Group Health Research Institute, Group Health, Seattle, Washington, USA.
Diabetes Care. 2010 Feb;33(2):264-9. doi: 10.2337/dc09-1068. Epub 2009 Nov 23.
To prospectively examine the association of depression with risks for advanced macrovascular and microvascular complications among patients with type 2 diabetes.
A longitudinal cohort of 4,623 primary care patients with type 2 diabetes was enrolled in 2000-2002 and followed through 2005-2007. Advanced microvascular complications included blindness, end-stage renal disease, amputations, and renal failure deaths. Advanced macrovascular complications included myocardial infarction, stroke, cardiovascular procedures, and deaths. Medical record review, ICD-9 diagnostic and procedural codes, and death certificate data were used to ascertain outcomes in the 5-year follow-up. Proportional hazard models analyzed the association between baseline depression and risks of adverse outcomes.
After adjustment for prior complications and demographic, clinical, and diabetes self-care variables, major depression was associated with significantly higher risks of adverse microvascular outcomes (hazard ratio 1.36 [95% CI 1.05-1.75]) and adverse macrovascular outcomes (1.24 [1.0-1.54]).
Among people with type 2 diabetes, major depression is associated with an increased risk of clinically significant microvascular and macrovascular complications over the ensuing 5 years, even after adjusting for diabetes severity and self-care activities. Clinical and public health significance of these findings rises as the incidence of type 2 diabetes soars. Further research is needed to clarify the underlying mechanisms for this association and to test interventions to reduce the risk of diabetes complications among patients with comorbid depression.
前瞻性研究抑郁症与 2 型糖尿病患者发生大血管和微血管并发症风险的相关性。
2000-2002 年，纳入了一个纵向队列的 4623 名 2 型糖尿病初级保健患者，并在 2005-2007 年进行了随访。微血管并发症包括失明、终末期肾病、截肢和肾衰竭死亡。大血管并发症包括心肌梗死、中风、心血管程序和死亡。使用病历回顾、ICD-9 诊断和程序代码以及死亡证明数据，在 5 年随访期间确定结局。比例风险模型分析了基线抑郁与不良结局风险之间的相关性。
在调整了既往并发症以及人口统计学、临床和糖尿病自我护理变量后，重度抑郁症与不良微血管结局（风险比 1.36[95%CI 1.05-1.75]）和不良大血管结局（1.24[1.0-1.54]）显著相关。
在 2 型糖尿病患者中，即使在调整了糖尿病严重程度和自我护理活动后，重度抑郁症与接下来 5 年内临床显著的微血管和大血管并发症风险增加相关。随着 2 型糖尿病发病率的飙升，这些发现的临床和公共卫生意义更加重大。需要进一步研究来阐明这种关联的潜在机制，并测试针对合并抑郁的患者降低糖尿病并发症风险的干预措施。
