Diabetic Peripheral Neuropathy and Depression

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Rev Diabet Stud, 2021, 17(1):17-20 DOI 10.1900/RDS.2021.17.17

Diabetic Peripheral Neuropathy and Depression: Dancing with Wolves? - Mini-Review and Commentary on Alghafri et al. "Screening for depressive symptoms amongst patients with diabetic peripheral neuropathy"

Prashanth R. J. Vas1,2, Nikolaos Papanas3

1Diabetes Foot Clinic, King´s College Hospital, London, UK
2King´s Health Partners´ Institute of Diabetes, Endocrinology and Obesity, London, UK
3Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
Address correspondence to: Nikolaos Papanas, e-mail: papanasnikos@yahoo.gr

Manuscript submitted October 31, 2020; resubmitted April 14, 2021; accepted May 28, 2021.

Keywords: comorbidities, complications, depression, diabetes mellitus, diabetic neuropathy

Abstract

The co-existence of diabetic peripheral neuropathy (DPN) and depression in subjects with diabetes is being increasingly recognized. The interaction of these two serious comorbidities may increase morbidity and mortality. An emerging thought is that persisting depression, along with stroke and cognitive dysfunction, may represent a cluster of potential microvascular injuries affecting the brain, which shares a common risk factor with DPN. Current evidence highlights metabolic and clinical covariates, which may interact in subjects with DPN and depression. However, there is a lack of rigorous enquiry into the confounding effect of cognitive dysfunction and vascular brain disease. Furthermore, high-quality longitudinal studies exploring the direct impact of these comorbidities on diabetes course and on the progression of the comorbidities themselves are lacking. Improved insights into comorbid DPN and depression may help to improve screening for and treatment of both these conditions.

1. Introduction

The association between diabetes mellitus and depression has long been recognized, particularly in type 2 diabetes (T2D). A diagnosis of T2D may increase the risk of incident clinical depression by approximately 25-52%, after adjusting for covariates and comorbidities [1, 2]. Indeed, a recent meta-analysis of epidemiological studies concluded that subjects with T2D had a 2-fold increased risk of major depressive disorder [3]. Conversely, individuals with depression exhibited an up to 1.5 times increased risk of developing T2D [4]. Likewise, depression in type 1 diabetes (T1D) is 3 times more prevalent than in the general population [5], with adolescents and younger adults with T1D tending to have disproportionately higher risk [6].

Importantly, comorbid diabetes and depression have been confirmed to increase the risk of mortality [7, 8]. In T2D, depression is linked with poor glycemic control and clinically significant micro- and macrovascular disease [8, 9]. In T1D, depression is associated with poor treatment adherence, higher diabetes distress scores [10], suboptimal glycemic control, and recurrent diabetic ketoacidosis [11, 12]. Diabetes-specific risk factors, such as micro- and macrovascular complications [13, 14], act in concert with traditional risk factors for depression, including female gender, lower levels of education, and psychosocial factors (e.g. childhood trauma and social deprivation), thereby creating a complex web of interactions [15].

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