The Relationship between Depression and Metabolic Control Parameters in Type 2 Diabetic Patients: A Cross-sectional and Feasibility Interventional Study.

BACKGROUND: Substantial evidence supports a bidirectional relationship between diabetes and clinical depression. However, little is known about the effect of treating one condition on the control of the other. Thus, this study aimed to determine the prevalence of depression among Type II diabetes mellitus (T2DM) patients and to assess the efficacy and feasibility of escitalopram treatment of depression on their metabolic control parameters.

METHODS: T2DM patients attending primary care clinics in the North of Jordan were enrolled in a cross-sectional study during the period from February to December 2019 (n=157). Depressive symptoms were screened utilizing the patient health questionnaire-9 (PHQ-9) tool. Metabolic control was assessed by measurement of glycated hemoglobin (HbA1c), triglycerides, cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Patients with moderate to severe depressive symptoms by PHQ-9 (n=58) were interviewed by a psychiatrist to confirm a clinical diagnosis of depression. Eligible depressed patients were administered escitalopram 10 mg orally once daily for three months (n=12). Thereafter, depressive symptoms and metabolic control measures were reassessed.

RESULTS: The prevalence of moderate to severe depressive symptoms among T2DM patients, according to PHQ-9, was 36.94%, while the prevalence of clinical depression based on interview was 7.64%. Baseline PHQ-9 scores correlated significantly with baseline levels of HbA1c, HDL, cholesterol, and triglycerides. Escitalopram treatment intervention resulted in significant improvement of PHQ-9 scores without significantly improving any of the metabolic control measures.

CONCLUSION: The relationship between depression and T2DM in the context of metabolic syndrome is plausible. However, our results show that escitalopram treatment may not be associated with significant improvement in metabolic control parameters among these patients. Our study has laid the groundwork for future randomized clinical trials with larger sample size and longer follow-up.