Indelicato L, Dauriz M, Santi L, Bonora F, Negri C, Cacciatori V, Targher G, Trento M, Bonora E
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
Nutr Metab Cardiovasc Dis. 2017 Apr;27(4):300-306. doi: 10.1016/j.numecd.2017.01.006. Epub 2017 Jan 31.
To investigate the association of glycemic control with depression, anxiety, self-efficacy and other diabetes-specific psychological measures in a cohort of adult patients with type 2 diabetes (T2D) free of severe chronic diabetes-related complications.
In 172 T2D outpatients consecutively recruited at the Diabetes Center of Verona City Hospital, we performed a standard medical assessment and completed the Beck Depression Inventory-II (BDI-II), the Beck Anxiety Inventory (BAI) and the Multidimensional Diabetes Questionnaire (MDQ) Age, body mass index (BMI) and glycosylated hemoglobin (HbA1c) were (median [IQR]): 64.0 [58.0-69.0] years, 31.0 [28.0-34.4] kg/m, and 7.3 [6.7-8.0] %, respectively. The overall prevalence of anxiety and depression was 14.5% and 18.6%, respectively. Higher levels of HbA1c were significantly (p < 0.001) associated with a number of MDQ dimensions, such as higher perceived interference with daily activities (Spearman's rho coefficient = 0.33), higher perceived diabetes severity (rho = 0.28) and lower self-efficacy (rho = -0.27), but not with depression or anxiety. These three variables were also independent predictors of higher HbA1c levels, when entered in a multivariable stepwise-forward regression model that also included age, BMI, diabetes duration and diabetes-specific social support as covariates.
Lower self-efficacy and higher diabetes distress were closely associated with poorer glycemic control. No direct association between HbA1c and clinical psychological symptoms was detected. These results highlight that a number of diabetes-specific psychological variables may play a role amidst psychological distress and glycemic control. Further studies are needed to elucidate the relevance of diabetes distress and self-efficacy to the achievement of individual glycemic targets.
在一组无严重慢性糖尿病相关并发症的成年2型糖尿病（T2D）患者中，研究血糖控制与抑郁、焦虑、自我效能及其他糖尿病特异性心理指标之间的关联。
在维罗纳市立医院糖尿病中心连续招募的172例T2D门诊患者中，我们进行了标准医学评估，并完成了贝克抑郁量表第二版（BDI-II）、贝克焦虑量表（BAI）和多维糖尿病问卷（MDQ）。年龄、体重指数（BMI）和糖化血红蛋白（HbA1c）分别为（中位数[四分位间距]）：64.0[58.0 - 69.0]岁、31.0[28.0 - 34.4]kg/m²和7.3[6.7 - 8.0]%。焦虑和抑郁的总体患病率分别为14.5%和18.6%。较高的HbA1c水平与MDQ的多个维度显著相关（p < 0.001），如对日常活动的较高感知干扰（斯皮尔曼等级相关系数 = 0.33）、较高的糖尿病严重程度感知（等级相关系数 = 0.28）和较低的自我效能（等级相关系数 = -0.27），但与抑郁或焦虑无关。当将这三个变量纳入多变量逐步向前回归模型（该模型还包括年龄、BMI、糖尿病病程和糖尿病特异性社会支持作为协变量）时，它们也是较高HbA1c水平的独立预测因素。
较低的自我效能和较高的糖尿病困扰与较差的血糖控制密切相关。未检测到HbA1c与临床心理症状之间的直接关联。这些结果表明，一些糖尿病特异性心理变量可能在心理困扰和血糖控制中起作用。需要进一步研究以阐明糖尿病困扰和自我效能与实现个体血糖目标的相关性。
