Diabetic complications and poor mental health in the aging population

Introduction: Diabetes is a known risk factor for mental health disorders in the older population. This effect can be due to direct impact of chronic disease or indirectly due to the impact of diabetic complications. This study aims to assess the association of individual diabetic complications with depression, generalized anxiety disorder (GAD), cognitive impairment, and quality of life (QOL) in older diabetic population. Materials and Methods: A cross-sectional study was performed in Geriatric Medicine OutPatient Department from November 2014 to June 2016. One hundred and eighty diabetic patients were diagnosed using the American Diabetes Association (ADA)-2015 diagnostic criteria and were included in the study. They were assessed for the presence of diabetic complications (diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, coronary artery disease , and cerebrovascular disease (CVD) as per the ADA-2015 guidelines. They were also subjected to assessment for the presence of depression, GAD, cognitive impairment, and health-related QOL by using Geriatric Depression Scale, Mini-International Neuropsychiatric Interview, Montreal Cognitive Assessment , and WHOQOL-BREF scale, respectively. The Chi-square test/Fisher's exact test and unpaired t-test were used for the statistical analysis. Results: Diabetic neuropathy and CVD in diabetes have higher risk of depression (49.3% vs. 27%; P = 0.002) and cognitive impairment (82.4% vs. 50.9%; P = 0.013), respectively, as compared to those with diabetes without such complications. Patients with diabetic nephropathy have poor environmental domain QOL (68.02 ± 15.16 vs. 72.82 ± 14.86; P = 0.040) as compared to those without diabetic nephropathy. Conclusions: Diabetic complications in old age are independently associated with increased risk of mental health disorders and impaired health-related QOL. Thus, patients with diabetic complications should be specifically assessed and managed for mental health disorders in addition to the management of metabolic abnormalities.