![]() The majority of previous studies have been cross-sectional, while in most, but not all, longitudinal studies, an association between low baseline blood 25(OH)D (25-hydroxyvitamin D) and development of depressive symptoms has been found. Furthermore, systematic reviews and meta-analyses have shown an association between low vitamin D levels and risk of depression, which has been replicated in more recent studies. Several previous studies have demonstrated an association between low levels of vitamin D and increased risk of impaired glucose tolerance, insulin resistance, and incidence of T2D. It would appear that important knowledge concerning certain biological factors is missing that would help to explain this association. ![]() However, a full understanding of the correlation between type 2 diabetes (T2D) and depression is yet lacking. For persons with depressive disorders, behavioral factors such as diet, exercising, and smoking habits associated with obesity and insulin resistance, poor self-care behavior, and biochemical changes, including increased hypothalamic-pituitary-adrenocortical axis activity and sympathetic nervous system activity resulting in elevated cortisol levels, together with increased synthesis of pro-inflammatory cytokines, may lead to diabetes. For individuals with diabetes, these include the psychosocial burden of having a chronic disease, the need for a high level of self-care including blood glucose monitoring, management of medication and strict nutrition, and the biochemical changes associated with diabetes-all of which may lead to depression. A systematic review of the bidirectional relationship has discussed the potential mechanisms. Diabetes may increase the risk of subsequent depression and vice versa. ![]() The prevalence of depression in patients with diabetes is twice that of those without diabetes and even more elevated in women than in men. ![]()
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