Department of Diabetes, Maidstone Hospital, Hermitage Lane, Maidstone, Kent, ME16 8QQ, United Kingdom; Department of Diabetes, Maidstone and Tunbridge Wells Hospitals Trust, Maidstone, United Kingdom.
Diabetes Metab. 2013 Oct;39(5):439-44. doi: 10.1016/j.diabet.2013.06.003. Epub 2013 Sep 26.
Continuous subcutaneous insulin infusion (CSII) is generally successful for patients with type 1 diabetes in improving glycaemic control, alleviating the burden of hypoglycaemia and improving the quality of life. There is however, a cohort of patients who fail to thrive on pump therapy and psychological factors or "brittleness" have been posited as a cause for this. We aimed to assess the extent and spectrum of psychological illness in a population of pump patients.
We analysed the patient data and records of 350 patients with type 1 diabetes who formed the insulin pump patient population from a large teaching hospital and compared them with an age and sex matched reference population of patients with type 1 diabetes. We quantified the prevalence of anxiety and depression before and after the initiation of pump therapy and looked to see whether this had implications for changes in glycaemic control and hypoglycaemia reduction.
Mental health problems amongst patients selected for CSII occur significantly more frequently than in a matched population with type 1 diabetes (51% vs 40%, P<0.05). Depression and anxiety were more prevalent in the CSII group. Of those with mental health problems, there is a tendency to do less well in terms of improvements in glycaemic control as indicated by changes in HbA(1c) and hypoglycaemia reduction--the latter most notable in patients with co-existent depression.
The incidence and prevalence of mental health problems in individuals with diabetes is greater than that of the general population. In patients who are selected to go onto insulin pump therapy, the incidence is again greater. We have shown that in those with psychological illness, they tend to do less well in terms of improving their overall diabetes control. These results suggest that CSII may not be a suitable route of therapy alone for all of those who would fulfill the traditional criteria and suggest that psychological assessment, therapy and intervention may be an altogether more appropriate or alternative or adjunctive course of action in supporting their diabetes self management. The wider implication is that all the patients with diabetes should be regularly assessed for psychological problems and that there needs to be greater psychology/psychiatric support available to intensive diabetes clinics, especially as part of a pre-pump pathway.
连续皮下胰岛素输注（CSII）通常可成功改善 1 型糖尿病患者的血糖控制，减轻低血糖负担并提高生活质量。但是，有一部分患者在接受泵治疗后并未得到改善，有人提出心理因素或“脆性”是导致这种情况的原因。我们旨在评估在接受胰岛素泵治疗的患者群体中，心理疾病的程度和范围。
我们分析了来自一家大型教学医院的 350 名 1 型糖尿病患者的患者数据和记录，将他们与年龄和性别匹配的 1 型糖尿病患者参考人群进行了比较。我们量化了在开始泵治疗前后焦虑和抑郁的患病率，并观察了这是否对血糖控制和低血糖减少产生影响。
选择接受 CSII 的患者的心理健康问题比 1 型糖尿病的匹配人群更常见（51%比 40%，P<0.05）。CSII 组的抑郁和焦虑更为普遍。在有心理健康问题的患者中，在血糖控制改善方面表现较差，这一点在合并抑郁的患者中最为明显，表现在 HbA1c 变化和低血糖减少方面。
患有糖尿病的个体的心理健康问题发生率和患病率高于普通人群。在选择接受胰岛素泵治疗的患者中，发病率再次升高。我们已经表明，在有心理疾病的患者中，他们在改善整体糖尿病控制方面的效果较差。这些结果表明，CSII 可能不适用于所有符合传统标准的患者，并且建议心理评估、治疗和干预可能是支持他们自我管理糖尿病的更为合适、替代或辅助方法。更广泛的意义是，所有糖尿病患者都应定期评估心理问题，并且需要为强化糖尿病诊所提供更多的心理/精神病学支持，特别是作为泵前途径的一部分。
