Depressive state among patients with type 2 diabetes mellitus on insulin-dependent period

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1 Research Article Depressive state among patients with type 2 diabetes mellitus on insulin-dependent period A. Sh. Seidinova 1 *, I. A. Ishigov 1, T. M. Narymbetova 1, Peyami Cinaz 2 ABSTRACT Background: Diabetes mellitus (DM) is the most common non-communicable disease in the world. There are many factors that influence the development of this disease. Depression is a widespread condition and one more factor that aggravates the condition of patients. The importance of in the development of diabetes is well known. Aim: The aim of the study was to study the depressive state in patients with type 2 DM on permanent subcutaneous insulin infusion (or insulin pump therapy) and multiple injectable insulin therapies. Methods: We selected the Beck Depression Inventory to assess the depressive syndrome of patients with DM. Results: Comparative analysis showed that, among patients with type 2 DM on the insulin-dependent period, more mild and moderate degrees syndrome were identified. According to the results of our study, it was revealed that, in women, the depressive condition was expressed, who was on multiple injectable insulin therapies, and in the men, on the contrary, was expressed in patients on insulin pump therapy. Conclusion: It can be said that the method of treatment for the duration of the disease affects only patients with type 2 DM up to 15 years of age. If we analyze by age subgroups, then further study of the influencing factors on in this age category is required. KEY WORDS: Beck Depression Inventory,, diabetes mellitus type 2, insulin pump therapy, subcutaneous insulin infusion INTRODUCTION Depressive syndrome has become widespread among the population in recent years. According to the estimates of the World Health Organization (WHO) of 2018, more than 300 million people worldwide suffer from depressive syndrome. [1] Men are less prone to depressive disorders compared to women. [1-2] In addition, the WHO (2016) stated that leads to a severe disability burden among mental and behavioral disorders. In the United States, 6.7% of all adults suffer from severe depressive syndrome. [3] Depression is a mental disorder characterized by loss of interest, joy, depressed state, poor concentration of attention, feelings of inferiority, guilt and low self-esteem, disturbed sleep, and appetite. [1] The development of the of in patients with diabetes is a serious problem. The special role of diabetes mellitus (DM) in the development of is confirmed by different research Access this article online Website: jprsolutions.info ISSN: works. [4,5,6] In addition, the authors indicate the effect of the severity of the depressive syndrome on the glycemic profile, diet compliance, and quality of life of patients. [7] According to different authors, moderate and severe degrees, even mild, can aggravate the course of DM. [8] The factors leading to this disease among patients with type 2 diabetes are determined by dysmetabolic changes in the body, lack of physical activity, stress, and unhappiness in personal and family life. [9] According to the conclusions of one of the large-scale and longterm studies conducted from 1980 to 2005, it was found that, in patients with type 2 diabetes, the risk of developing is 2 times higher, compared with somatically healthy people (17.6% vs. 9.8%). [10] The aim of the study was to study the depressive state in patients with type 2 DM on permanent subcutaneous insulin infusion (SCII) (or insulin pump therapy) and multiple injectable insulin therapy. MATERIALS AND METHODS A total of 210 people with type 2 DM were examined on an insulin-dependent period from 45 to 65 years 1 Department of Human Physiology and Morphology, International Kazakh-Turkish University Named after H.A. Yassawi, Turkestan, Kazakhstan, 2 Department of Endocrinology, Gazi University, Ankara, Turkey *Corresponding author: A. Sh. Seidinova, Department of Human Physiology and Morphology, International Kazakh-Turkish University Named after H. A. Yassawi, B. Sattarkhanov Street - 29, Turkestan, Kazakhstan. aigerimsa@mail.ru Received on: ; Revised on: ; Accepted on:

2 with a duration of disease of at least 5 years (mean age 56.1 ± 0.39 years). Of these, 105 patients with continuous SCII (insulin pump therapy) were in the main group (63 60% of women and 42 40% of men, mean age ± 0.54 years) and 105 people entered the control group with multiple injectable insulin therapy ( % of women and % of men, mean age 57.1 ± 0.56 years). The total of two groups (131 of them % of women and % of men, mean age 56.1 ± 0.39 years). Patients with DM were approximately comparable to the control group by age and sex. By age, all patients from the main and control groups were divided into three subgroups: 1-subgroup: from 45 years to 50 years; 2-subgroup: from 51 to 55 years; and 3-subgroup: from 56 years to 65 years. The age group was chosen in view of the fact that, according to experts, the risk of developing DM increases after 45 years. At the same time, in the choice of patients, the risk disorders related to age-related changes, which rises after years, was taken into consideration in selecting patients. Therefore, the optimal age for our study was chosen years. It is known that the duration of diabetes affects metabolic processes. [11] Given this important factor, both the duration of the disease affecting the level of glycemic exchange, all patients of the main and control groups were divided into three subgroups: 1-subgroup: Experience of disease from 5 to 10 years; 2-subgroup: Experience of disease from 11 to 15 years; and 3-subgroup: Experience of disease from 16 years and above. To identify or exclude a depressive factor, the most popular test is the Beck Depression Inventory (BDI). The scale was proposed by A.T. Beck together with coauthors in [12] Depressive state in patients with DM type 2 was determined with a questionnaire BDI. An open, comparative, prospective study was conducted with an analysis of the depressive state between two groups differing in the treatment method. All patients were informed of testing and passed the informed consent procedure. Data from 210 patients with diabetes were collected, recorded, and evaluated according to the statistical program SPSS 22. The study was conducted in the Research Clinic of the Diabetes Center at Kazakh National Medical University named after S.D. Asfendiyarov, in Kazakhstan, Almaty, from 2015 to December All patients had type 2 DM. The criterion for the exclusion for patients was the diagnosis of and the use of any antidepressant. The scale is presented from the 21 questions to determine the most important clinical signs of. When interpreting the data, the total score for all categories was taken into account. Accordingly, the most significant for clinical characteristics of depressive disorders - moderate started from 16 to 19 points, points of the scale - severe or moderate severity, and points corresponded to severe. Each point of the questionnaire scale corresponds to the specific signs of. This scale expresses advantages in the precise definition of both the severity of the depressive syndrome and the somatic signs of. The Beck scale is considered an accurate and reliable test questionnaire in detecting the level of and is used as a diagnostic screening method in many research papers. [13] RESULTS The average value status among patients on SCII (pump insulin therapy) was 11.77, and in the control group, the mean value of the depressive state was Analysis of the depressive scale in those who were on pump therapy determined that, among men more often, there is a mild (26.2%) and moderate degree (9.5%) of (total 35.7%), and severe was detected in 21.4% of the men surveyed. In the control group, the severity syndrome among men was less, compared to the main group %. Similarly, the rates of mild and moderate were 29.7%, which means that men are more susceptible to depressive conditions in the main group [Table 1 and Figure 1]. The evaluation of in women revealed that women on pump insulin therapy are more likely to suffer mild and moderate, 36.5%, and in patients with multiple injecting therapy, these indicators were 39.7%. A comparative analysis showed that the depressive state in women was more pronounced in the control group of patients [Table 2 and Figure 2]. As can be seen from Tables 1 and 2 and Figures 1and 2, the quantitative relationship between the variable - BDI and the type of therapy used by female and male patients is not statistically significant since the critical values of χ 2 at significance level P > are In addition, the calculated criteria of V Cramer showed a weak connection between the investigated nominal variables at the level of

3 Table 1: Characteristics of in patients with type 2 DM in men, depending on the type of treatment From 0 to 9 absence Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total χ , P>0.26; V Cramer 0.17, P>0.26. DM: Diabetes mellitus Table 2: Characteristics of in patients with type 2 DM in women, depending on the type of treatment From 0 to 9 absence Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total χ , P>0.26; V Cramer 0.17, P>0.26. DM: Diabetes mellitus As can be seen from Table 3 and Figure 3, the quantitative relationship between the variable-bdi and the type of therapy used by patients in the age group of years is reliable, since the critical value of χ 2 at a significance level of P < 0.05 is At 0 9 points (absence ), patients have a significant difference between the levels of 56.0% and 20.0% of the two types of therapy by 36.0% (P < 0.02). In addition, the calculated criterion of V Cramer showed a relatively strong relationship between the investigated nominal variables at the level of Thus, analysis of the scale revealed a significant difference between the groups, differing according to the treatment method in the age group from 45 to 50 years. In the remaining two subgroups, the age-separated relationship was not reliable. In the first subgroup by age from 45 to 50 years with the method of treatment of pump insulin therapy, the evaluation showed significant differences in the level of in comparison with the control group. In addition, it was noted that, in patients with type 2 DM, the degree of mild and moderate was more frequent than in the group with traditional multiple injectable insulin therapies. There are also cases of severe among patients with type 2 DM in this age category. Thus, among patients with pump insulin therapy (SCII), the severity of was 16%, among patients with multiple injections, the severity of was 40%. 2562

4 Table 3: Characteristics of in patients with type 2 DM by age from 45 to 50 years according to the data of the Beck questionnaire From 0 to 9 absence of depressive Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total χ , Р<0.05; V Cramer 0.43, Р<0.05. DM: Diabetes mellitus Figure 1: Depression level according to the data of the Beck questionnaire among men, depending on the type of treatment Figure 3: Depression level according to the Beck questionnaire among patients aged years, depending on the type of treatment the presented nominal variables (χ 2 = , P > , V Cramer ). In assessing the moderate and mild degree syndrome among the subgroups of age years, it was found that, in the main group, the mild and moderate degree condition was 25.9% and 14.8%, respectively, and in the control group, it was 32.1% and 10.7%. The level of severe [Table 4 and Figure 4] in patients with pump insulin therapy was significantly higher (29.6%) than in the control group (7.1%). Figure 2: Depression level according to the data of the Beck questionnaire among women, depending on the type of treatment However, in the age subgroups of years and years in patients [Tables 4 and 5, Figure 4 and 5], there was no significant statistical relationship between Analysis of the subgroup by the age of years showed that the level was mild and moderate in both groups, and severe was more evident in the control group [Table 5 and Figure 5]. The next evaluation for the duration of the disease was a subgroup of patients with experience of diabetes 5 10 years. 2563

5 Table 4: Characteristics of in patients with type 2 DM by age from 51 to 55 years according to the data of the Beck questionnaire From 0 to 9 absence Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total χ , Р>0.13; V Cramer 0.32, Р>0.13. DM: Diabetes mellitus Table 5: Characteristics of in patients with type 2 DM by age from 56 to 65 years according to the data of the Beck questionnaire From 0 to 9 absence Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total χ , P>0.48; V Cramer 0.14, P>0.48. DM: Diabetes mellitus Figure 4: Depression level according to the Beck questionnaire among patients aged years, depending on the type of treatment As can be seen from Table 7 and Figure 6, the quantitative relationship between the variable - BDI and the type of therapy applied by patients in the group for the duration of the disease years is significant, since the critical value of χ 2 at significance level P < 0.05 is In the columns of the table from 16 to 19 (moderate ) and from 20 to 63 (severe ), patients have a significant difference between the comparable levels of the two types of therapy. However, it is worth noting that, in the given cells of the table, there are values <5, which can give an error when calculating the value of χ 2. In addition, the calculated criterion of V Cramer showed the average relationship between the investigated nominal variables at the level of However, in groups of 5 10 years of age and 16 years and older in 2564

6 Table 6: Characteristics of in patients with type 2 DM by duration of the disease from 5 to 10 years From 0 to 9 absence of depressive Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total χ , P>0.65; V Cramer 0.12, P>0.65. DM: Diabetes mellitus Table 7: Characteristics of in patients with type 2 DM by duration of the disease from 11 to 15 years From 0 to 9 absence patients [Tables 6 and 8, Figures 7 and 8], there was no significant statistical relationship between the nominal variables presented (χ 2 = , P > , V Cramer ). CONCLUSION Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total χ , P<0.05; V Cramer 0.37, P<0.05. DM: Diabetes mellitus Comparative analysis showed that, among patients with type 2 DM on the insulin-dependent period, more mild and moderate degrees syndrome were identified. Figure 5: Depression level according to the Beck questionnaire among patients from 56 to 65 years depending on the type of treatment According to the results of our study, it was revealed that, in women, the depressive condition was expressed, who was on multiple injectable insulin therapies, and in the men, on the contrary, was expressed in patients on insulin pump therapy [Table 8]. 2565

7 Table 8: Characteristics of in patients with type 2 DM by duration of the disease from 16 years and above From 0 to 9 absence Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total Quantity, abs. number % for therapy % on the scale of % of the total χ , P>0.30; V Cramer 0.29, P>0.30. DM: Diabetes mellitus Figure 6: Depression level according to the Beck questionnaire among patients with duration of the disease from 11 to 15 years, depending on the type of treatment Figure 8: Depression level according to the Beck questionnaire among patients with a disease duration of 16 years and above, depending on the type of treatment Figure 7: Depression level according to the Beck questionnaire among patients with a disease duration of 5 10 years, depending on the type of treatment Depressive manifestations, in general, are found among patients with multiple injectable insulin therapies compared to insulin pump therapy. However, in patients with a duration of disease of 16 years and above, a severe depressive condition was found more who was on insulin pump therapy. By age subgroups, it was found that, in patients with type 2 DM at the age of years, the manifestation of a depressive state was detected on pump insulin therapy. One systematic review explains that this can be associated with personal psychological stress and unhappy life situations. The same study showed that anxiety was more common only among participants who knew about their disease. One possible explanation may be that the psychological burden of being sick can play an important role in the occurrence of anxiety and. [12] Thus, in conclusion, it can be said that the method of treatment for the duration of the disease affects only patients with type 2 DM up to 15 years of age. If we analyze by age subgroups, then further study of the influencing factors on in this age category is required. 2566

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