抑郁症状的减轻可预测血糖控制的改善：来自 DIAMOS 研究的次要结果。

Reduction of depressive symptoms predicts improved glycaemic control: Secondary results from the DIAMOS study.

机构信息

Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbuecher-Str. 12, 97980 Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), 85764 Muenchen, Neuherberg, Germany.

出版信息

J Diabetes Complications. 2017 Nov;31(11):1608-1613. doi: 10.1016/j.jdiacomp.2017.08.004. Epub 2017 Aug 9.

DOI:10.1016/j.jdiacomp.2017.08.004

PMID:28865713

Abstract

AIMS

Evidence from randomised trials analysing effects of depression treatment on glycaemic control in group comparisons is inconsistent. The aim of this study was to test if the reduction of depressive symptoms would explain improved glycaemic control irrespective of treatment groups.

METHODS

The DIAMOS study tested effects of cognitive-behavioural therapy (CBT) versus usual care on depressive symptoms in a 12-month prospective trial; HbA was a secondary outcome. Since the results suggested superiority of CBT for improving depressive symptoms, but not HbA, we conducted this secondary analysis to test if reduction of depressive symptoms could explain improved glycaemic control when assessed irrespective of treatment group affiliation. Reduction of depressive symptoms was assessed using baseline-to-follow-up changes in the Center for Epidemiologic Studies Depression Scale (CES-D). We used multiple regression analyses, adjusting for baseline HbA and depression, group affiliation and covariates, to assess associations between reduction of depressive symptoms and follow-up HbA.

RESULTS

181 participants provided eligible data. Depressive symptoms decreased between baseline and follow-up by averagely -5.1±11.8 CES-D points. Greater reduction of depressive symptoms predicted greater improvement of HbA at follow-up, while adjusting for baseline HbA and covariates (Beta=-0.24, P=0.004). Additionally, patients with greater reduction of depressive symptoms were more likely to reach in-target HbA (<7.5%) at follow-up (adjusted OR=1.04, 95% CI 1.01-1.08, P=0.023).

CONCLUSIONS

The findings suggest that reduction of depressive symptoms can explain improved glycaemic control. Behavioural treatments might aim to improve both affective and glycaemic outcomes.

摘要

目的

分析群组比较中抑郁治疗对血糖控制影响的随机试验证据不一致。本研究旨在检验抑郁症状的减轻是否可以解释血糖控制的改善，而不考虑治疗组。

方法

DIAMOS 研究在一项为期 12 个月的前瞻性试验中测试了认知行为疗法（CBT）与常规护理对抑郁症状的影响；HbA 是次要结局。由于结果表明 CBT 在改善抑郁症状方面具有优越性，但不能改善 HbA，因此我们进行了这项二次分析，以检验无论治疗组归属如何，抑郁症状的减轻是否可以解释血糖控制的改善。抑郁症状的减轻是通过基线到随访期间的中心流行病学研究抑郁量表（CES-D）的变化来评估的。我们使用多元回归分析，调整基线 HbA 和抑郁、治疗组归属和协变量，以评估抑郁症状减轻与随访 HbA 之间的关联。

结果

181 名参与者提供了合格的数据。抑郁症状在基线到随访期间平均减轻了 -5.1±11.8 个 CES-D 点。抑郁症状减轻与随访时 HbA 的改善呈正相关，调整基线 HbA 和协变量后（β=-0.24，P=0.004）。此外，抑郁症状减轻较大的患者在随访时更有可能达到目标 HbA（<7.5%）（调整后的 OR=1.04，95%CI 1.01-1.08，P=0.023）。