Aftab Awais, Bhat Chetan, Gunzler Douglas, Cassidy Kristin, Thomas Charles, McCormick Richard, Dawson Neal V, Sajatovic Martha
1 Case Western Reserve University School of Medicine/University Hospitals Cleveland Medical Center, Cleveland, USA.
2 Case Western Reserve University School of Medicine, Cleveland, USA.
Int J Psychiatry Med. 2018 May;53(3):126-140. doi: 10.1177/0091217417749795. Epub 2017 Dec 27.
Objective Serious mental illness and type II diabetes mellitus have a high comorbidity, and both have a higher prevalence of anxiety disorders compared to the general population. Targeted Training in Illness Management is a group-based self-management training approach which targets serious mental illness and type II diabetes mellitus concurrently. This analysis examines data from a randomized controlled trial of Targeted Training in Illness Management intervention to examine the impact of comorbid anxiety on baseline psychiatric symptomatology and diabetic control, and on longitudinal treatment outcomes. Methods We conducted secondary analyses on data from a prospective, 60-week, randomized controlled trial testing Targeted Training in Illness Management versus treatment as usual in 200 individuals with serious mental illness and diabetes. Primary outcomes included measures related to serious mental illness symptoms, functional status, general health status, and diabetes control. Measures were compared between those participants with anxiety disorders versus those without anxiety at baseline as well as over time using linear mixed effects analyses. Results Forty seven percent of the participants had one or more anxiety disorders. At baseline, those with an anxiety diagnosis had higher illness severity, depressive, and other psychiatric symptomatology and disability. Diabetic control (HbA1c) was not significantly different at baseline. In the longitudinal analyses, no significant mean slope differences over time (group-by-time interaction effect) between those with anxiety diagnoses and those without in treatment as usual group were found for primary outcomes. Within the Targeted Training in Illness Management arm, those with anxiety disorders had significantly greater improvement in mental health functioning. Those with anxiety comorbidity in the Targeted Training in Illness Management group demonstrated significantly lower HbA1c levels compared to no anxiety comorbidity and also demonstrated a greater improvement in HbA1c over the first 30 weeks compared to those without anxiety comorbidity. Conclusion Comorbid anxiety in serious mental illness and type II diabetes mellitus population is associated with increased psychiatric symptomatology and greater disability. Individuals from this population appear to experience greater improvement in functioning from baseline with the Targeted Training in Illness Management intervention. Anxiety comorbidity in the serious mental illness and type II diabetes mellitus population does not appear to have a negative impact on diabetic control. These complex relationships need further study. Clinical Trials Registration ClinicalTrials.gov: Improving outcomes for individuals with serious mental illness and diabetes (NCT01410357).
目的 严重精神疾病与2型糖尿病共病率高，且二者焦虑症患病率均高于普通人群。疾病管理针对性训练是一种基于小组的自我管理训练方法，同时针对严重精神疾病和2型糖尿病。本分析检查了疾病管理针对性训练干预随机对照试验的数据，以研究共病焦虑对基线精神症状和糖尿病控制以及纵向治疗结果的影响。方法 我们对一项前瞻性、为期60周的随机对照试验数据进行了二次分析，该试验在200名患有严重精神疾病和糖尿病的个体中测试疾病管理针对性训练与常规治疗。主要结局包括与严重精神疾病症状、功能状态、总体健康状况和糖尿病控制相关的指标。在基线时以及随着时间的推移，使用线性混合效应分析比较有焦虑症的参与者与无焦虑症的参与者之间的指标。结果 47%的参与者患有一种或多种焦虑症。在基线时，有焦虑症诊断的参与者疾病严重程度、抑郁及其他精神症状和残疾程度更高。基线时糖尿病控制情况（糖化血红蛋白）无显著差异。在纵向分析中，对于主要结局，在常规治疗组中，有焦虑症诊断的参与者与无焦虑症诊断的参与者之间未发现随时间的显著平均斜率差异（组×时间交互效应）。在疾病管理针对性训练组中，有焦虑症的参与者心理健康功能有显著更大改善。疾病管理针对性训练组中有焦虑症共病的参与者与无焦虑症共病的参与者相比，糖化血红蛋白水平显著更低，并且与无焦虑症共病的参与者相比，在最初30周内糖化血红蛋白改善更大。结论 严重精神疾病和2型糖尿病人群中的共病焦虑与精神症状增加和残疾程度加重相关。该人群个体通过疾病管理针对性训练干预似乎从基线开始功能改善更大。严重精神疾病和2型糖尿病人群中的焦虑症共病似乎对糖尿病控制没有负面影响。这些复杂关系需要进一步研究。临床试验注册 ClinicalTrials.gov：改善严重精神疾病和糖尿病个体的结局（NCT01410357）
