Tong Aihua, Wang Xihui, Li Fuyuan, Xu Fangjiang, Li Qun, Zhang Fenghua
Department of Endocrine, Yishui Central Hospital, Linyi, Shandong, China.
Department of Nursing, People's Hospital of Linyi City, NO. 27 of Jiefang Road, Linyi, 276000, Shandong, China.
Acta Diabetol. 2016 Aug;53(4):589-98. doi: 10.1007/s00592-016-0845-1. Epub 2016 Feb 29.
Patients with diabetes had a higher risk of developing depressive symptoms. Little is known about the risk of depressive symptoms associated with different glucose metabolism status. We performed a meta-analysis of prospective cohort studies to investigate the risk of depressive symptoms among individuals with impaired glucose metabolism (IGM), newly diagnosed diabetes (NDM), and previously diagnosed diabetes (PDM), compared with those with normal glucose metabolism (NGM), and further examined the influence of diabetes-related comorbidities on the association.
PubMed and EMBASE were searched for relevant studies through 5 September 2015. The random-effects model was used to calculated overall relative risk (RR) and confidence interval (CI). Three separated meta-analyses were conducted by estimating the risk of depressive symptoms among people with IGM, NDM, and PDM, with NGM as a common reference category. Secondary analyses were conducted to examine whether adjustment for diabetes-related comorbidities affected the association.
Five prospective cohort studies were included in the analyses, with a total of 18,051 participants involved. People with IGM (RR = 1.08, 95 % CI 0.84-1.38) and NDM (RR = 1.07, 95 % CI 0.74-1.55) were not associated with risk of developing depressive symptoms, whereas patients with PDM were associated with a modest increased risk of depressive symptoms (RR = 1.29, 95 % CI 1.03-1.63), after adjustment for demographic/socioeconomic factors. The risk of depressive symptoms associated with PDM was attenuated to be non-significant after pooling RRs that were adjusted for diabetes-related comorbidities.
Our meta-analysis suggested people with PDM, but not IGM or NDM had an increased risk of developing depressive symptoms, and the risk was partially explained by diabetes-related comorbidities. Our findings indicated that routine diabetes care should put more emphasis on psychological problems of diabetic patients with complications.
糖尿病患者出现抑郁症状的风险较高。关于不同糖代谢状态与抑郁症状风险之间的关系，人们了解甚少。我们进行了一项前瞻性队列研究的荟萃分析，以调查糖代谢受损（IGM）、新诊断糖尿病（NDM）和既往诊断糖尿病（PDM）个体与糖代谢正常（NGM）个体相比发生抑郁症状的风险，并进一步研究糖尿病相关合并症对这种关联的影响。
通过检索截至2015年9月5日的PubMed和EMBASE数据库查找相关研究。采用随机效应模型计算总体相对风险（RR）和置信区间（CI）。通过估计IGM、NDM和PDM人群中抑郁症状的风险，以NGM作为共同对照类别，进行三项独立的荟萃分析。进行二次分析以检验对糖尿病相关合并症的调整是否会影响这种关联。
分析纳入了五项前瞻性队列研究，共涉及18051名参与者。在调整人口统计学/社会经济因素后，IGM人群（RR = 1.08，95%CI 0.84 - 1.38）和NDM人群（RR = 1.07，95%CI 0.74 - 1.55）与发生抑郁症状的风险无关，而PDM患者发生抑郁症状的风险适度增加（RR = 1.29，95%CI 1.03 - 1.63）。在汇总针对糖尿病相关合并症进行调整后的RR后，与PDM相关的抑郁症状风险减弱至无统计学意义。
我们的荟萃分析表明，PDM患者而非IGM或NDM患者发生抑郁症状的风险增加，且该风险部分由糖尿病相关合并症所解释。我们的研究结果表明，常规糖尿病护理应更重视有并发症的糖尿病患者的心理问题。
