Association of depression with increased risk of severe hypoglycemic episodes in patients with diabetes

Ann Fam Med. 2013 May-Jun;11(3):245-50. doi: 10.1370/afm.1501.


Purpose: Although psychosocial and clinical factors have been found to be associated with hypoglycemic episodes in patients with diabetes, few studies have examined the association of depression with severe hypoglycemic episodes. This study examined the prospective association of depression with risk of hypoglycemic episodes requiring either an emergency department visit or hospitalization.

Methods: In a longitudinal cohort study, a sample of 4,117 patients with diabetes enrolled between 2000 and 2002 were observed from 2005 to 2007. Meeting major depression criteria on the Patient Health Questionnaire-9 was the exposure of interest, and the outcome of interest was an International Classification of Disease, Ninth Revision code for a hypoglycemic episode requiring an emergency department visit or hospitalization. Proportional hazard models were used to analyze the association of baseline depression and risk of one or more severe hypoglycemic episodes. Poisson regression was used to determine whether depression status was associated with the number of hypoglycemic episodes.

Results: After adjusting for sociodemographic, clinical measures of diabetes severity, non-diabetes-related medical comorbidity, prior hypoglycemic episodes, and health risk behaviors, depressed compared with nondepressed patients who had diabetes had a significantly higher risk of a severe hypoglycemic episode (hazard ratio = 1.42, 95% CI, 1.03-1.96) and a greater number of hypoglycemic episodes (odds ratio = 1.34, 95% CI, 1.03-1.74).

Conclusion: Depression was significantly associated with time to first severe hypoglycemic episode and number of hypoglycemic episodes. Research assessing whether recognition and effective treatment of depression among persons with diabetes prevents severe hypoglycemic episodes is needed.

Keywords: depression; diabetes; hypoglycemia; mental health.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Activities of Daily Living
  • Adult
  • Aged
  • Analysis of Variance
  • Cohort Studies
  • Comorbidity
  • Depression / diagnosis
  • Depression / epidemiology*
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Diabetes Mellitus, Type 1 / psychology
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetes Mellitus, Type 2 / psychology
  • Female
  • Health Behavior
  • Humans
  • Hypoglycemia / diagnosis
  • Hypoglycemia / epidemiology*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Risk Factors
  • Severity of Illness Index*
  • Socioeconomic Factors