Prevalence of depression, hemoglobin A1C level, and associated factors in outpatients with type-2 diabetes

Background: The prevalence of type-2 diabetes is increasing worldwide. Glycemic control has been demonstrated to reduce the morbidity and mortality in patients with type-2 diabetes. Several factors determine the glycemic control, and include the psychological factor, particularly depression. Objectives: To estimate the prevalence of depression, and poor glycemic control, and to determine the associated factors in outpatients with type-2 diabetes. Material and method: A cross-sectional study was conducted in 250 participants at endocrine clinic of King Chulalongkorn Memorial Hospital between June and December 2008. Participants completed the questionnaire and tests for socio-demographic characteristics and medical information, Thai-HADS, the Thai Mental State Examination (TMSE), Montreal Cognitive Assessment (MoCA) Test, Summary of Diabetes Self-Care Activities (SDSCA), Life Events Stress test, and questionnaire for assessment of social support. Results: Approximately 64% of the samples were female with the mean age of 63 years, and 54% had at least 12-year education. The prevalence of depression in patients with type-2 diabetes was 28%, and of poor glycemic control (hemoglobin A1C ≥7%) was 56%. Depression and poor glycemic control showed a linear relationship if depression scores in Thai-HADS were more than 12. Multivariate analysis indicated that the significant risk factors associated with depression were anxiety, low education level, history of diabetes related admissions, perceived deteriorating health status, non-adherence to DM treatment, and diabetic nephropathy. The significant risk factors associated with poor glycemic control were no hypertension, diabetic retinopathy, perceived deteriorating health status, coffee drinking, high serum LDL, and albuminuria or proteinuria. Conclusion: Among patients with type-2 diabetes, poor glycemic control and depression were prevalent. Marked depression might be associated with poor glycemic control. Health care providers should monitor and early detect of such conditions, particular in patients with the significant risk factors to reduce morbidity and mortality holistically in long-term care.