Plener Paul L, Molz Esther, Berger Gabriele, Schober Edith, Mönkemöller Kirsten, Denzer Christian, Goldbeck Lutz, Holl Reinhard W
Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany.
Pediatr Diabetes. 2015 Feb;16(1):58-66. doi: 10.1111/pedi.12130. Epub 2014 Mar 17.
Recent literature suggests an association between type 1 diabetes (T1D) and depression. So far, most studies explored this link in adult populations, with few data being available on diabetes and depression from minors and young adults. This study aimed to look for associations between symptoms of depression/antidepressant treatment and metabolic outcomes of T1D.
We conducted an observational study using the German diabetes database (Diabetes-Patienten-Verlaufsdokumentation--DPV) and searched for patients up to the age of 25 yr, with depressive symptoms and/or receiving antidepressant medication.
Of 53 986 T1D patients below the age of 25 yr, antidepressant medication and/or depressive symptoms were reported in 419 (0.78%). After adjustment for age, gender, diabetes duration and center heterogeneity, minors and young adults with depressive symptoms showed worse outcome parameters such as a higher rate of severe hypoglycemia (0.56 vs. 0.20/patient year, p = 0.005) and more episodes of diabetic ketoacidosis (0.20 vs. 0.07/patient year, p < 0.001). Hemoglobin A1c (HbA1c) was higher in the depression group (74.50 vs. 67.58 mmol/mol, p < 0.001) and young patients with T1D and depression showed longer duration of inpatient treatment (7.04 vs. 3.10 hospital days/patient year, p < 0.001) and more frequent admissions to hospital care (0.63 vs. 0.32/patient year, p < 0.001). Antidepressant medication was recorded in 52.3% of the depressed patients, with selective serotonin reuptake inhibitors (SSRIs) being the most widely described class of antidepressants (29.1%).
Our findings demonstrate an adverse treatment outcome for young patients with T1D and comorbid depressive symptoms underlining an urgent need for collaborative mental and somatic health care for patients with T1D and depression.
近期文献表明1型糖尿病（T1D）与抑郁症之间存在关联。到目前为止，大多数研究在成年人群中探讨了这种联系，关于未成年人和青年糖尿病与抑郁症的数据很少。本研究旨在寻找抑郁症症状/抗抑郁治疗与T1D代谢结局之间的关联。
我们使用德国糖尿病数据库（糖尿病患者病程记录——DPV）进行了一项观察性研究，并搜索了25岁及以下有抑郁症状和/或正在接受抗抑郁药物治疗的患者。
在53986名25岁以下的T1D患者中，有419名（0.78%）报告了抗抑郁药物治疗和/或抑郁症状。在对年龄、性别、糖尿病病程和中心异质性进行调整后，有抑郁症状的未成年人和青年患者表现出更差的结局参数，如严重低血糖发生率更高（0.56对0.20/患者年，p = 0.005）以及糖尿病酮症酸中毒发作更多（0.20对0.07/患者年，p < 0.001）。抑郁症组的糖化血红蛋白（HbA1c）更高（74.50对67.58 mmol/mol，p < 0.001），患有T1D和抑郁症的年轻患者住院治疗时间更长（7.04对3.10住院日/患者年，p < 0.001）且住院护理入院更频繁（0.63对0.32/患者年，p < 0.001）。52.3%的抑郁症患者记录了抗抑郁药物治疗，其中选择性5-羟色胺再摄取抑制剂（SSRIs）是描述最多的一类抗抑郁药（29.1%）。
我们的研究结果表明，患有T1D且伴有抑郁症状的年轻患者治疗结局不佳，突出了对患有T1D和抑郁症的患者进行精神和躯体联合医疗护理的迫切需求。
