Concern between medication non-adherence and diabetes associated depression

Krishnan Vengadaragava Chary, Porchelvan Swaminathan


Background: Diabetes mellitus is one of the health disorders that acquire mankind immensely. An ominous twin of diabetes mellitus is diabetes associated depression which is often unrecognised in routine diabetic care. The objective of this study was to find the prevalence and correlation between medication adherence and diabetes associated depression.

Methods: It is a conducted as cross sectional study using Morisky medication adherence scale to evaluate treatment adherence of type II diabetes mellitus. Patient health questionnaire-9 was used to scale the level of depression among our study subjects. Correlation between measures of treatment non adherence and level of depression was elucidated.

Results: Out of 250 patients, 167 (66.8%) (Males -103, Females-64) and 83 (33.2%) (Males-31, Females-52) subjects has medium & low adherence to medication with an average score 6.8 and 4.2 respectively. Total prevalence of depression among diabetics in our study is 41.1% (males-19.2%, females 21.9%). Percentage of patients found to have minor depression was 22.3 % and 18.8 % of depressive subjects falls under major depression category according to PHQ-9 questionnaire with average score of 8.6 for minor depression and 11.9 for major depression. Positive correlation is seen between medication non adherence and diabetes associated depression (Low adherence & Major depression -0.85, Medium adherence &Minor depression -0.79).

Conclusions: Unnoticed depression among diabetic individuals reduces treatment adherence and must be addressed in any patient showing poor response to the treatment. Improving treatment adherence helps to combat diabetes as well as depression.


Diabetes associated depression, Diabetes education, Medication adherence

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International diabetes federation: diabetes atlas 2000. Brussels, international diabetes federation, 2000.

Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK et al. Diabetes epidemiology study group in India (DESI). High prevalence of diabetes and impaired glucose tolerance in India: National urban diabetes survey. Diabetologia. 2001;44:1094-10.

Gelaw BK, Mohammed A, Tegegne GT, Defersha AD, Fromsa M , Tadesse E et al. Non-adherence and contributing factors among ambulatory patients with antidiabetic medications in Adama Referral Hospital. J Diabet Res. 2014;2014:617041.

Medication Adherence Interventions: Comparative Effectiveness. Available at: Accessed on 15 January, 2016.

Riaz M, Basit A, Fawwad A, Yakoob Ahmedani M, Ali Rizvi Z. Factors associated with non-adherence to insulin in patients with type 1 diabetes. Pakistan J Med Sci. 2014;30(2):233-9.

Katon WJ. The Comorbidity of diabetes mellitus and depression. The American J Med. 2008;121(1):8-15.

Gonzalez JS, Peyrot M, McCarl LA, Collins EM, Serpa L, Mimiaga MJ et al. Depression and diabetes treatment non-adherence: a meta-analysis. Diabet Care. 2008;31(12):2398-403.

Leone T, Coast E, Narayanan S, de Graft Aikins A. Diabetes and depression comorbidity and socio-economic status in low and middle income countries (LMICs): a mapping of the evidence. Global Health. 2012;11:8-39.

Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 2000;23:934-42.

Goldman DP, Joyce GF, Zheng Y. Prescription drug cost sharing: associations with medication and medical utilization and spending and health. JAMA. 2007;298:61-9.

George J, Shalansky SJ. Predictors of refill non-adherence in patients with heart failure. British J Clin Pharmacol. 2007;63(4):488-93.

SA, TM. Self-care and medication adherence among type 2 diabetics in Puducherry, Southern India: a hospital based study. J Clin Diagn Res. 2014;8(4):UC01-3.

Mukherjee S, Sharmasarkar B, Das KK, Bhattacharyya A, Deb A. Compliance to anti-diabetic drugs: observations from the diabetic clinic of a medical college in Kolkata, India. J Clin Diagn Res. 2013;7(4):661-5.

Santhanakrishnan I, Lakshminarayanan S, Kar SS. Factors affecting compliance to management of diabetes in urban health center of a tertiary care teaching hospital of south India. J Natur Sci Biol Med. 2014;5(2):365-8.

Raval A, Dhanaraj E, Bhansali A, Grover S, Tiwari P. Prevalence & determinants of depression in type 2 diabetes patients in a tertiary care centre. Indian J Med Res. 2010;132(8):195-200.

Roy T, Lloyd CE. Epidemiology of depression and diabetes: A 3. Systematic review. J Affect Disord. 2012;142:8-21.

Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001;24:1069-78.

Visakh P, Deepali G, Prateek K, Radhakrishnan M. Diabetes-associated depression: the serotonergic system as a novel multifunctional target. 2015;47(1):4-10.

Dou JT, Chen M, Dufour F, Alkon DL, Zhao WQ. Insulin receptor signaling in long-term memory consolidation following spatial learning. Learn Mem. 2005;12:646-55.

Smith GS, Kramer E, Hermann C, Ma Y, Dhawan V, Chaly T et al. Serotonin modulation of cerebral glucose metabolism in depressed older adults. Biol Psychiatry. 2009;66:259-66.

Wilhelm K, Gillis I, Reddy J, Mitchell PB, Campbell L, Dobson-Stone C et al. Association between serotonin transporter promoter polymorphisms and psychological distress in a diabetic population. Psychiatry Res. 2012;200:343-8.

Zalsman G, Huang YY, Oquendo MA, Burke AK, Hu XZ, Brent DA et al. Association of a triallelic serotonin transporter gene promoter region (5-HTTLPR) polymorphism with stressful life events and severity of depression. Am J Psychiatry. 2006;163:1588-93.

Manjarrez-Gutiérrez G, Herrera-Márquez JR, Molina-Hernández A, Bueno-Santoyo S, González-Ramírez M, Hernández J. Changes in cerebral serotonin synthesis induced by insulin-dependent diabetes mellitus. Rev Invest Clin. 1999;51:293-302.

Herrera R, Manjarrez G, Hernandez J. Inhibition and kinetic changes of brain tryptophan-5-hydroxylase during insulin-dependent diabetes mellitus in the rat. Nutr Neurosci. 2005;8:57-62.

Miyata S, Hirano S, Kamei J. Diabetes attenuates the antidepressant-like effect mediated by the activation of 5-HT1A receptor in the mouse tail suspension test. Neuropsychopharmacol. 2004;29:461-9.

Sandrini M, Vitale G, Vergoni AV, Ottani A, Bertolini A. Streptozotocin-induced diabetes provokes changes in serotonin concentration and on 5-HT1A and 5-HT2 receptors in the rat brain. Life Sci. 1997;60:1393-7.

Kinder LS, Katon WJ, Ludman E, Russo J, Simon G, Lin EHB et al. Improving depression care in patients with diabetes and multiple complications. J Gen Intern Med. 2006;21(10):1036-41.

Lin EHB, Rutter CM, Katon W, Heckbert SR, Ciechanowski P, Oliver MM et al. Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care. 2010;33(2):264-9.

Lin EHB, Heckbert SR, Rutter CM, Katon WJ, Ciechanowski P, Ludman EJ et al. Depression and increased mortality in diabetes: unexpected causes of death. Ann Family Med. 2009;7(5):414-21.

Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;(2):CD000011.

Chen B, Zhang X, Xu X, Xiaofeng Lv, Lu Yao, Xu Huang et al. Diabetes education improves depressive state in newly diagnosed patients with type 2 diabetes. Pakistan J Med Sci. 2013;29(5):1147-52.