Összefoglaló. A cukorbetegség és a depresszió kapcsolatáról számos tanulmány született. A szorongás és a diabetes közti összefüggést már kevesebben vizsgálták, pedig jelentős szerepük van a szorongásos kórképeknek is, hiszen nagyon gyakori a két betegség együttes előfordulása. A diabetes már önmagában is nagy betegségterhet jelent a betegek számára, a társuló pszichiátriai kórképek pedig tovább rontják a kezelés minőségét, ezért fontos a korai felismerésük és kezelésük. Jelen összefoglaló közleményünk célja a szorongásos kórképek és elsősorban a 2-es típusú cukorbetegség közti összefüggés feltárása. Több elmélet született a köztük lévő kapcsolat magyarázatára. Egyesek szerint szerepet játszhat benne a közös etiológiai háttér, mások szerint a cukorbetegség diagnózisa és a gondozásával kapcsolatos feladatok vezetnek szorongáshoz. Megint mások pedig ellentétes irányból vizsgálva a köztük lévő kapcsolatot, arra a megállapításra jutottak, hogy a szorongás különböző fiziológiai mechanizmusokon keresztül vezethet cukorbetegséghez. A szorongás és a diabetes közti kapcsolat irányától függetlenül javasolt a depresszió mellett a szorongásnak a szűrése és minél korábbi kezelése a cukorbetegek körében, így csökkennének a komorbiditásból származó szövődmények, a kezelési nehézségek, javulna a betegek életminősége és a terápiával való együttműködésük. Orv Hetil. 2021; 162(31): 1226–1232.
Summary. The relationship between diabetes and depression has been evaluated in numerous studies. The association between diabetes and anxiety was less investigated, although the importance of anxiety disorders is underlined by its frequent co-occurrence with diabetes. Diabetes alone carries a significant disease burden for patients. Comorbidity with psychiatric disorders deteriorates the quality of care, therefore early treatment and diagnosis of these conditions are essential. The aim of the present review is to outline the relationship between anxiety and mainly type 2 diabetes. There are several theories to explain the relationship between them. Some researchers suggest that common etiological background may play a role in their co-occurrence, some believe that the diagnosis of diabetes and the burden of self-management lead to anxiety, while others – investigating the relationship from the opposite direction – suggest that anxiety leads to diabetes through physiological mechanisms. Independently of the direction of the relationship, screening for anxiety and timely treatment among diabetic patients may decrease the risk of complications, the difficulty in treatment arising from the co-occurrence of these two conditions and may improve patients’ quality of life and adherence to therapy. Orv Hetil. 2021; 162(31): 1226–1232.
Faludi G, Gonda X, Döme P. An update on the conceptual and classification issues of anxiety, its neuroanatomy and problems of anxiolytic drug discovery. [A szorongás konceptuális aspektusai, klasszifikációja, neuroanatómiája és az anxiolitikum-fejlesztés problémái.] Neuropsychopharmacol Hung. 2015; 17: 69–80. [Hungarian]
World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates. WHO, Geneva, 2017. Available from: http://www.who.int/mental_health/management/depression/prevalence_global_health_estimates/en/ [accessed: September 10, 2020].
Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015; 17: 327–335.
Szádóczky E, Rihmer Z, Papp Z, et al. The prevalence of affective and anxiety disorders in primary care practice in Hungary. J Affect Disord. 1997; 43: 239–244.
Wittchen HU, Jacobi F, Rehm J, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011; 21: 655–679.
Kroenke K, Spitzer RL, Williams JB, et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007; 146: 317–325.
International Diabetes Federation. IDF Diabetes Atlas, 9th edn. Brussels, 2019. Available from: https://www.diabetesatlas.org/en/ [accessed: September 10, 2020].
World Health Organization. Diabetes country profiles 2016. Hungary. WHO, Geneva. Available from: http://www.who.int/diabetes/country-profiles/en/#H [accessed: September 10, 2020].
Kempler P, Putz Zs, Kiss Z, et al. Prevalence and financial burden of type 2 diabetes mellitus in Hungary between 2001–2014 – results of the analysis of the National Health Insurance Fund database. [A 2-es típusú diabetes előfordulása és költségterheinek alakulása Magyarországon 2001–2014 között – az Országos Egészségbiztosítási Pénztár adatbázis-elemzésének eredményei.] Diabetol Hung. 2016; 24: 177–188. [Hungarian]
Jermendy Gy, Kiss Z, Rokszin Gy, et al. Epidemiological data of pharmacologically treated patients with type 2 diabetes registered in a central database in Hungary in 2016. [Antidiabetikummal kezelt 2-es típusú cukorbetegek epidemiológiai adatai Magyarországon 2016-ban – központi regiszter adatbázisának elemzése.] Diabetol Hung. 2019; 27: 205–211. [Hungarian]
Smith KJ, Béland M, Clyde M, et al. Association of diabetes with anxiety: a systematic review and meta-analysis. J Psychosom Res. 2013; 74: 89–99.
Chaturvedi SK, Manche Gowda S, Ahmed HU, et al. More anxious than depressed: prevalence and correlates in a 15-nation study of anxiety disorders in people with type 2 diabetes mellitus. Gen Psychiatr. 2019; 32: e100076.
Bouwman V, Adriaanse MC, van ’t Riet E, et al. Depression, anxiety and glucose metabolism in the general Dutch population: the new Hoorn study. PLoS ONE 2010; 5: e9971.
Degmečić D, Bacun T, Kovač V, et al. Depression, anxiety and cognitive dysfunction in patients with type 2 diabetes mellitus – a study of adult patients with type 2 diabetes mellitus in Osijek, Croatia. Coll Antropol. 2014; 38: 711–716.
Hermanns N, Kulzer B, Krichbaum M, et al. Affective and anxiety disorders in a German sample of diabetic patients: prevalence, comorbidity and risk factors. Diabet Med. 2005; 22: 293–300.
Indelicato L, Dauriz M, Santi L, et al. Psychological distress, self-efficacy and glycemic control in type 2 diabetes. Nutr Metab Cardiovasc Dis. 2017; 27: 300–306.
Lewko J, Zarzycki W, Krajewska-Kułak E. Relationship between the occurrence of symptoms of anxiety and depression, quality of life, and level of acceptance of illness in patients with type 2 diabetes. Saudi Med J. 2012; 33: 887–894.
Mikaliūkštienė A, Žagminas K, Juozulynas A, et al. Prevalence and determinants of anxiety and depression symptoms in patients with type 2 diabetes in Lithuania. Med Sci Monit. 2014; 20: 182–190.
Naicker K, Johnson JA, Skogen JC, et al. Type 2 diabetes and comorbid symptoms of depression and anxiety: longitudinal associations with mortality risk. Diabetes Care 2017; 40: 352–358.
Gonda X. The serotonin transporter gene and personality: association of the 5-HTTLPR s allele, anxiety, depression and affective temperaments. [A szerotonintranszporter gén és a személyiség: az 5-HTTLPR s allél, a szorongás, a depresszió és az affektív temperamentumok összefüggése.] Orv Hetil. 2008; 149: 1569–1573. [Hungarian]
Bagdy Gy. Our genes and mental health. Lesson learned from the relationship between the consequences of stress and the genomics of depression. [Génjeink és a lelki egészség. A stressz hatásának és a depresszió genomikájának összefüggései és tanulságai.] Magy Tud. 2012; 173: 660–672. [Hungarian]
Iordanidou M, Tavridou A, Petridis I, et al. The serotonin transporter promoter polymorphism (5-HTTLPR) is associated with type 2 diabetes. Clin Chim Acta 2010; 411: 167–171.
Hameed A, Ajmal M, Nasir M, et al. Genetic association analysis of serotonin transporter polymorphism (5-HTTLPR) with type 2 diabetes patients of Pakistani population. Diabetes Res Clin Pract. 2015; 108: 67–71.
Peralta-Leal V, Leal-Ugarte E, Meza-Espinoza JP, et al. Association of a serotonin transporter gene (SLC6A4) 5-HTTLPR polymorphism with body mass index categories but not type 2 diabetes mellitus in Mexicans. Genet Mol Biol. 2012; 35: 589–593.
Miyata S, Yamada N, Hirano S, et al. Diabetes attenuates psychological stress-elicited 5-HT secretion in the prefrontal cortex but not in the amygdala of mice. Brain Res. 2007; 1147: 233–239.
Wilhelm K, Gillis I, Reddy J, et al. Association between serotonin transporter promoter polymorphisms and psychological distress in a diabetic population. Psychiatry Res. 2012; 200: 343–348.
Agardh E, Allebeck P, Hallqvist J, et al. Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol. 2011; 40: 804–818.
Baum A, Garofalo JP, Yali AM. Socioeconomic status and chronic stress. Does stress account for SES effects on health? Ann N Y Acad Sci. 1999; 896: 131–144.
Smith KJ, Deschênes SS, Schmitz N. Investigating the longitudinal association between diabetes and anxiety: a systematic review and meta-analysis. Diabet Med. 2018; 35: 677–693.
Bonnet F, Irving K, Terra J-L, et al. Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease. Atherosclerosis 2005; 178: 339–344.
Jansson-Fröjmark M, Lindblom K. A bidirectional relationship between anxiety and depression, and insomnia? A prospective study in the general population. J Psychosom Res. 2008; 64: 443–449.
Gariepy G, Nitka D, Schmitz N. The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis. Int J Obes. 2010; 34: 407–419.
van Dam RM. The epidemiology of lifestyle and risk for type 2 diabetes. Eur J Epidemiol. 2003; 18: 1115–1125.
Anothaisintawee T, Reutrakul S, van Cauter E, et al. Sleep disturbances compared to traditional risk factors for diabetes development: systematic review and meta-analysis. Sleep Med Rev. 2016; 30: 11–24.
Chrousos GP. The role of stress and the hypothalamic–pituitary–adrenal axis in the pathogenesis of the metabolic syndrome: neuro-endocrine and target tissue-related causes. Int J Obes Relat Metab Disord. 2000; 24(Suppl 2): S50–S55.
Tian R, Hou G, Li D, et al. A possible change process of inflammatory cytokines in the prolonged chronic stress and its ultimate implications for health. Scientific World J. 2014; 2014: 780616.
Pickup JC, Crook MA. Is type II diabetes mellitus a disease of the innate immune system? Diabetologia 1998; 41: 1241–1248.
O’Donovan A, Hughes BM, Slavich GM, et al. Clinical anxiety, cortisol and interleukin-6: evidence for specificity in emotion–biology relationships. Brain Behav Immun. 2010; 24: 1074–1077.
Pouwer F. Should we screen for emotional distress in type 2 diabetes mellitus? Nat Rev Endocrinol. 2009; 5: 665–671.
Meurs M, Roest AM, Wolffenbuttel BH, et al. Association of depressive and anxiety disorders with diagnosed versus undiagnosed diabetes: an epidemiological study of 90,686 participants. Psychosom Med. 2016; 78: 233–241.
Young-Hyman D, de Groot M, Hill-Briggs F, et al. Psychosocial care for people with diabetes: a position statement of the American Diabetes Association. Diabetes Care 2016; 39: 2126–2140.
Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959; 32: 50–55.
Selye J. Stress without distress. [Stressz distressz nélkül.] Akadémiai Kiadó, Budapest, 1976. [Hungarian]
Nakaya N, Kogure M, Saito-Nakaya K, et al. The association between self-reported history of physical diseases and psychological distress in a community-dwelling Japanese population: the Ohsaki Cohort 2006 Study. Eur J Public Health 2014; 24: 45–49.
Radics J. Anxiety-solving as an essential ingredient for the treatment. [Szorongásoldás mint a gyógyítás nélkülözhetetlen kelléke.] Orv Hetil. 2014; 155: 859–864. [Hungarian]
Fisher L, Hessler DM, Polonsky WH, et al. When is diabetes distress clinically meaningful? Establishing cut points for the Diabetes Distress Scale. Diabetes Care 2012; 35: 259–264.
Jacobson NC, Newman MG. Anxiety and depression as bidirectional risk factors for one another: a meta-analysis of longitudinal studies. Psychol Bull. 2017; 143: 1155–1200.
Hargittay Cs, Márkus B, Vörös K, et al. Co-occurrence of diabetes and depression, their potential bidirectional association and the significance of their screening. [A diabetes és a depresszió együttes előfordulása, lehetséges kétirányú kapcsolata és szűrésük jelentősége.] Orv Hetil. 2019; 160: 807–814. [Hungarian]
International Diabetes Federation. Recommendations for managing type 2 diabetes in primary care. IDF, Brussels, 2017. Available from: https://www.idf.org/managing-type2-diabetes [accessed: December 10, 2020].
Karádi I, Jermendy Gy, Gaál Zs, et al. Clinical practice guideline – Diagnosis of diabetes, and antihyperglycaemic treatment and care of patients with diabetes in adulthood. [Egészségügyi szakmai irányelv – A diabetes mellitus kórismézéséről, a cukorbetegek antihyperglykaemiás kezeléséről és gondozásáról felnőttkorban.] Diabetol Hung. 2020; 28(3): 119–204.