Naicker Kiyuri, Øverland Simon, Johnson Jeffrey A, Manuel Douglas, Skogen Jens C, Sivertsen Børge, Colman Ian
School of Public Health and Preventive Medicine, University of Ottawa, Ontario Canada.
Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Psychosocial Science, University of Bergen, Norway.
Psychoneuroendocrinology. 2017 Oct;84:116-123. doi: 10.1016/j.psyneuen.2017.07.002. Epub 2017 Jul 6.
To determine if symptoms of depression and anxiety are differentially associated with clinical diabetes measures and self-management behaviours in individuals with Type 2 diabetes, and whether these associations vary by patient sex.
A cross-sectional analysis using data from 2035 adults with Type 2 diabetes in the Nord-Trøndelag Health Study. Multivariate logistic regression was used to explore associations between symptoms of depression and anxiety and waist girth, HDL cholesterol, systolic blood pressure, triglycerides, c-reactive protein, glycemic control, diet adherence, exercise, glucose monitoring, foot checks for ulcers, and the subjective patient experience. Analyses were stratified by sex.
Depression was associated with a lower likelihood of avoiding saturated fats (OR=0.20 [95% CI: 0.06, 0.68]) and increased odds of physical inactivity (OR=1.69 [95% CI: 1.37, 2.72]). Anxiety was associated with increased odds of eating vegetables (OR=1.66 [95% CI: 1.02, 2.73]), and an over two-fold increase of feeling that having diabetes is difficult. In women, anxiety was associated with elevated c-reactive protein levels (OR=1.57 [95% CI: 1.05, 2.34]). In men, depressive symptoms were associated with elevated HbA1c (OR=5.00 [95% CI: 1.15, 8.23).
Symptoms of depression and anxiety were differentially associated with some key diabetes-related measures. Our results suggest sex-specific differences with respect to two important clinical outcomes (i.e., anxiety and CRP in women and depression and glycemic control in men). These findings should alert practitioners to the importance of detection and management of psychological symptoms in individuals with Type 2 diabetes.
确定2型糖尿病患者的抑郁和焦虑症状与临床糖尿病指标及自我管理行为之间是否存在差异关联，以及这些关联是否因患者性别而异。
采用来自北特伦德拉格健康研究中2035名2型糖尿病成年人的数据进行横断面分析。使用多变量逻辑回归来探讨抑郁和焦虑症状与腰围、高密度脂蛋白胆固醇、收缩压、甘油三酯、C反应蛋白、血糖控制、饮食依从性、运动、血糖监测、足部溃疡检查以及患者主观体验之间的关联。分析按性别分层。
抑郁与避免摄入饱和脂肪的可能性较低相关（比值比[OR]=0.20[95%置信区间：0.06,0.68]），且身体不活动的几率增加（OR=1.69[95%置信区间：1.37,2.72]）。焦虑与食用蔬菜的几率增加相关（OR=1.66[95%置信区间：1.02,2.73]），以及感觉患糖尿病困难的几率增加两倍多。在女性中，焦虑与C反应蛋白水平升高相关（OR=1.57[95%置信区间：1.05,2.34]）。在男性中，抑郁症状与糖化血红蛋白升高相关（OR=5.00[95%置信区间：1.15,8.23]）。
抑郁和焦虑症状与一些关键的糖尿病相关指标存在差异关联。我们的结果表明在两个重要临床结局方面存在性别差异（即女性的焦虑和C反应蛋白，男性的抑郁和血糖控制）。这些发现应提醒从业者注意2型糖尿病患者心理症状检测和管理的重要性。
