Journal of Psychology and Clinical Psychiatry Depressive Symptoms, Age at Diagnosis and A Clinically Defined Metabolic Syndrome as Independent Correlates of Glycemic Control in Patients with Type 2 Diabetes Mellitus Volume 2 Issue 6 - 2015 Elias Andreoulakis 1 , Thomas Hyphantis 2 *, Apostolos Iacovides 1 , Dimitrios Kandylis 1 , John G Yovos 3 and Ioannis Nimatoudis 1 1 Department of Psychiatry, Aristotle University of Thessaloniki, Greece 2 Department of Psychiatry, University of Ioannina, Greece 3 Department of Internal Medicine, Aristotle University of Thessaloniki, Greece *Corresponding author: Thomas Hyphantis, Department of Psychiatry, Medical School, University of Ioannina, Ioannina 45110, Greece, Tel: +30 26510 07322; Email: Received: April 05, 2015 | Published: May 05, 2015 Abstract Objective: The findings concerning the association of metabolic syndrome (MetS) and depression with glycemic control are controversial. Recently, age at type 2 diabetes mellitus (T2DM) diagnosis has attracted particular attention but the relevant findings are limited. This study aimed to further assess the association between age at T2DM diagnosis, depressive symptoms and MetS with glycemic control in T2DM patients. Methods: In 116 T2DM patients we assessed disease-related and MetS-related variables as well as depressive symptom severity (Center for Epidemiological Studies-Depression scale - CES-D). Glycemic control, as assessed by glycated hemoglobin (HBA1c) levels, was the dependent variable. Results: Suboptimal HBA1c levels, i.e. 7% (53 mmol/mol) or higher, were found in 35.3% of the patients. Elevated CES-D scores indicative of clinically relevant depressive symptoms (CES-D≥16) or possible major depression (CES-D>23) where found in 31.9% and 11.2% of the patients, respectively. Younger age at T2DM diagnosis (p=0.004), greater treatment intensity (p=0.009), higher levels of depressive symptoms (p=0.011) and the presence of a clinically defined MetS (p=0.012) were the variables independently associated with glycemic control in multiple regression analysis after adjusting for sex, education, marital status, family history of diabetes and disease duration. Conclusion: In T2DM patients, the linear association found between depressive symptom severity and glycemic control points to the need of depressive symptoms being timely addressed. Younger age at T2DM onset may also be an important correlate of suboptimal glycemic control, independent of disease duration. Finally, classification of MetS in T2DM by clinical severity might help delineate its impact on glycemic control. Keywords: Diabetes mellitus; HBA1c; Age at onset; Disease duration; Depression; Metabolic syndrome; Biopsychosocial Submit Manuscript | http://medcraveonline.com J Psychol Clin Psychiatry 2015, 2(6): 00093 Abbreviations: BMI: Body Mass Index; CES-D: Centre for Epidemiological Studies-Depression Scale; DM: Diabetes Mellitus; EM: Expectation-Maximization; HBA1c: Glycated Haemoglobin; HDL-C: High-Density Lipoprotein Cholesterol; IDF: International Diabetes Federation; LDL-C: Low-Density Lipoprotein Cholesterol; MCAR: Missing Completely at Random; MetS: Metabolic Syndrome; MNAR: Missing not at Random; NCEP-ATP- III: National Cholesterol Education Programme-Adult Treatment Panel III; T2DM: Type 2 Diabetes Mellitus; WHO: World Health Organization Introduction Diabetes mellitus (DM) affects nearly 6% of the population [1] and long-term maintenance of optimal glycemic control has been established as a major therapeutic goal [2], since it has been prospectively associated with decreased risk of diabetic complications [3,4]. Therefore, the identification of the factors associated with optimal glycemic control is considered a research priority. Depression is approximately twice as frequent in patients with DM compared to individuals without DM [5,6]. Furthermore, depression among patients with DM seems to be more prevalent in low- and middle-income countries than in high-income countries, although the relevant studies are limited [7]. The risk for incident depression in patients with DM is estimated at approximately 1.25 [8,9]. Comorbid depression in patients with DM has been associated with compromised adherence to self-care and adverse health outcomes [8,10]. The findings concerning the association between depression and glycemic control in patients with type 2 DM (T2DM) remain controversial; a meta-analysis [11], a number of cross-sectional [12,13] and longitudinal [14- 17] studies as well as findings of clinical trials [18] argue in favor of such an association. However, there are also studies that did either found no association [19], or found an association that did not hold after controlling for factors such as social support and social comparison [20]. In addition, there are longitudinal studies that found no association between improvement in depressive symptoms and improvement in HBA1c [21-23], while others Research article