The Association Between Depressive Symptoms, Access to Diabetes Care, and Glycemic Control in Five Middle-Income Countries,Diabetes Care

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The Association Between Depressive Symptoms, Access to Diabetes Care, and Glycemic Control in Five Middle-Income Countries
Diabetes Care ( IF 14.8 ) Pub Date : 2024-06-25 , DOI: 10.2337/dc23-1507
Lena Merkel _{1,

2} , Felix Teufel ₃ , Deborah Carvalho Malta ₄ , Michaela Theilmann _{5,

6} , Maja-Emilia Marcus _{5,

6} , David Flood ₇ , Pascal Geldsetzer _{8,

9,

10} , Jennifer Manne-Goehler _{5,

6} , Frank Petrak _{11,

12} , Sebastian Vollmer ₁₃ , Justine Davies _{14,

15,

16}

Affiliation

Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
German Institute for Global and Area Studies, Hamburg, Germany.
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA.
Emory Global Diabetes Research Center of the Woodruff Health Sciences Center and Emory University, Atlanta, GA.
Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Brigham and Women's Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
University of Michigan, Ann Arbor, MI.
Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA.
Chan Zuckerberg Biohub - San Francisco, San Francisco, CA.
Department of Psychosomatic Medicine and Psychotherapy, University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany.
Center for Psychotherapy Wiesbaden MVZ GmbH, Wiesbaden, Germany.
Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany.
Institute of Applied Health Research, University of Birmingham, Birmingham, U.K.
Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa.

OBJECTIVE The relationship between depression, diabetes, and access to diabetes care is established in high-income countries (HICs) but not in middle-income countries (MICs), where contexts and health systems differ and may impact this relationship. In this study, we investigate access to diabetes care for individuals with and without depressive symptoms in MICs. RESEARCH DESIGN AND METHODS We analyzed pooled data from nationally representative household surveys across Brazil, Chile, China, Indonesia, and Mexico. Validated survey tools Center for Epidemiologic Studies Depression Scale Revised, Composite International Diagnostic Interview, Short Form, and Patient Health Questionnaire identified participants with depressive symptoms. Diabetes, defined per World Health Organization Package of Essential Noncommunicable Disease Interventions guidelines, included self-reported medication use and biochemical data. The primary focus was on tracking diabetes care progression through the stages of diagnosis, treatment, and glycemic control. Descriptive and multivariable logistic regression analyses, accounting for gender, age, education, and BMI, examined diabetes prevalence and care continuum progression. RESULTS The pooled sample included 18,301 individuals aged 50 years and above; 3,309 (18.1%) had diabetes, and 3,934 (21.5%) exhibited depressive symptoms. Diabetes prevalence was insignificantly higher among those with depressive symptoms (28.9%) compared with those without (23.8%, P = 0.071). Co-occurrence of diabetes and depression was associated with increased odds of diabetes detection (odds ratio [OR] 1.398, P < 0.001) and treatment (OR 1.344, P < 0.001), but not with higher odds of glycemic control (OR 0.913, P = 0.377). CONCLUSIONS In MICs, individuals aged 50 years and older with diabetes and depression showed heightened diabetes identification and treatment probabilities, unlike patterns seen in HICs. This underscores the unique interplay of these conditions in different income settings.

更新日期：2024-06-25

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