Prevalence of depression in type 2 diabetic patients in Trinidad and Tobago / Prevalencia de la depresión en pacientes con diabetes tipo 2 en Trinidad y Tobago

BACKGROUND: Depression is a common problem among those suffering from diabetes mellitus. The dual diagnoses of a chronic medical disease and mental disorder, symptomatic presentation and stringent treatment regimen are sources ofpsychological distress for patients and present a major challenge for healthcare workers. METHOD: In a cross-sectional study, one hundred and twenty-eight Type 2 diabetic patients were investigated for depression using the Zung Depression Scale. All cases were diagnosed by a physician and patients were selected from outpatient clinics of the four major hospitals in Trinidad. The Pearson product-moment correlation coefficient, stepwise multiple regression and t-test were utilized to examine the relationship between participant's age, gender, glucose control, coexisting medical complications and depression. RESULTS: The patients were primarily Indo-Trinidadians (49%), over 50 years (79.7%) and women (60%). The prevalence of depression was 17.9% of Type 2 diabetic patients reporting mild to moderate levels of depression. Female Type 2 diabetics had higher scores of depression (M = 42.13, SD = 9.83, p = 0.011) than male Type 2 diabetics (M = 38.71, SD = 8.9). Patients with coexisting medical complications had higher levels of depression (M = 44.01, SD = 9.52) than those with diabetes alone (M= 37.74, SD = 8.79, p = 0.000). CONCLUSION: The prevalence of depression in Type 2 diabetic patients highlights the necessity for psychological screening at diabetic health clinics in Trinidad and Tobago, particularly for women and those with co-morbid medical complications. This will aid in better control, quality of life and longevity.

ANTECEDENTES: La depresión es un problema común entre las personas que sufren de diabetes mellitus. El diagnóstico dual de una enfermedad médica crónica y un trastorno mental, la presentación sintomática y un régimen de tratamiento estricto, son fuentes de angustia psicológica para los pacientes y representan un reto importante para los trabajadores de la salud. MÉTODO: En un estudio transversal, ciento veintiocho pacientes con diabetes tipo 2 fueron investigados en relación con estados depresivos, usando la Escala de Depresión de Zung. Todos los casos fueron diagnosticados por un médico, y los pacientes fueron seleccionados de clínicas ambulatorias de los cuatro hospitales principales en Trinidad. El coeficiente de correlación producto-momento de Pearson, la regresión gradual múltiple, y la prueba t, fueron utilizados para examinar la relación entre la edad del participante, el género, el control de la glucosa, las complicaciones médicas coexistentes, y la depresión. RESULTADOS: Los pacientes eran principalmente indotrinitenses (49%), más de 50 años (79.7%) y mujeres (60%). La prevalencia de la depresión fue 17.9% de los pacientes diabéticos tipo 2 que reportaban niveles de depresión de leves a moderados. Las mujeres diabéticas tipo 2 tuvieron puntuaciones de depresión mayores (M= 42.13, SD = 9.83, p = 0.011) en comparación con los hombres diabéticos tipo 2 (M= 38.71, SD = 8.9). Los pacientes con complicaciones médicas coexistentes tenían niveles más altos de depresión (M= 44.01, SD = 9,52) que aquellos sólo con diabetes (M = 37.74, SD = 8.79, p = 0.000). CONCLUSIÓN: La prevalencia de la depresión en pacientes diabéticos tipo 2 señala la necesidad de realizar tamizajes psicológicos en las clínicas para diabéticos en Trinidad y Tobago, en particular para las mujeres y aquellos con complicaciones médicas comórbidas. Esto ayudará a un mejor control, calidad de vida y longevidad de los pacientes con diabetes tipo 2.

Temperature dependence of Na+-H+ exchange, Na+-HCO3- co-transport, intracellular buffering and intracellular pH in guinea-pig ventricular myocytes.

Almost all aspects of cardiac function are sensitive to modest changes of temperature. We have examined the thermal sensitivity of intracellular pH regulation in the heart. To do this we determined the temperature sensitivity of pHi, intracellular buffering capacity, and the activity of sarcolemmal acid-extrusion proteins, Na+-H+ exchange (NHE) and Na+-HCO3- co-transport (NBC) in guinea-pig isolated ventricular myocytes. pHi was recorded fluorimetrically with acetoxymethyl (AM)-loaded carboxy-SNARF-1 at either 27 or 37 degrees C. At 27 degrees C, intrinsic (non-CO2-dependent) buffering power (betai) was approximately 60% of that at 37 degrees C. Acid-extrusion (Je) through NHE was approximately 50% slower than at 37 degrees C, consistent with a Q10 of approximately 2. In 5% CO2/HCO3--buffered conditions, in the presence of 30 microM cariporide to inhibit NHE, acid extrusion via NBC was also slowed at 27 degrees C, suggestive of a comparable Q10. Resting pHi at 27 degrees C was similar in Hepes- or 5% CO2/HCO3--buffered superfusates but, in both cases, was approximately 0.1 pH units lower at 37 degrees C. The higher the starting pHi, the larger was the thermally induced fall of pHi, consistent with a mathematical model where intrinsic buffers with a low principal pKa (e.g. close to 6.0) are less temperature-sensitive than those with a higher pKa. The high temperature sensitivity of pHi regulation in mammalian cardiac cells has implications for experimental work conducted at room temperature. It also has implications for the ability of intracellular acidosis to generate intracellular Na+ and Ca2+ overload, cardiac injury and arrhythmia in the heart.