1 型糖尿病成人的抑郁症状与脑微血管病。
Depressive symptoms and cerebral microvascular disease in adults with Type 1 diabetes mellitus.
机构信息
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
Diabet Med. 2019 Sep;36(9):1168-1175. doi: 10.1111/dme.13879. Epub 2019 Jan 18.
AIM
To assess the prevalence of, and risk factors for, depressive symptoms, comparing a sample of middle-aged adults with and without juvenile-onset Type 1 diabetes mellitus, and to determine if depressive symptoms were associated with white matter hyperintensity volume among those with Type 1 diabetes.
METHODS
Depressive symptoms and white matter hyperintensities were compared between adults (age range 30-65 years) with juvenile-onset Type 1 diabetes (n=130) and adults without Type 1 diabetes (n=133). The association of Type 1 diabetes with depression was computed before and after adjustment for white matter hyperintensities. Among the Type 1 diabetes group, the primary associations of interest were between depressive symptoms (Beck Depression Inventory score ≥10) and white matter hyperintensities (n=71), hyperglycaemia and physical activity. Associations between depressive symptoms and diabetes-related complications, cognitive impairment, smoking and self-reported disability were examined. Analyses were controlled for education, sex, age and antidepressant use.
RESULTS
Depressive symptoms were more prevalent among those with vs those without Type 1 diabetes (28% vs 3%; P<0.001). White matter hyperintensities explained 40% of the association of Type 1 diabetes with depressive symptoms, while Type 1 diabetes had a direct effect of 68% on depressive symptoms. Among those with Type 1 diabetes, depressive symptoms were related to white matter hyperintensity volume, a 16-year average HbA ≥58 mmol/mol (7.5%), and lower physical activity levels. Associations with other characteristics were not significant.
CONCLUSION
These findings suggest a cerebrovascular origin for depressive symptoms in adults with Type 1 diabetes, perhaps triggered by hyperglycaemia. Future longitudinal studies should investigate whether targeting hyperglycaemia and physical inactivity alleviates depressive symptoms, possibly by slowing the development of cerebral microvascular disease, in people with Type 1 diabetes.
目的
评估中年成人中伴有和不伴有青少年起病 1 型糖尿病患者的抑郁症状的流行率和相关因素，并确定抑郁症状是否与 1 型糖尿病患者的脑白质高信号体积有关。
方法
比较了年龄在 30-65 岁之间的患有青少年起病 1 型糖尿病（n=130）和不患有 1 型糖尿病的成年人（n=133）的抑郁症状和脑白质高信号。在调整脑白质高信号后，计算了 1 型糖尿病与抑郁的关联。在 1 型糖尿病组中，主要关注的关联是抑郁症状（贝克抑郁量表评分≥10）与脑白质高信号（n=71）、高血糖和体力活动之间的关系。还检查了抑郁症状与糖尿病相关并发症、认知障碍、吸烟和自我报告残疾之间的关系。分析控制了教育程度、性别、年龄和抗抑郁药的使用。
结果
与不患有 1 型糖尿病的人相比，患有 1 型糖尿病的人抑郁症状更为常见（28% vs 3%；P<0.001）。脑白质高信号解释了 1 型糖尿病与抑郁症状之间 40%的关联，而 1 型糖尿病对抑郁症状的直接影响为 68%。在患有 1 型糖尿病的人群中，抑郁症状与脑白质高信号体积、16 年内平均 HbA ≥58 mmol/mol（7.5%）和较低的体力活动水平有关。与其他特征的关联不显著。
结论
这些发现表明，1 型糖尿病成年人的抑郁症状可能与脑血管疾病有关，其发病机制可能与高血糖有关。未来的纵向研究应该调查是否通过针对高血糖和体力活动不足来减轻抑郁症状，从而可能减缓 1 型糖尿病患者的脑微血管疾病的发展。
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