Posted on Diabetes, Mental health

Pandemic exacerbated depression in older adults with diabetes

Risk factors for depression included loneliness, chronic pain and being female.
Risk factors for depression included loneliness, chronic pain and being female.

 A recent study of more than 2,700 older Canadians reported older adults with diabetes faced a heightened risk of depression during the COVID-19 pandemic. In this cohort, almost 50% of those who had a pre-pandemic history of depression experienced depression during the pandemic.

Those who experienced loneliness were among the most impacted.

“During the pandemic, loneliness almost tripled the risk of depression in older adults with diabetes,” says clinical pharmacist and first author ZhiDi Deng. “This not only highlights the impact of quarantines and lock-downs on individuals’ mental health. It also shows us that there is room for improvement on how we can better deliver services to older adults with diabetes in future public health crises.”

Although not as severely impacted as those with a history of depression, one in eight older adults with diabetes who had no history of depression prior to the pandemic were depressed in the autumn of 2020. “The pandemic has taken a significant toll on the mental health of everyone, particularly older adults with chronic conditions such as diabetes,” says co-author Grace Li, a research assistant at the University of Toronto’s Institute for Life Course and Aging (ILCA). “It’s important for primary health providers to be vigilant for signs of depression among their older patients, even those who were doing well in the past.”

The researchers identified several other factors that were associated with a higher risk of depression among those with diabetes, such as being female, having functional limitations or chronic pain, and experiencing family conflict.

They also reported some unexpected findings. The researchers found that those who were separated, divorced, or widowed had lower odds of recurrent depression during the pandemic than those who were married or in common-law relationships. “This is different from research conducted before the pandemic that indicated married individuals usually are less depressed,” said co-author Dorina Cadar, Senior Lecturer in Neuroepidemiology and Dementia at the Centre for Dementia Studies at Brighton and Sussex Medical School and the director of the Cognitive Epidemiology, Dementia, and Ageing Research lab. “We hypothesized that participants who were married during the pandemic experienced worse mental health because the need to stay for extended periods of time in close living proximity during the lockdowns or quarantine could possibly exacerbate any relationship conflicts. Our findings indicate that those who were experiencing family conflict during the pandemic had more than triple the risk of depression during the pandemic.”

The second unexpected finding was that those with higher income prior to the pandemic had a greater risk of depression during the pandemic than those who were poorer.  In pre-pandemic research, higher income is associated with a lower prevalence of depression. 

“We hypothesized that this finding may have been influenced by the generous response of the Canadian government with the Canadian Emergency Response Benefit (CERB), which may have had a protective impact on the mental health of low-income Canadians. CERB provided Canadians who lost employment during the pandemic with a $2000 monthly income. For some low-income individuals and households, this would actually increase their monthly income, thereby reducing financial-related stress among this population,” said co-author Maria Rowsell, a research assistant at the University of Toronto’s ILCA.

The study was conducted using data from the Canadian Longitudinal Study on Aging (CLSA) surveys. The CLSA is a large national longitudinal study involving older Canadians with diabetes. This study identified 2,730 individuals with diabetes in the CLSA sample. In this group, 1,757 individuals had no pre-pandemic history of depression, and 973 had a pre-pandemic history of depression. The study was published online this month in the journal Archives of Gerontology and Geriatrics Plus.

“The long-term implications of the pandemic extend far beyond physical health,” said senior author Professor Esme Fuller-Thomson of the University of Toronto’s Factor-Inwentash Faculty of Social Work and Director of the ILCA. “It is important to improve access to mental health services for people with diabetes, particularly during periods of increased stress. Interventions that have shown promising results to support the mental health of individuals with comorbid depression and diabetes include cognitive behavioural therapy and psychoeducation.  We need to improve access to these important services.”

Posted on Diet

New England Journal of Medicine suggests plant protein beats animal protein

New findings show plants contain all essential amino acids, in contrast to mistaken long-held belief
New findings show plants contain all essential amino acids, in contrast to mistaken long-held belief

Plant-based proteins have major health advantages over animal-based proteins, according to a New England Journal of Medicine letter to the editor by Neal D. Barnard, MD, published Aug. 1, 2024. New findings show that all plants contain all essential amino acids, in contrast to the common but mistaken belief that plants lack one or more amino acids. Of the 20 amino acids that are the building blocks of protein, nine cannot be produced by the human body. All are found in plant sources.

“In addition, plant-based proteins are associated with reduced mortality compared with animal proteins,” says Dr. Barnard, president of the Physicians Committee for Responsible Medicine, a nonprofit public health advocacy organization, and adjunct professor of medicine at the George Washington University School of Medicine and Health Sciences in Washington, D.C. “A major Harvard study showed that when plant-based proteins are consumed instead of protein from beef, poultry, fish, dairy products, or eggs, mortality is reduced.”

People drawing their nutrition from plant-based diets enjoy a reduced risk of diabetes, obesity, heart disease, and cancer. Even so, people on any diet should pay attention to their need for vitamin B12 and other nutrients.

The letter was published in response to a New England Journal of Medicine article introducing a new series on nutrition. “Many people are now shifting to plant-based diets, and their nutrition improves in the process,” Dr. Barnard says. 

Posted on Autism

Top Twenty Inspirational Autistic Folks

Nothing can keep these inspirational figures down! For this list, we’re taking a look at public figures with known diagnoses and/or who identify as being on the autism spectrum. Our countdown includes Dan Harmon, Elon Musk, Clay Marzo, Susan Boyle, Dan Aykroyd, and more! What has your experience with autism been? Let us know in the comments!

Posted on Patient Talk

MS Treatment De-Escalation

May people believe stronger MS medications are better despite the increased risks. But should you take them long term? Is it safe to “deescalate” to a more conservative approach to reduce the risk of side effects (especially infections with immunosuppressants). I review the scientific evidence and multiple observational studies.

Posted on Diabetes, Sleep disorders

Unhealthy sleep linked to diabetes in a diverse population

Kelsie Full

Kelsie Full, PhD, MPH, a behavioural epidemiologist and assistant professor of Medicine at Vanderbilt University Medical Center.

Persistently unhealthy sleep, either not enough or too much, is associated with a significantly increased risk of Type 2 diabetes in a racially and economically diverse adult population, an international team of researchers has reported.

Suboptimal sleep duration is defined as sleeping fewer than seven hours or more than nine hours a night.

Previous studies have found that Black adults are more likely than their white counterparts to experience long-term, unhealthy sleep patterns, as well as a disproportionately high burden of diabetes. Low-income people also are more likely to sleep poorly and develop diabetes.

The current study was based on questionnaires completed by approximately 36,000 adult participants in the Southern Community Cohort Study, which follows the health of a racially and economically diverse group of people in 12 south-eastern states. Most members of the cohort were recruited through community health centers.

Unlike prior studies, which were conducted in predominantly white or exclusively Chinese populations with sleep assessment at a single point in time, approximately 62% of participants in the current study were Black, and their sleep durations were reported in two separate surveys administered an average of five years apart.

“One of the main strengths of our study was that we focused on long-term sleep pattern rather than one-time measurement,” noted Xiao, associate professor of epidemiology, human genetics, and environmental sciences at the UT Health Science Center at Houston School of Public Health.

“Moreover, we conducted the study in a large cohort of predominantly low-income and Black populations, which have been traditionally understudied in health research,” she said. “By focusing on longitudinal sleep patterns, we demonstrated the importance of maintaining a healthy sleep pattern over time for metabolic health.”

The strongest association with diabetes was found among participants reporting more extreme changes and higher variability in their sleep durations. Highly variable periods of sleep have been linked in other studies to poorer control of blood glucose levels, as well as to obesity and diabetes.

The current findings “suggest that a highly variable sleep duration in disadvantaged populations may be an important contributing factor to racial and socioeconomic disparities in cardiometabolic health,” the researchers concluded.

While an abnormally long sleep duration may not directly cause diabetes, it may reflect the presence of other diabetes risk factors, including diabetes-related fatigue. As such, “long sleep is still an important behavioral predictor of diabetes risk that may be used for risk prediction and disease screening,” they added.

The authors recommended further investigation to identify social and environmental factors, such as living in stressful, disadvantaged neighborhoods, which can disrupt normal, healthy sleep, and how sleep disruption may contribute to racial and socioeconomic disparities in health outcomes.

“Intervention studies are also needed to evaluate whether improving sleep health may reduce health disparities in the USA,” they wrote.