Otieno Cf Frederick, Kanu Joseph E, Karari Emma M, Okech-Helu Violet, Joshi Mark D, Mutai Kenn
Department of Clinical Medicine and Therapeutics, University of Nairobi.
Kenyatta National Hospital, Nairobi, Kenya.
Diabetes Metab Syndr Obes. 2017 Apr 28;10:141-149. doi: 10.2147/DMSO.S124473. eCollection 2017.
Depression and diabetes mellitus are important comorbid conditions with serious health consequences. When depression and diabetes are comorbid, depression negatively affects self-management activities of diabetes with serious consequences. Relationship between treatment regimens of diabetes, the adequacy of glycemic control, and occurrence of comorbid depression is not known among our patients.
This was a cross-sectional descriptive study at the outpatient diabetes clinic of the Kenyatta National Hospital where 220 ambulatory patients with type 2 diabetes on follow-up were systematically sampled. Sociodemographic data and clinical information were documented. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression. Ethylenediaminetetraacetic acid-anticoagulated blood was used for glycated hemoglobin (HbA) assay on automated system, COBAS INTEGRA machine.
Two hundred twenty patients with type 2 diabetes were enrolled. The prevalence of comorbid depression by PHQ-9 was 32.3% (95% confidence interval: 26.4%-38.6%). The majority, 69.5%, had poor glycemic control, HbA >7.0%, mean HbA was 8.9%±2.4%. Half, 50.4%, of the study subjects were on insulin-containing regimens. Over 8% (84.5%) of the participants with comorbid depression had poor glycemic control, which worsened with increasing severity of depression. There was significant correlation between comorbid depression and poor glycemic control, which is more consistent in the insulin-treated patients. However, patients on oral agents only, both with and without comorbid depression, were similar in their glycemic control.
Among our type 2 diabetic population with comorbid depression, a large proportion had poor glycemic control, which worsened with increasing severity of depression. The insulin treatment increased the odds of comorbid depression and poor glycemic control in patients. It is justifiable to screen for comorbid depression in patients with type 2 diabetes who are in poor glycemic control, especially the insulin-treated, and then provide specific and appropriate interventions that are necessary to optimize their metabolic outcomes.
抑郁症和糖尿病是重要的共病情况，会带来严重的健康后果。当抑郁症与糖尿病共病时，抑郁症会对糖尿病的自我管理活动产生负面影响，后果严重。在我们的患者中，糖尿病治疗方案、血糖控制的充分性与共病抑郁症的发生之间的关系尚不清楚。
这是一项在肯雅塔国家医院门诊糖尿病诊所进行的横断面描述性研究，对220名接受随访的2型糖尿病门诊患者进行了系统抽样。记录了社会人口学数据和临床信息。使用患者健康问卷-9（PHQ-9）评估抑郁症。采用乙二胺四乙酸抗凝血液，在COBAS INTEGRA自动化系统上检测糖化血红蛋白（HbA）。
纳入了220名2型糖尿病患者。根据PHQ-9评估，共病抑郁症的患病率为32.3%（95%置信区间：26.4%-38.6%）。大多数患者（69.5%）血糖控制不佳，糖化血红蛋白>7.0%，平均糖化血红蛋白为8.9%±2.4%。一半（50.4%）的研究对象采用含胰岛素的治疗方案。超过8%（84.5%）的共病抑郁症患者血糖控制不佳，且随着抑郁症严重程度的增加而恶化。共病抑郁症与血糖控制不佳之间存在显著相关性，在接受胰岛素治疗的患者中更为一致。然而，仅接受口服药物治疗的患者，无论是否合并抑郁症，血糖控制情况相似。
在我们患有共病抑郁症的2型糖尿病患者中，很大一部分患者血糖控制不佳，且随着抑郁症严重程度的增加而恶化。胰岛素治疗增加了患者共病抑郁症和血糖控制不佳的几率。对于血糖控制不佳的2型糖尿病患者，尤其是接受胰岛素治疗的患者，筛查共病抑郁症并提供优化其代谢结局所需的特定且适当的干预措施是合理可行的。
