Primary Care, Kronoberg County Council, Växjö, Sweden.
Eur J Endocrinol. 2013 May 2;168(6):861-9. doi: 10.1530/EJE-13-0137. Print 2013 Jun.
The aim of this study was to explore the associations between inadequate glycemic control of diabetes and psychological, anthropometric, and lifestyle variables in a population-based cohort of type 1 diabetes patients.
Cross-sectional study.
In this study, 292 patients with type 1 diabetes, aged 1859 years, participated. psychological data were assessed by self-report instruments: Hospital Anxiety and Depression Scale and Toronto Alexithymia Scale-20. Anthropometrics, blood analyses, data from medical records, and data from the Swedish National Diabetes Registry were collected.
Self-reported depression (adjusted odds ratio (AOR) 4.8), obesity (AOR 4.3), and smoking (AOR 3.0) were independently associated with inadequate glycemic control of diabetes (HbA1c>8.6%). Gender-stratified analyses showed that self-reported depression (AOR 19.8) and obesity (AOR 7.0) in women and smoking in men (AOR 4.2) were associated with HbA1c>8.6%. Alexithymia, antidepressant medication, and physical inactivity were associated with HbA1c>8.6% only in bivariate analyses. Alexithymia, self-rated anxiety, physical inactivity, and absence of abdominal obesity were associated with self-reported depression.
Depression was the only psychological factor independently associated with HbA1c>8.6%. The association was of comparable importance as obesity and smoking, well-known risk factors for inadequate glycemic control and diabetes complications. The association between depression and HbA1c>8.6% was particularly strong for women. Alexithymia, which is a relatively stable personality trait, was associated with depression. In the future care of patients with diabetes, psychological aspects should be considered alongside anthropometrics and lifestyle factors in order to achieve the goals for HbA1c.
本研究旨在探讨 1 型糖尿病患者人群中，血糖控制不佳与心理、人体测量学和生活方式变量之间的关系。
横断面研究。
本研究纳入了 292 名年龄在 18-59 岁的 1 型糖尿病患者。通过自我报告工具评估心理数据：医院焦虑和抑郁量表和多伦多述情障碍量表-20。收集人体测量学、血液分析、病历数据和瑞典国家糖尿病登记处的数据。
自我报告的抑郁（调整后的优势比 (AOR) 4.8）、肥胖（AOR 4.3）和吸烟（AOR 3.0）与糖尿病血糖控制不佳（HbA1c>8.6%）独立相关。性别分层分析显示，女性自我报告的抑郁（AOR 19.8）和肥胖（AOR 7.0）以及男性吸烟（AOR 4.2）与 HbA1c>8.6%相关。述情障碍、抗抑郁药物和身体活动不足仅在双变量分析中与 HbA1c>8.6%相关。述情障碍、自我评估的焦虑、身体活动不足和无腹部肥胖与自我报告的抑郁相关。
抑郁是唯一与 HbA1c>8.6%独立相关的心理因素。这种关联与肥胖和吸烟一样重要，肥胖和吸烟是血糖控制不佳和糖尿病并发症的已知危险因素。抑郁与 HbA1c>8.6%之间的关联在女性中尤为强烈。述情障碍是一种相对稳定的个性特征，与抑郁有关。在未来对糖尿病患者的治疗中，应将心理方面与人体测量学和生活方式因素一起考虑，以实现 HbA1c 的目标。
