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  • 1.
    Melin, Eva O.
    et al.
    Lund University, Sweden;Kronoberg County Council, Sweden.
    Thunander, Maria
    Lund University, Sweden;Kronoberg County Council, Sweden.
    Landin-Olsson, Mona
    Lund University, Sweden;Lund University Hospital, Sweden.
    Hillman, Magnus
    Lund University, Sweden.
    Thulesius, Hans
    Kronoberg County Council, Sweden;Lund University, Sweden.
    Depression, smoking, physical inactivity and season independently associated with midnight salivary cortisol in type 1 diabetes2014In: BMC Endocrine Disorders, ISSN 1472-6823, E-ISSN 1472-6823, Vol. 14, p. 1-10, article id 75Article in journal (Refereed)
    Abstract [en]

    Background: Disturbances of the circadian rhythm of cortisol secretion are associated with depression, coronary calcification, and higher all-cause and cardiovascular mortality. The primary aim of this study was to test the associations between midnight salivary cortisol (MSC), depression and HbA1c, and control for behavioural, environmental and intra individual factors with possible impact on cortisol secretion, like smoking, physical inactivity, season, medication, diabetes duration, severe hypoglycemia episodes, age and gender in patients with type 1 diabetes. Secondary aims were to present MSC levels for a reference group of non-depressed type 1 diabetes patients with a healthy life style (physically active and non-smoking), and to explore seasonal variations. Methods: A cross-sectional population based study of 196 patients (54% men and 46% women) aged 18-59 years that participated in a randomized controlled trial targeting depression in type 1 diabetes. Depression was assessed by the Hospital Anxiety and Depression Scale-depression subscale. MSC, HbA1c, serum-lipids, blood pressure, waist circumference and data from medical records and the Swedish National Diabetes Registry were collected. Results: Thirty four patients (17%) had MSC >= 9.3 nmol/L, which was associated with smoking (AOR 5.5), spring season (AOR 4.3), physical inactivity (AOR 3.9), self-reported depression (AOR 3.1), and older age (per year) (AOR 1.08). HbA1c > 70 mmol/mol (>8.6%) (AOR 4.2) and MSC >= 9.3 nmol/L (AOR 4.4) were independently linked to self-reported depression. Season was strongly associated with MSC levels and no other variables studied showed seasonal variations. In a reference group of 137 non-depressed patients with a healthy life style (physically active, non-smoking) the median MSC level was 4.6 nmol/L (range 1.9-23.0). Conclusions: In this study of patients with type 1 diabetes high MSC was linked to smoking, physical inactivity, depression, season and older age. Thus a high cortisol value identified three major targets for treatment in type 1 diabetes.

  • 2.
    Melin, Eva O.
    et al.
    Kronoberg County Council, Sweden;Lund University, Sweden.
    Thunander, Maria
    Lund University, Sweden;Kronoberg County Council, Sweden;Växjö Central Hospital, Sweden.
    Svensson, Ralph
    Kronoberg County Council, Sweden.
    Landin-Olsson, Mona
    Lund University, Sweden.
    Thulesius, Hans
    Kronoberg County Council, Sweden;Lund University, Sweden.
    Depression, obesity, and smoking were independently associated with inadequate glycemic control in patients with type 1 diabetes2013In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 168, no 6, p. 861-869Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore the associations between inadequate glycemic control of diabetes and psychological, anthropometric, and lifestyle variables in a population-based cohort of type 1 diabetes patients. Design: Cross-sectional study. Methods: In this study, 292 patients with type 1 diabetes, aged 18-59 years, participated. Psychological data were assessed by self-report instruments: Hospital Anxiety and Depression Scale and Toronto Alexithymia Scale-20. Anthropometrics, blood analyses, data from medical records, and data from the Swedish National Diabetes Registry were collected. Results: Self-reported depression (adjusted odds ratio (AOR) 4.8), obesity (AOR 4.3), and smoking (AOR 3.0) were independently associated with inadequate glycemic control of diabetes (HbA1c>8.6%). Gender-stratified analyses showed that self-reported depression (AOR 19.8) and obesity (AOR 7.0) in women and smoking in men (AOR 4.2) were associated with HbA1c>8.6%. Alexithymia, antidepressant medication, and physical inactivity were associated with HbA1c>8.6% only in bivariate analyses. Alexithymia, self-rated anxiety, physical inactivity, and absence of abdominal obesity were associated with self-reported depression. Conclusions: Depression was the only psychological factor independently associated with HbA1c>8.6%. The association was of comparable importance as obesity and smoking, well-known risk factors for inadequate glycemic control and diabetes complications. The association between depression and HbA1c>8.6% was particularly strong for women. Alexithymia, which is a relatively stable personality trait, was associated with depression. In the future care of patients with diabetes, psychological aspects should be considered alongside anthropometrics and lifestyle factors in order to achieve the goals for HbA1c.

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