Aims: To analyse depression in German type 2 diabetes patients with or without diabetes complications.
Methods: Longitudinal data from nationwide general practices in Germany (n=1,202) were analysed. People initially diagnosed with type 2 diabetes (2004-2013) were identified and 90,412 patients were included (age: 65.5 years, SD: 11.7). The main outcome measure was the first diagnosis of depression (ICD 10: F32, F33) within ten years after index date in patients with and without diabetes complications. Cox proportional hazards models were used to adjust for confounders.
Results: At baseline, most patients had diabetes complications and 6.4% of them had private insurance. Ten years after type 2 diabetes diagnosis, 30.3% of patients showed symptoms of depression. The prevalence of depression was higher in women than in men (33.7% versus 26.8%), in patients with high HbA1c levels (31.3% when Hb1Ac ≥ 9 versus 27.5% when HbA1c < 7) and in patients with diabetes complications (37.7% when there were more than two complications versus 29.1% when there were no complications). Women and patients without private health insurance were at a higher risk of developing depression. Retinopathy, neuropathy, nephropathy, coronary heart disease, stroke and HbA1c levels higher than 7 were also positively associated with depression.
Conclusions: Diabetes complications and high HbA1c levels had a substantial impact on depression in primary care patients with type 2 diabetes.
Keywords: Diabetes; Macrovascular disease; Microvascular disease; Prevalence; Primary care; Psychosocial stressors.
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