Shomaker Lauren B, Kelly Nichole R, Pickworth Courtney K, Cassidy Omni L, Radin Rachel M, Shank Lisa M, Vannucci Anna, Thompson Katherine A, Armaiz-Flores Sara A, Brady Sheila M, Demidowich Andrew P, Galescu Ovidiu A, Courville Amber B, Olsen Cara, Chen Kong Y, Stice Eric, Tanofsky-Kraff Marian, Yanovski Jack A
Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Hatfield Clinical Research Center, 10 Center Drive, Building 10, Room 1-3330, MSC 1103, Bethesda, MD, 20892-1103, USA.
Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD, 20814-4712, USA.
Ann Behav Med. 2016 Oct;50(5):762-774. doi: 10.1007/s12160-016-9801-0.
Prospective data suggest depressive symptoms worsen insulin resistance and accelerate type 2 diabetes (T2D) onset.
We sought to determine whether reducing depressive symptoms in overweight/obese adolescents at risk for T2D would increase insulin sensitivity and mitigate T2D risk.
We conducted a parallel-group, randomized controlled trial comparing a 6-week cognitive-behavioral (CB) depression prevention group with a 6-week health education (HE) control group in 119 overweight/obese adolescent girls with mild-to-moderate depressive symptoms (Center for Epidemiological Studies-Depression Scale [CES-D] ≥16) and T2D family history. Primary outcomes were baseline to post-intervention changes in CES-D and whole body insulin sensitivity index (WBISI), derived from 2-h oral glucose tolerance tests. Outcome changes were compared between groups using ANCOVA, adjusting for respective baseline outcome, puberty, race, facilitator, T2D family history degree, baseline age, adiposity, and adiposity change. Multiple imputation was used for missing data.
Depressive symptoms decreased (p < 0.001) in CB and HE from baseline to posttreatment, but did not differ between groups (ΔCESD = -12 vs. -11, 95 % CI difference = -4 to +1, p = 0.31). Insulin sensitivity was stable (p > 0.29) in CB and HE (ΔWBISI = 0.1 vs. 0.2, 95 % CI difference = -0.6 to +0.4, p = 0.63). Among all participants, reductions in depressive symptoms were associated with improvements in insulin sensitivity (p = 0.02).
Girls at risk for T2D displayed reduced depressive symptoms following 6 weeks of CB or HE. Decreases in depressive symptoms related to improvements in insulin sensitivity. Longer-term follow-up is needed to determine whether either program causes sustained decreases in depressive symptoms and improvements in insulin sensitivity.
The trial was registered with clinicaltrials.gov (NCT01425905).
前瞻性数据表明，抑郁症状会加重胰岛素抵抗并加速2型糖尿病（T2D）的发病。
我们试图确定减轻有T2D风险的超重/肥胖青少年的抑郁症状是否会提高胰岛素敏感性并降低T2D风险。
我们进行了一项平行组随机对照试验，比较了119名有轻度至中度抑郁症状（流行病学研究中心抑郁量表[CES-D]≥16）且有T2D家族史的超重/肥胖青春期女孩的6周认知行为（CB）抑郁预防组和6周健康教育（HE）对照组。主要结局是干预后CES-D和全身胰岛素敏感性指数（WBISI）相对于基线的变化，全身胰岛素敏感性指数来自2小时口服葡萄糖耐量试验。使用协方差分析比较组间结局变化，并对各自的基线结局、青春期、种族、促进因素、T2D家族史程度、基线年龄、肥胖程度和肥胖变化进行校正。对缺失数据采用多重填补法。
从基线到治疗后，CB组和HE组的抑郁症状均有所减轻（p < 0.001），但两组间无差异（CES-D变化量=-12 vs. -11，95%CI差异=-4至+1，p = 0.31）。CB组和HE组的胰岛素敏感性保持稳定（p > 0.29）（WBISI变化量=0.1 vs. 0.2，95%CI差异=-0.6至+0.4，p = 0.63）。在所有参与者中，抑郁症状的减轻与胰岛素敏感性的改善相关（p = 0.02）。
有T2D风险的女孩在接受6周的CB或HE治疗后，抑郁症状有所减轻。抑郁症状的减轻与胰岛素敏感性的改善有关。需要进行更长时间的随访，以确定这两种方案是否会导致抑郁症状持续减轻和胰岛素敏感性改善。
该试验已在clinicaltrials.gov注册（NCT01425905）。
