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Depression and Type 2 Diabetes Mellitus: The Multiethnic Study of Atherosclerosis

From the Departments of Medicine (S.H.G.), Epidemiology (S.H.G., M.S.), and Psychiatry (H.B.L., C.L.), Johns Hopkins University, Baltimore, Maryland; Division of Epidemiology (P.J.S.), University of Minnesota, St. Paul-Minneapolis, Minnesota; Department of Epidemiology (A.D.R.), University of Michigan, Ann Arbor, Michigan; and Department of Epidemiology (A.L.F.), University of Washington, Seattle, Washington.

Address correspondence and reprint requests to Sherita Hill Golden, Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Suite 2-600, Baltimore, MD, 21205. E-mail: sahill{at}jhmi.edu

Objective: To assess the cross-sectional association between depression and glucose tolerance status.

Methods: We conducted a study of 6754 White, Black, Hispanic, and Chinese men and women aged 45 to 84 years in the Multiethnic Study of Atherosclerosis (MESA). Depression was defined as Center for Epidemiologic Studies Depression scale score of 16 and/or antidepressant use. Glucose tolerance status was defined as normal, impaired fasting glucose (IFG) or Type 2 diabetes mellitus (untreated and treated).

Results: In the minimally adjusted model, although depression was not associated with a greater odds of IFG (odds ratio (OR) = 1.01; 95% confidence interval (CI): 0.87–1.18) or untreated diabetes (OR = 1.03; 95% CI: 0.74–1.45), it was associated with a greater odds of treated diabetes (OR = 1.57; 95% CI: 1.27–1.96). This persisted following adjustment for body mass index (OR = 1.52; 95% CI: 1.22–1.90), metabolic (OR = 1.54; 95% CI: 1.23–1.93), and inflammatory (OR=1.53; 95% CI: 1.21–1.92) factors, daily caloric intake and smoking (OR = 1.48; 95% CI: 1.16–1.88), and socioeconomic markers (OR = 1.47; 95% CI: 1.17–1.85). Among individuals with treated diabetes, median depression scores were higher in those with microalbuminuria compared with those without microalbuminuria (median = 7; interquartile range: 3–13 versus median = 6; interquartile range: 2–11; p = .046). Depression scores were not associated with homeostatic model assessment of insulin resistance among individuals without diabetes.

Conclusions: In MESA, depression was significantly associated with treated diabetes. Further studies are needed to determine the temporality of this association.

Key Words: diabetes mellitus • impaired fasting glucose • depression • epidemiology • insulin resistance

Abbreviations: BMI = body mass index; CES-D = Center for Epidemiologic Studies Depression (CES-D) scale; CI = confidence interval; CRP = C-reactive protein; HOMA-IR = homeostatic model assessment of insulin resistance; IFG = impaired fasting glucose; IL-6 = interleukin-6; MESA = Multiethnic Study of Atherosclerosis; OR = odds ratio.

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