Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RJ, UK.
Division of Diabetes and Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Diabetologia. 2017 Oct;60(10):2092-2102. doi: 10.1007/s00125-017-4367-3. Epub 2017 Aug 3.
AIMS/HYPOTHESIS: We examined the associations between depressive symptoms and diabetes distress with glycaemic control and diabetes complications over 2 years, after diagnosis of type 2 diabetes.
In a multi-ethnic, primary care cohort (n = 1735) of adults, all with recent (<6 months) diagnosis of type 2 diabetes, we measured the associations between depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) and diabetes distress (Problem Areas in Diabetes [PAID] score ≥40), with change in 2 year HbA as the primary outcome and with incident rates of diabetes complications as secondary outcomes. Multivariate models were used to account for potential confounders.
Of the 1651 participants (95.2%) of the total primary care cohort with available baseline PHQ-9 and PAID scores, mean ± SD age was 56.2 ± 11.1 years, 55.1% were men and 49.1% were of non-white ethnicity; 232 (14.1%) and 111 (6.7%) had depressive symptoms and diabetes distress, respectively. After adjustment for confounders, depressive symptoms were not associated with worsening HbA. After adjustment for age, sex, ethnicity, vascular risk factors and diabetes treatments, depressive symptoms were associated with increased risk of incident macrovascular complications (OR 2.78 [95% CI 1.19, 6.49], p = 0.018) but not microvascular complications. This was attenuated (p = 0.09) after adjustment for IL-1 receptor antagonist concentration. Diabetes distress was not associated with worsening HbA or incident complications.
CONCLUSIONS/INTERPRETATION: In the first 2 years of type 2 diabetes, the effect of depressive symptoms and diabetes distress on glycaemic control is minimal. There was, however, an association between depressive symptoms and incidence of macrovascular complications. Elevated innate inflammation may be common to both depression and macrovascular diabetes complications, but these findings require replication.
目的/假设：我们研究了抑郁症状和糖尿病困扰与血糖控制以及 2 型糖尿病确诊后 2 年内糖尿病并发症之间的关联。
在一个多民族、初级保健队列（n=1735）中，所有患者均为近期（<6 个月）确诊的 2 型糖尿病患者，我们测量了抑郁症状（PHQ-9 评分≥10）和糖尿病困扰（PAID 评分≥40）与 2 年 HbA 变化的相关性，将 HbA 变化作为主要结果，将糖尿病并发症的发生率作为次要结果。采用多变量模型来考虑潜在的混杂因素。
在具有基线 PHQ-9 和 PAID 评分的 1651 名（95.2%）初级保健队列的参与者中，平均年龄±标准差为 56.2±11.1 岁，55.1%为男性，49.1%为非白种人；232（14.1%）和 111（6.7%）名患者存在抑郁症状和糖尿病困扰。在调整混杂因素后，抑郁症状与 HbA 恶化无关。在调整年龄、性别、种族、血管危险因素和糖尿病治疗后，抑郁症状与大血管并发症的发生风险增加相关（OR 2.78 [95%CI 1.19, 6.49]，p=0.018），但与微血管并发症无关。在调整白细胞介素-1 受体拮抗剂浓度后，这种关联减弱（p=0.09）。糖尿病困扰与 HbA 恶化或并发症发生无关。
结论/解释：在 2 型糖尿病确诊后的头 2 年中，抑郁症状和糖尿病困扰对血糖控制的影响很小。然而，抑郁症状与大血管并发症的发生有关。内源性炎症的升高可能与抑郁和大血管糖尿病并发症都有关，但这些发现需要进一步证实。
