Schmitt Andreas, Reimer André, Kulzer Bernhard, Haak Thomas, Gahr Annika, Hermanns Norbert
Research Institute of the Diabetes Academy Mergentheim (FIDAM), German Diabetes Center Mergentheim, Theodor-Klotzbücher-Str. 12, 97980, Bad Mergentheim, Germany,
J Behav Med. 2015 Jun;38(3):556-64. doi: 10.1007/s10865-014-9604-3. Epub 2014 Oct 19.
Evidence of the negative impact of depression on glycaemic control is equivocal, and diabetes-related distress has been proposed as potential mediator. 466 diabetes patients were cross-sectionally assessed for depression (Center for Epidemiologic Studies Depression Scale), diabetes-related distress (Diabetes Distress Scale), and glycaemic control (HbA1c). We distinguished the associations of depression and diabetes distress with glycaemic control using analysis of variance and multiple regression. Neither patients with depression only nor diabetes distress only differed significantly from controls regarding HbA1c. However, HbA1c was substantially increased when both conditions were present (9.2 vs. 8.6 %, P = 0.01). As in previous studies, we observed a significant association between depression and hyperglycaemia (P < 0.01). However, a mediation analysis revealed that this association in fact depended on the presence of diabetes distress (P < 0.01). Depression seems to be associated with hyperglycaemia particularly when accompanied by diabetes distress, suggesting that adjusting clinical procedures regarding diabetes distress may facilitate the identification and care of high-risk patients.
抑郁症对血糖控制的负面影响的证据并不明确，糖尿病相关困扰被认为是潜在的中介因素。对466名糖尿病患者进行了横断面评估，包括抑郁症（流行病学研究中心抑郁量表）、糖尿病相关困扰（糖尿病困扰量表）和血糖控制（糖化血红蛋白）。我们使用方差分析和多元回归来区分抑郁症和糖尿病困扰与血糖控制之间的关联。仅患有抑郁症的患者和仅患有糖尿病困扰的患者在糖化血红蛋白方面与对照组相比均无显著差异。然而，当两种情况都存在时，糖化血红蛋白显著升高（9.2%对8.6%，P = 0.01）。与先前的研究一样，我们观察到抑郁症与高血糖之间存在显著关联（P < 0.01）。然而，中介分析显示，这种关联实际上取决于糖尿病困扰的存在（P < 0.01）。抑郁症似乎与高血糖有关，尤其是在伴有糖尿病困扰时，这表明调整关于糖尿病困扰的临床程序可能有助于识别和护理高危患者。
