Poongothai Subramani, Anjana Ranjit Mohan, Pradeepa Rajendra, Ganesan Anbazhagan, Unnikrishnan Ranjit, Rema Mohan, Mohan Viswanathan
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention & Control IDF Centre of Education, Gopalapuram, Chennai, India.
J Assoc Physicians India. 2011 Oct;59:644-8.
The aim of the study was to assess the relationship between depression and diabetic complications among urban south Indian type 2 diabetic subjects [T2DM].
T2DM subjects [n = 847] were recruited from the Chennai Urban Rural Epidemiology Study [CURES], a population based study in Chennai (formerly Madras) in South India. A previously validated depression questionnaire [PHQ-12 item] was administered. Four field stereo retinal colour photography was done and diabetic retinopathy [DR] was classified according to the Early Treatment Diabetic Retinopathy Study grading system. Neuropathy was diagnosed if the vibratory perception threshold of the right great toe, measured by biothesiometry, was > or = 20. Nephropathy was diagnosed if urinary albumin excretion was > or = 300 microg/mg creatinine. Peripheral vascular disease [PVD] was diagnosed if an ankle-brachial index was < 0.9. Coronary artery disease [CAD] was diagnosed based on a past history of documented myocardial infarction and/or electrocardiographic evidence of Q wave and/or ST segment changes.
Of the 847 T2DM studied, 198 (23.4%) were found have depression. The prevalence of depression was significantly higher among diabetic subjects with DR (35.0% vs 21.1%, p < 0.001), neuropathy (28.4% vs 15.9%, p = 0.023), nephropathy (35.6% vs 24.5%, p = 0.04) and PVD (48.0% vs 27.4%, p < 0.001) as compared to subjects without these complications. DR, neuropathy, nephropathy, and PVD were associated with depression even after adjusting for age, gender, duration of diabetes and glycated haemoglobin. DR (Odds ratio [OR] = 2.19, Confidence interval [CI]:1.45-3.51, p < 0.001) was associated with depression even after adjusting for neuropathy and nephropathy. There was also a significant association between depression and neuropathy, after adjusting for retinopathy and nephropathy (OR = 2.07, CI: 1.41-3.04, p < 0.001). There was a significant association of depression with nephropathy but this was lost (OR = 1.71, CI: 0.87-3.35, p = 0.119) after adjustment for retinopathy. PVD (OR = 3.52, CI: 1.94-6.40, p < 0.001) remained significantly associated with depression even after adjusting for CAD. However, there was no significant association of depression with CAD (OR = 0.73, CI: 0.42 -1.27, p = 0.264).
Among Asian Indians, the prevalence of depression is higher in T2DM subjects with retinopathy, neuropathy, nephropathy and PVD compared to those without the respective complications.
本研究旨在评估印度南部城市2型糖尿病（T2DM）患者中抑郁症与糖尿病并发症之间的关系。
从金奈城乡流行病学研究（CURES）中招募了847名T2DM患者，该研究是在印度南部金奈（原马德拉斯）进行的一项基于人群的研究。使用了先前经过验证的抑郁症问卷（PHQ - 12项）。进行了四视野立体视网膜彩色摄影，并根据早期糖尿病视网膜病变研究分级系统对糖尿病视网膜病变（DR）进行分类。如果通过生物感觉测量法测得右大足趾的振动感觉阈值≥20，则诊断为神经病变。如果尿白蛋白排泄量≥300微克/毫克肌酐，则诊断为肾病。如果踝臂指数<0.9，则诊断为外周血管疾病（PVD）。冠心病（CAD）根据既往有记录的心肌梗死病史和/或Q波和/或ST段改变的心电图证据进行诊断。
在研究的847名T2DM患者中，发现198名（23.4%）患有抑郁症。与没有这些并发症的患者相比，患有DR（35.0%对21.1%，p<0.001）、神经病变（28.4%对15.9%，p = 0.023）、肾病（35.6%对24.5%，p = 0.04）和PVD（48.0%对27.4%，p<0.001）的糖尿病患者中抑郁症的患病率显著更高。即使在调整了年龄、性别、糖尿病病程和糖化血红蛋白后，DR、神经病变、肾病和PVD仍与抑郁症相关。即使在调整了神经病变和肾病后，DR（优势比[OR]=2.19，置信区间[CI]：1.45 - 3.51，p<0.001）仍与抑郁症相关。在调整了视网膜病变和肾病后，抑郁症与神经病变之间也存在显著关联（OR = 2.07，CI：1.41 - 3.04，p<0.001）。抑郁症与肾病存在显著关联，但在调整视网膜病变后这种关联消失了（OR = 1.71，CI：0.87 - 3.35，p = 0.119）。即使在调整了CAD后，PVD（OR = 3.52，CI：1.94 - 6.40，p<0.001）仍与抑郁症显著相关。然而，抑郁症与CAD之间没有显著关联（OR = 0.73，CI：0.42 - 1.27，p = 0.264）。
在亚洲印度人中，与没有相应并发症的T2DM患者相比，患有视网膜病变、神经病变、肾病和PVD的T2DM患者中抑郁症的患病率更高。
