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• W2053177568 abstract "To the Editor: Kimbro et al.1 showed that older people with diabetes mellitus (DM) should be considered a high priority for depression screening and treatment because their mortality rate is high. The association between glucose intolerance and depression and the effect of annual education on lifestyle modification was examined in a 5-year longitudinal study in Japanese older people newly diagnosed with diabetes mellitus according to an oral glucose tolerance test (OGTT). Screening of 378 community-dwelling people aged 60 and older using OGTT (World Health Organization criteria) took place for the first time in 2006 in Tosa, Japan.2, 3 There were 212 people with normal glucose tolerance (NGT), 127 with impaired glucose tolerance (IGT), and 39 with DM. Depressive state was defined as a Geriatric Depression Scale (GDS-15) score of 10 or greater and depressive tendency as score of 6 to 9.4, 5 Depressive state was diagnosed in 11.3% with NGT, 10.2% with IGT, and 7.7% with DM at baseline. Glucose intolerance was not associated with the prevalence of depressive state (DM, odds ratio (OR) = 0.68, 95% confidence interval (CI) = 0.19–2.50; IGT, OR = 1.08, 95% CI = 0.51–2.29) as assessed using multiple logistic regression after adjusting for sex (female, OR = 5.26, 95% CI = 1.61–17.12, P = .006), dependence in activities of daily living (ADLs) (OR = 2.46, 95% CI = 1.01–6.00, P = .048],6 history of a fall in the past year (OR = 2.31, 95% CI = 1.12–4.77, P = .02), age, and dependence in instrumental ADLs (IADLs)3 (Figure 1A). The ethics committees of Kyoto University and the Research Institute approved this study for humanity and nature. Of the 294 participants not in a depressive state at baseline (GDS < 10) who could be followed during the study, the incidence of depressive state at 5 years was 4.3% for NGT, 9.7% for IGT, and 13.3% for DM (chi-square test, P = .10). DM (OR = 6.47, 95% CI = 1.48–28.35, P = .01) and IGT (OR = 3.20, 95% CI = 1.06–9.64, P = .04) were associated with the incidence of depressive state as assessed using multiple logistic regression after adjusting for depressive tendency in baseline (OR = 4.32, 95% CI = 1.59–11.71, P = .004), dependence in IADLs (OR = 2.93, 95% CI = 0.86–10.03, P = .09),5 age, sex, and dependence in ADLs (Figure 1B). All subjects were invited to participate in the five annual glucose intolerance and geriatric functional analyses and education about lifestyle modification during the 5-year study period.3, 7 To analyze the preventive effect of follow-up participation of subjects with NGT, IGT, and DM on the incidence of depressive state, all subjects were assigned to one of two groups: more (≥3) or less (≤2) participation. The incidence of depressive state was 6.7% for NGT with less participation (n = 75), 2.3% for NGT with more participation (n = 86), 13.6% for IGT with less participation (n = 22), 8.6% for IGT with more participation (n = 81), 16.7% for DM with less participation (n = 6), and 12.5% for DM with more participation (n = 24). The OR of more participation compared with less participation was calculated in the NGT, IGT, and DM groups for incidence of depressive state during the 5 years (Figure 1C). In IGT, more participation had a protective effect against depressive state (OR = 0.11, 95% CI = 0.01–0.96, P = .045), as assessed using multiple logistic regression after adjusting for depressive tendency in baseline (OR = 7.34, 95% CI = 1.27–42.37, P = .02), dependence in IADLs (OR = 6.10, 95% CI = 0.82–45.60, P = .08), age, and sex. There was no significant protective effect of more participation in NGT (OR = 0.51, 95% CI = 0.08–3.14) or DM (OR = 0.78, 95% CI = 0.03–17.94). At baseline, no subject was taking antidiabetes medication, but 11 people in the DM or IGT group started taking antidiabetes medication during the 5 years of the study. In the analysis of subjects not taking antidiabetes medication, the significant protective effect against a depressive state of more participation was preserved in the IGT group. Despite no association between glucose intolerance and depressive symptoms at baseline, depressive symptoms increased in IGT and more in DM during the 5 years. Although there was a protective effect against depression in IGT of more participation, the effect was limited, and depressive symptoms apparently increased longitudinally in IGT and DM, as contrasted with the preventive effect against dependence in IADLs in the recent report.3 More attention should be paid to depression in older adults with glucose intolerance.1, 8, 9 Not only early diagnosis and annual follow-up, but also participation in group programs such as music or exercise therapy10 and other activities in social network may be effective in stopping the cycle of depression, housebound status, and deterioration in glucose tolerance. We thank all staff members and participants in Tosa town for their assistance and collaboration in the study. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Study design: Okumiya, Matsubayashi, Otsuka. Analyzed data, wrote manuscript: Okumiya, Fujisawa, Sakamoto, Wada, Imai, Matsubayashi. Participated in baseline or follow-up study: Okumiya, Fujisawa, Sakamoto, Wada, Chen, Imai, Ishimoto, Kimura, Fukutomi, Kato, Tanaka, Hirosaki, Kasahara, Nose, Ishine, Yamamoto, Otsuka, Matsubayashi. Participated in discussion: Okumiya, Sakamoto, Fujisawa, Wada, Chen, Imai, Ishimoto, Kasahara, Fukutomi, Sasiwongsaroj, Kato, Tanaka, Hirosaki, Nakatsuka, Nose, Yamamoto, Matsubayashi. Sponsor's Role: None." @default.
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• W2053177568 date "2015-02-01" @default.
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• W2053177568 title "Effect of Early Diagnosis and Lifestyle Modification on Depressive Symptoms in Community-Dwelling Elderly Adults with Glucose Intolerance: 5-Year Longitudinal Study" @default.
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• W2053177568 doi "https://doi.org/10.1111/jgs.13269" @default.
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