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Depression is a Risk Factor for Poor Glycemic Control and Retinopathy in African-Americans With Type 1 Diabetes

From the University of Medicine and Dentistry (M.S.R.), New Jersey Medical School, Institute of Ophthalmology and Visual Science, Newark, New Jersey; Psychiatry Service (A.R.), Veterans Administration Medical Center, East Orange, New Jersey; and Department of Mathematics (M.A.), Kean University, Union, New Jersey.

Address correspondence and reprint requests to Monique S. Roy, Department of Ophthalmology, UMDNJ-New Jersey Medical School, 90 Bergen Street, Room 6164, Newark, NJ 07101-1709. E-mail address: Roymo{at}umdnj.edu

Objective: To examine longitudinal data about depression in relationship to glycemic control and as a risk factor for diabetic retinopathy (DR). Depression is a common psychiatric disorder among diabetic persons and has been shown in cross-sectional studies to be associated with the vascular complications of diabetes.

Methods: A total of 483 African-American patients with Type 1 diabetes had a baseline examination and 6-year follow-up examination. Evaluations at both visits included administering the Beck Depression Inventory (BDI), a detailed ophthalmologic examination, retinal photographs, and measurement of glycosylated hemoglobin as an index of glycemic control. Six-year progression of DR between baseline and follow-up visits was evaluated from the change in retinopathy severity using the Early Treatment of Diabetic Retinopathy Study grading scale.

Results: Patients with high BDI scores at both baseline and 6-year follow-up visits had significantly higher baseline glycosylated hemoglobin values (p = .01), and were more likely to show progression of DR (odds ratio (OR) = 2.44; 95% confidence interval (CI): 1.01–5.88; p = .049) and progression to proliferative diabetic retinopathy (PDR) (OR = 3.19; 95% CI: 1.30–7.87; p = .01) than patients with low BDI scores at both visits. This was independent of baseline medical risk factors for DR.

Conclusion: Six-year longitudinal data indicate that depression is significantly associated with both poor glycemic control and higher 6-year progression to PDR in African-Americans with Type 1 diabetes.

Key Words: depression • diabetes • glycemic control • retinopathy

Abbreviations: AER = albumin excretion rate; BDI = Beck Depression Inventory; CI = confidence interval; DR = diabetic retinopathy; HbA1C = hemoglobin A1C; HPA = hypothalamo-pituitary-adrenal; OR = odds ratio; PDR = proliferative diabetic retinopathy.