The Relation Between HbA1c Levels and Depression Symptoms in Ethnically Diverse, Rural Sample: A Project FRONTIER Study

Diabetes is a serious public health issue and roughly 40% of Americans have hyperglycemic conditions.  Additionally, it is the third highest ranking health concern among rural Americans.  Previous studies have shown that diabetic indicators, such as HbA1c levels, are associated with depression.  The present study sought to examine the relation between depression symptoms and glycemic control (HbA1c) in a rural population. Data was analyzed from 582 rural dwelling participants (331 non-Hispanics and 251 Hispanics) sampled from Project FRONTIER.   Project FRONTIER is a community-based participatory research project studying rural health in West Texas.  Depression symptoms were assessed using the Geriatric Depression Scale and its four sub-factors (Dysphoria, Meaninglessness, Apathy, and Cognitive Impairment).  HbA1c levels and age were entered into the models as predictor variables with the Geriatric Depression Scale sub-factors as the outcome variables.  Follow-up analyses were split by ethnicity in order to see if the relationship differed by ethnicity. For non-Hispanics, there was a significant relationship between Hba1c levels and dysphoria (B=0.23, p<0.05) and cognitive impairment (B=0.16, p<0.05).  For Hispanics, no significant relationships were found between HbA1c levels and GDS sub-factors.  The current findings demonstrate that HbA1c levels are associated with specific symptoms of depression and this link is only significant for non-Hispanics.  As diabetes is a major issue in rural America, it is important that researchers investigate diabetes related topics in rural settings, where certain ethnicities prevail more than others, so evidenced-based relevant practice guidelines can be generated.