Template Design: M. Jiménez © 2008Template Design: M. Jiménez © 2008

Ching-Ju Chiu1, Feng-Hwa Lu12, Linda, A. Wray3, Elizabeth A. Beverly4, Siao-Ling Lee1

1Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan 2Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

3Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, United States4Joslin Diabetes Medical Center, Harvard Medical School, Boston, MA, United States

Diabetes is a prevalent chronic disease. Currently, about one in ten people of all ages and more than 20% of older adults aged 65 and above, are living with diabetes in Taiwan.

It is estimated that 15-40% of individuals with diabetes have comorbid depression.

If improvements in depression are associated with preferable weight, behavioral and cognitive trajectories in adults with diabetes, perhaps proactively and optimally treating depression in diabetes patients could ultimately reduce the complications attendant to poor weight control, exercise behavior or cognitive functions.

Although the groups had almost identical cognitive function at baseline, those whose depressive symptoms decreased had a significantly lower rate of decline in cognitive function compared to those with persistently high depressive symptoms.

To investigate the associations between longitudinal changes in depressive symptoms and trajectories in weight, cognitive function and health behaviors in adults with diabetes in Taiwan.

1. Weight management and maintain of healthy behaviors may be jeopardized by increment in depressive symptoms even for those with low depressive symptoms at baseline.

2. In persons with diabetes who have high score of depressive symptoms, improvement in depressive symptomatology may guard against cognitive deterioration.

3. The management of psychological burden in adults with diabetes cannot be overemphasized.

Background

Objectives

Methods

ResultsConclusion

Acknowledgements/ Contacts

Figure 3. Exercise Score after 1996 by Depressive Symptom Group

How Does Change in Depressive Symptomatology Influence Trajectories in Weight, Cognitive

Function and Behaviors in Patients with Diabetes?

Design

Compared a) patients with persistently low depressive symptoms with those whose depressive symptoms increased (at least 5 points on CES-D) over 7 years from 1996 to 2003 and b) patients with persistently high depressive symptoms with those whose symptoms decreased (at least 5 points on CES-D) on the same period on their levels of and rates of change in weight, exercise, and cognitive function during 1999, 2003 and 2007.

Data

1996-2007 Survey of Health and Living Status of the Elderly in Taiwan (a.k.a., Taiwan Longitudinal Study of Aging, TLSA).

Sample

Members of diabetes participants who completed CES-D scale on both 1996 and 2003 (N=292).

Measures

Depressive symptoms. 10-item version of the Center for Epidemiologic Studies Depression Scale (CES-D)

Weight. Self-reported weight (kg) divided by height in meters squared (m2) BMI.

Cognitive Function. 9-item Short Portable Mental Status Questionnaire (SPMSQ) and the modified Rey Auditory Verbal Learning Test (m-RAVLT).

Covariates. Demographic variables (age, gender, race/ethnicity, education), behavioral (smoking and drinking status), and clinical variables (years with diabetes, number of comorbidity, disability, using hypnotics or sedatives.

Analyses

Growth Curve Modeling with SAS Proc Mixed.

Grant 2012-2013, National Science Council, Taiwan.

Grant 2011-2012, Research Center for Humanities and Social Sciences (CHASS), National Cheng Kung University.

For more information :Ching-Ju ChiuEmail: cjchiu@mail.ncku.edu.tw

65th of the Gerontological Society of America (GSA), San Diego, CA. November 14-18, 2012

Figure 2. BMI Change after 1996 by Depressive Symptom Group

Figure 1. Memory function (m-RAVLT) after 1996 by Depressive Symptom Group

Compared to those with persistently low depressive symptoms, those whose depressive symptoms increased did not differ in their patterns of cognitive function, but they had a significantly faster increase in BMI and decrease in amount of exercise they participated in.

    Baseline CESD<10(n=216)   Baseline CESD>=10(n=76) 

Total sample

(N=292)

Persistently low depression

symptoms(n=159)

Worsening depression symptoms

(n=57)Statistical test

(X2 or t)

  Persistently high

depression symptoms

(n=36)

Improving depression symptoms

(n=40)Statistical test

(X2 or t)Age(y),M(SD) 65.09

(7.75) 64.43 (7.71) 66.00 (8.04) 1.28 

66.67 (7.46) 64.98 (7.70) -0.97Gender                 %Women 58.90 50.94 61.40 1.85   86.11 62.50 5.45*Education(y),M(SD) 4.41(4.58

) 5.25 (4.45) 4.63(5.17) -0.80 

2.19 (3.57) 2.73 (3.96) 0.61Ethnicity       0.47       0.65 %Fuchien 66.44 66.04 64.91     63.89 72.50   %Mainlander 16.78 18.24 15.79     16.67 12.50   %Hakka and others 16.78 15.72 19.30     19.44 15.00  Years with diabetes, M(SD)

6.58 (6.35) 6.06 (6.34) 8.21 (7.10) 2.01*

 7.53 (6.30) 5.43 (4.80) -1.62

#of comorbidity, M(SD)

2.16(1.31) 1.96(1.14) 2.04(1.13) 0.45

 2.92 (1.90) 2.50 (1.26) -1.11

#of disability, M(SD)

1.63(2.65) 1.09(1.99) 1.37(2.56) 0.73

 2.86(3.01) 3.05(3.76) 0.24

%Using hypnotics/ sedatives 10.27 5.03 8.77 1.04

 25.00 20.00 0.27

%current smoker 19.86 21.38 21.05 0.0027   5.56 25.00 5.39*%current drinker 17.81 22.01 17.54 0.51   8.33 18.42 0.06

Table2. Fixed Effect Coefficients from Mixed Models

Table1. Baseline Characteristics of Participants by Baseline and 7-Year CESD scores

  Baseline CESD<10 (n=216) Baseline CESD≧10 (n=76)

  Recall(m-RAVLT) BMI Exercise Recall(m-RAVLT) BMI Exercise

  Concurre

nt

Prospectiv

e

Concurre

nt

Prospectiv

e

Concurren

t

Prospectiv

e

Concurre

nt

Prospectiv

e

Concurre

nt

Prospectiv

e

Concurre

nt

Prospectiv

e

Interce

pt 4.71*** 4.84*** - 24.04*** 1.48*** 1.51*** 4.44*** 3.64*** - 26.14*** 0.79** 0.60

Year

-0.15*** -0.15*** - -0.09* 0.08*** 0.04* -0.26*** -0.13^ - 0.022 0.04 0.10**

I/W -0.21 -0.36 - -1.00 -0.07 -0.11 -0.37 0.69 - -1.77* 0.23 0.29

Year*

I/W 0.01 0.048 - 0.25* -0.06^ -0.06 0.17^ -0.03 - 0.02 0.02 -0.02