Emotional Distress and Cardiovascular Disease Risk among Participants enrolled in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study

Gladys Crespo-Ramos, Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA.
Ionut Bebu, The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD.
Heidi Krause-Steinrauf, The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD.
Claire J. Hoogendoorn, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
Ran Fang, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
Dominic Ehrmann, Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.
Caroline Presley, Department of Medicine (General Internal and Preventive Medicine) University of Alabama, Birmingham, Birmingham, AL.
Aanand D. Naik, School of Public Health, University of Texas Health Science Center, Houston, Texas, USA.
Aimee Katona, University of Michigan, Ann Arbor, MI, United States.
Elizabeth A. Walker, Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA.
Andrea Cherrington, Department of Medicine (General Internal and Preventive Medicine) University of Alabama, Birmingham, Birmingham, AL.
Jeffrey S. Gonzalez, Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA; Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA; New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, New York, USA. Electronic address: grademail@bsc.gwu.edu.

Document Type

Journal Article

Publication Date

6-30-2023

Journal

Diabetes research and clinical practice

DOI

10.1016/j.diabres.2023.110808

Keywords

cardiovascular complications; depression; diabetes-related distress; type 2 diabetes

Abstract

AIMS: People with type 2 diabetes (T2DM) have an increased risk of cardiovascular disease (CVD). We examined depressive symptoms (DS) and diabetes distress (DD) in relation to the estimated 10-year risk of CVD in adults with T2DM enrolled in the GRADE Emotional Distress Substudy. METHODS: Linear regression models examined the associations of baseline DS and DD with estimated 10-year risk of CVD using the Atherosclerotic Cardiovascular Disease (ASCVD) risk score, adjusting for age, sex, race/ethnicity, education, income, diabetes duration, diabetes-related complications, and HbA1c. RESULTS: A total of 1,605 GRADE participants were included: 54% Non-Latino (NL) White, 19% Latino, 18% NL-Black, 66% male, mean age 57.5 (SD=10.25) years, diabetes duration 4.2 (SD=2.8) years, and HbA1c 7.5% (SD=0.5%). After incorporating covariates, only DS, especially cognitive-affective symptoms, were associated with ASCVD risk (estimate=0.15 [95% CI: 0.04, 0.26], p=0.006). Higher DS remained significantly associated with higher ASCVD risk when adding DD to covariates (estimate=0.19 [95% CI: 0.07, 0.30], p=0.002). DD was not associated with ASCVD risk when accounting for covariates. CONCLUSIONS: Depressive symptoms, particularly cognitive-affective symptoms, are associated with increased 10-year predicted ASCVD risk among adults with early T2DM. Diabetes distress is not significantly associated with the predicted ASCVD risk when accounting for covariates.

Department

Biostatistics and Bioinformatics

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