Hall Kirsty K, Tambekou Joelle, Penn Linda, Camara Alioune, Balde Naby M, Sobngwi Eugene
Institute of Health and Society, Newcastle University, United Kingdom.
Catholic University of Central Africa, Cameroon.
S Afr J Psychiatr. 2017 Jun 1;23:983. doi: 10.4102/sajpsychiatry.v23i0.983. eCollection 2017.
The prevalence of diabetes mellitus is increasing especially in low- and middle-income countries in which 75% of the world's diabetic population reside. The macro- and microvascular complications of diabetes such as diabetic retinopathy are also set to increase in these populations.The relationship between depression and glycaemic control has been established in high-income countries, but evidence from low- and middle-income countries is scarce. This research aimed to determine an association between depression and glycaemic control and record the prevalence of diabetic retinopathy in a diabetic population in Cameroon.
Analysis of cross-sectional data from the 'Improving access to HbA1c measurements in sub-Saharan Africa' study was used. Primary data were collected from six diabetic care facilities in Yaoundé, Cameroon. Participants were aged ≥ 18 years with at least a 6-month history of diabetes. Depression was assessed using the Centre for Epidemiological Studies Depression Scale (CES-D). A CES-D score ≥ 16 was used to identify the presence of clinically significant depressive symptoms. Data on glycaemic control were measured using HbA1c measurements at baseline. The presence of diabetic retinopathy was established through ophthalmoscopy and angiography using the Early Treatment Diabetic Retinopathy Study classification.
A total of 261 participants were included in the study, and information on depressive symptoms at baseline (CES-D score) were available for 240 participants. The results of the data analysis found that 60% of the study participants had clinically significant depressive symptoms (CES-D > 16). A weak non-significant positive correlation was found between CES-D score and HbA1c level ( = 0.46, = 0.05) using the Pearson's correlation co-efficient. Gender and attendance to a patient support group were significantly associated with the presence of clinically significant depressive symptoms. Poor glycaemic control (HbA1c > 7%) was found in 72.8% of the population. Educational level and insulin use were significantly associated with glycaemic control.The prevalence of diabetic retinopathy was 27.2% (23.4% non-proliferative, 2.5% pre-proliferative and 3.2% proliferative), and the prevalence of diabetic maculopathy was 10.0%.
The study found that a large proportion of diabetic patients may be experiencing depressive symptoms for which they are currently not receiving treatment or support. We also found a large proportion to have poor glycaemic control that is known to worsen the vascular complications of diabetes. In light of the increasing epidemic of type 2 diabetes in sub-Saharan Africa, it is important that the recognition of depressive symptoms becomes integrated into future healthcare policies in the nations of sub-Saharan Africa. This research suggests that individuals experiencing depressive symptoms may be more likely to engage in patient support groups. These groups can be beneficial in providing patients with diabetes valuable information, which could lead to better glycaemic control.
糖尿病的患病率正在上升，尤其是在中低收入国家，全球75%的糖尿病患者居住在这些国家。糖尿病的大血管和微血管并发症，如糖尿病视网膜病变，在这些人群中也预计会增加。抑郁症与血糖控制之间的关系在高收入国家已得到证实，但来自中低收入国家的证据很少。本研究旨在确定喀麦隆糖尿病患者中抑郁症与血糖控制之间的关联，并记录糖尿病视网膜病变的患病率。
使用“改善撒哈拉以南非洲地区糖化血红蛋白测量的可及性”研究的横断面数据分析。主要数据从喀麦隆雅温得的六个糖尿病护理机构收集。参与者年龄≥18岁，患有至少6个月的糖尿病病史。使用流行病学研究中心抑郁量表（CES-D）评估抑郁症。CES-D评分≥16用于确定存在具有临床意义的抑郁症状。在基线时使用糖化血红蛋白测量来测量血糖控制数据。通过眼科检查和血管造影术，采用早期糖尿病视网膜病变治疗研究分类法确定糖尿病视网膜病变的存在。
共有261名参与者纳入研究，240名参与者有基线时抑郁症状的信息（CES-D评分）。数据分析结果发现，60%的研究参与者有具有临床意义的抑郁症状（CES-D>16）。使用Pearson相关系数，发现CES-D评分与糖化血红蛋白水平之间存在微弱的非显著正相关（r=0.46，p=0.05）。性别和参加患者支持小组与存在具有临床意义的抑郁症状显著相关。72.8%的人群血糖控制不佳（糖化血红蛋白>7%）。教育水平和胰岛素使用与血糖控制显著相关。糖尿病视网膜病变的患病率为27.2%（非增殖性23.4%，增殖前期2.5%，增殖性3.2%），糖尿病黄斑病变的患病率为10.0%。
该研究发现，很大一部分糖尿病患者可能正在经历抑郁症状，但目前他们未得到治疗或支持。我们还发现很大一部分患者血糖控制不佳，而血糖控制不佳已知会使糖尿病的血管并发症恶化。鉴于撒哈拉以南非洲地区2型糖尿病的流行日益加剧，将抑郁症状的识别纳入撒哈拉以南非洲国家未来的医疗政策中很重要。这项研究表明，经历抑郁症状的个体可能更有可能参加患者支持小组。这些小组有助于为糖尿病患者提供有价值的信息，从而可能实现更好的血糖控制。
