifiable independent risk factor for the development of T2DM and for progression of complications from either type 1 or T2DM. Objectives: The aim of the study was to find out the distribution and determinants of depression among T2DM patients attending an integrated diabetes and gestational diabetes clinic (IDGDC) of a tertiary care hospital of West Bengal, East India. Materials and Methods: This cross-sectional, observational study was conducted among T2DM patients who attended IDGDC during May 2017–June 2017. Public Health Questionnaire-9 was used to assess depression and its severity. A total of 196 study subjects participated in the study. Results: The prevalence of depression was found to be 54.6%. About 28.1% of the study subjects had mild depression, 17.9%, 6.1%, and 2.6% subjects had moderate, moderately severe, and severe depression, respectively. Women gender, increasing age, rural residence, low literacy, longer duration of diabetes, and overweight/obesity were significantly associated with high frequency of depression. Addiction was significantly higher among depressed T2DM patients. Mean hemoglobin A1c level was significantly lower among non-depressed T2DM patients. Conclusion: More than half of the T2DM patients are suffering from depression of varying severity. There should be a dedicated counselor in diabetes clinics for routine screening of depression among all T2DM patients to identify the high-risk patients requiring urgent psychiatrist consultation.
ABSTRACT
Background: Globally, about 425 million people are suffering from diabetes mellitus (DM) which will be about 629 million by 2045. India is popularly known as “World Diabetes Capital” and is presently home of about 72.9 million diabetes patients. Poorly managed DM will increase the burden of both microvascular and macrovascular complications. One of the most common complications among them is diabetic foot ulcer (DFU) which affects about 7%–24% of DM patients. Aims and Objectives: This study was planned to determine the burden of DFU and its determinants among Type 2 diabetes mellitus (T2DM) patients attending integrated diabetes and gestational diabetes clinic. Materials and Methods: An institution-based, observational, cross-sectional study was conducted from July to September 2018. A pre-designed, pre-tested, semi-structured schedule was used to collect clinicosocial data. Blood pressure of the study subjects was measured and classified as per Joint National Committee-8 guidelines. Peripheral vascular assessment of the feet was done by calculating “ankle-brachial index (ABI)” in both lower limbs using “Diabetik Foot Care India Pvt. Limited” vascular Doppler instrument having 8 MHz transducer. ABI ≤0.9 and absence of pulse in dorsalis pedis and/or posterior tibial arteries were considered as peripheral artery disease (PAD). Vibration perception threshold for peripheral sensory neuropathy was tested with the help of Diabetik Foot Care Pvt. Limited Digital Biothesiometer using 50 Hz frequency. Results: Data were collected from 338 study participants. The frequency of DFU was found to be 9.5%. Increasing age, longer duration of diabetes, poor educational status, overweight/obesity, poor glycemic control, treatment with insulin, PAD, diabetic peripheral neuropathy, hypertension, ischemic heart disease, and hypothyroidism were significantly associated with DFU. Conclusion: There is high frequency of DFU among T2DM patients. Most of the risk factors are modifiable and if taken care of the occurrence of DFU can be prevented and/or delayed.