Ciechanowski Paul S, Katon Wayne J, Russo Joan E, Hirsch Irl B
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA.
Gen Hosp Psychiatry. 2003 Jul-Aug;25(4):246-52. doi: 10.1016/s0163-8343(03)00055-0.
Depressive symptoms are common among patients with diabetes and may have a significant impact on self-management and health outcomes. In this study we predicted that: 1) there would be a significant association between depressive symptoms and diabetes symptom burden, physical functioning, diabetes self-care, and HbA1c levels; and, 2) that the association between depressive symptoms and HbA1c levels would be significantly greater in type 1, as compared to type 2 diabetic patients. This cross-sectional observational study of 276 type 1 and 199 type 2 diabetes patients took place in a tertiary care specialty clinic. We collected self-reported data on depressive symptoms, complications, medical comorbidity, diabetes symptoms, diabetes self-care behaviors, physical functioning, and demographics. From automated data we determined mean HbA1c levels over the prior year. We performed linear regression analyses to assess the association between depressive symptoms and diabetes symptom perception, diabetes self-care behaviors, physical functioning, and glycemic control. Among patients with type 1 and 2 diabetes, depressive symptoms were associated with greater diabetes symptom reporting, poorer physical functioning, and less adherence to exercise regimens and diet. There was a significant association between depressive symptoms and HbA1c levels in type 1, but not type 2 diabetic patients. Because of their association with clinical aspects of diabetes care such as diabetes symptom reporting and adherence to diabetes self-care, depressive symptoms are important to recognize in treating patients with diabetes.
抑郁症状在糖尿病患者中很常见，可能对自我管理和健康结果产生重大影响。在本研究中，我们预测：1）抑郁症状与糖尿病症状负担、身体功能、糖尿病自我护理及糖化血红蛋白（HbA1c）水平之间将存在显著关联；2）与2型糖尿病患者相比，1型糖尿病患者中抑郁症状与HbA1c水平之间的关联将显著更强。这项横断面观察性研究对276例1型糖尿病患者和199例2型糖尿病患者在一家三级护理专科诊所进行。我们收集了关于抑郁症状、并发症、合并症、糖尿病症状、糖尿病自我护理行为、身体功能和人口统计学的自我报告数据。从自动化数据中，我们确定了前一年的平均HbA1c水平。我们进行线性回归分析，以评估抑郁症状与糖尿病症状感知、糖尿病自我护理行为、身体功能和血糖控制之间的关联。在1型和2型糖尿病患者中，抑郁症状与更多的糖尿病症状报告、更差的身体功能以及较少坚持运动方案和饮食有关。1型糖尿病患者中抑郁症状与HbA1c水平之间存在显著关联，而2型糖尿病患者中则不然。由于抑郁症状与糖尿病护理的临床方面（如糖尿病症状报告和坚持糖尿病自我护理）相关，因此在治疗糖尿病患者时识别抑郁症状很重要。
