心理健康症状与患者报告的糖尿病症状负担：对药物治疗方案改变的影响。
Mental health symptoms and patient-reported diabetes symptom burden: implications for medication regimen changes.
作者信息
Sorkin Dara H, Billimek John, August Kristin J, Ngo-Metzger Quyen, Kaplan Sherrie H, Reikes Andrew R, Greenfield Sheldon
机构信息
Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and
Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and.
出版信息
Fam Pract. 2015 Jun;32(3):317-22. doi: 10.1093/fampra/cmv014. Epub 2015 Apr 5.
AIMS
To examine the relative contribution of glycaemic control (HbA1C) and depressive symptoms on diabetes-related symptom burden (hypoglycaemia and hyperglycaemia) in order to guide medication modification.
METHODS
Secondary analysis of medical records data and questionnaires collected from a racially/ethnically diverse sample of adult patients with type 2 diabetes (n = 710) from seven outpatient clinics affiliated with an academic medical centre over a 1-year period as part of the Reducing Racial Disparities in Diabetes: Coached Care (R2D2C2) study.
RESULTS
Results from linear regression analysis revealed that patients with high levels of depressive symptoms had more diabetes-related symptom burden (both hypoglycaemia and hyperglycaemia) than patients with low levels of depressive symptoms (βs = 0.09-0.17, Ps < 0.02). Furthermore, results from two logistic regression analyses suggested that the odds of regimen intensification at 1-year follow-up was marginally associated with patient-reported symptoms of hypoglycaemia [adjusted odds ratio (aOR) = 1.24, 95% CI: 0.98-1.58; P = 0.08] and hyperglycaemia (aOR = 1.21, 95% CI: 1.00-1.46; P = 0.05), after controlling for patients' HbA1C, comorbidity, insulin use and demographics. These associations, however, were diminished for patients with high self-reported hypoglycaemia and high levels of depressive symptoms, but not low depressive symptoms (interaction terms for hypoglycaemia by depressive symptoms, aOR = 0.98, 95% CI: 0.97-0.99; P = 0.03).
CONCLUSIONS
Mental health symptoms are associated with higher levels of patient-reported of diabetes-related symptoms, but the association between diabetes-related symptoms and subsequent regimen modifications is diminished in patients with greater depressive symptoms. Clinicians should focus attention on identifying and treating patients' mental health concerns in order to address the role of diabetes-related symptom burden in guiding physician medication prescribing behaviour.
目的
研究血糖控制（糖化血红蛋白）和抑郁症状对糖尿病相关症状负担（低血糖和高血糖）的相对影响，以指导药物调整。
方法
对来自一所学术医疗中心下属7家门诊的2型糖尿病成年患者（n = 710）进行种族/民族多样化抽样，收集其病历数据和问卷，并进行二次分析。这些数据收集于1年期间，是“减少糖尿病种族差异：指导护理（R2D2C2）”研究的一部分。
结果
线性回归分析结果显示，抑郁症状水平高的患者比抑郁症状水平低的患者有更多的糖尿病相关症状负担（包括低血糖和高血糖）（β值 = 0.09 - 0.17，P值 < 0.02）。此外，两项逻辑回归分析结果表明，在控制患者的糖化血红蛋白、合并症、胰岛素使用情况和人口统计学因素后，1年随访时强化治疗方案的几率与患者报告的低血糖症状[调整后的优势比（aOR） = 1.24，95%置信区间：0.98 - 1.58；P = 0.08]和高血糖症状（aOR = 1.21，95%置信区间：1.00 - 1.46；P = 0.05）存在微弱关联。然而，对于自我报告低血糖水平高且抑郁症状水平高的患者，这些关联减弱，但对于抑郁症状水平低的患者则不然（低血糖与抑郁症状的交互项，aOR = 0.98，95%置信区间：0.97 - 0.99；P = 0.03）。
结论
心理健康症状与患者报告的较高水平的糖尿病相关症状有关，但在抑郁症状更严重的患者中，糖尿病相关症状与后续治疗方案调整之间的关联减弱。临床医生应关注识别和治疗患者的心理健康问题，以解决糖尿病相关症状负担在指导医生用药行为方面的作用。
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