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Brynn Wajda, Allen C Ho, Barry Rovner, Ann P Murchison, Robin J Casten, Julia A Haller; Depression and Self-Care Behaviors Among Patients with Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):187.
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To evaluate the relationships between depression, cognition, perceptions of risk for diabetic complications, and diabetes self-care behaviors among older patients with varying levels of diabetic retinopathy (DR).
Cross-sectional study of patients aged 65 or older with DR. Demographics, self-management practices, perception of risk for diabetic complications, degree of DR, HbA1c, and depression data were collected. The sample was selected to be racially diverse. Cognitive function was assessed using the Hopkins Verbal Learning Test. Initial multivariable analysis performed on 63 patients was conducted to delineate correlates of DR severity and depression. Further multivariate analysis will be presented on a larger cohort.
The majority of patients were African American (66.7%) and female (55.6%). Visual acuity (in the better eye) was not related to depression, but was related to worse cognition (p=0.024). Severity of either DR or A1c elevation was also not related to depression. Degree of worry about losing vision was related to depression severity (p=0.050). Worry about losing eyesight was also related to best eye acuity (p=0.001) as determined by dividing patients into groups with best visual acuity 20/70 or worse versus better than 20/70. Subjects with greater worry and expectation of losing eyesight were more educated (p=0.052), had better cognition (p=0.047), but were less likely to check their glucose (p=0.007). There was a trend toward subjects with macular edema having worse A1c (p=0.071); however subjects with macular edema had better diabetes self-management scores and behaviors compared to those without macular edema (p=0.071).
Patients with DR, poor visual acuity, or worry about visual loss may benefit from referral or screening for poor cognition or mental health care. Those with greater worry about losing vision may also benefit from participation in diabetes education programs that discuss the importance of disease management behaviors such as regular exercise, eating recommended foods and meal portions, checking blood glucose with a monitor, recording blood sugars, taking the correct dosage of diabetic medications at the correct time, treating low blood glucose, and adhering to scheduled medical appointments. The presence of macular edema may be related to higher blood glucose as reflected by a higher A1c.
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