Diabetes Research Centre, University of Leicester, Leicester, U.K.
NIHR Leicester Biomedical Research Centre, Leicester, U.K.
Diabetes Care. 2019 Oct;42(10):1847-1853. doi: 10.2337/dc19-0400. Epub 2019 Aug 9.
The impact of major affective disorders on the effectiveness of diabetes prevention programs at promoting health behaviors has not been established. We investigated whether depression modifies the effectiveness of two pragmatic diabetes prevention programs at promoting increased physical activity.
This study pooled data from two cluster randomized controlled trials (Walking Away from Type 2 Diabetes and Let's Prevent Type 2 Diabetes) that included individuals at high risk of type 2 diabetes who were recruited from primary care. The trials used very similar intervention methods to promote physical activity and had annual follow-up over a 36-month period. Depressive symptoms were measured by the Hospital Anxiety and Depression Scale, and physical activity was measured by a piezoelectric pedometer (Let's Prevent Type 2 Diabetes) or an accelerometer (Walking Away from Type 2 Diabetes) and expressed as steps per day.
This analysis included 1,163 individuals (571 control, 592 intervention) who had concurrent baseline and follow-up data for ambulatory activity, depression, and anxiety. The median depression score was 3 at baseline; 11% of individuals were classified as having mild to severe depression. Those with no depressive symptoms at baseline or during follow-up increased their ambulatory activity by 592 steps per day ( < 0.001); this effect decayed by 88 steps per day (95% CI 21, 155) for every additional depressive symptom score at baseline, and each increase in the depressive symptom score between baseline and follow-up further attenuated the intervention effect by 99 steps per day (95% CI 2, 196).
Both depressive symptom burden at baseline and change in this burden are associated with a graded reduction in the effectiveness of diabetes prevention programs at increasing physical activity in primary care.
尚未确定主要情感障碍对促进健康行为的糖尿病预防计划有效性的影响。我们研究了抑郁是否会改变两种实用的糖尿病预防计划在促进增加身体活动方面的有效性。
这项研究汇集了两项基于群组的随机对照试验（Walking Away from Type 2 Diabetes 和 Let's Prevent Type 2 Diabetes）的数据，这些试验纳入了来自初级保健的 2 型糖尿病高危人群。这些试验使用非常相似的干预方法来促进身体活动，并且在 36 个月的时间内进行了年度随访。抑郁症状通过医院焦虑和抑郁量表进行测量，身体活动通过压电计（Let's Prevent Type 2 Diabetes）或加速度计（Walking Away from Type 2 Diabetes）进行测量，并用每天的步数表示。
本分析包括 1163 名（571 名对照组，592 名干预组）同时具有基线和随访的步行活动、抑郁和焦虑数据的个体。基线时的中位抑郁评分是 3 分；11%的个体被归类为有轻度至重度抑郁。那些在基线或随访期间没有抑郁症状的个体，每天增加了 592 步的活动量（<0.001）；在基线时每增加一个额外的抑郁症状评分，这种效果就会减少 88 步/天（95%CI 21，155），而在基线和随访之间抑郁症状评分的每次增加，都会使干预效果进一步减少 99 步/天（95%CI 2，196）。
基线时的抑郁症状负担以及这种负担的变化，与初级保健中增加身体活动的糖尿病预防计划有效性的逐渐降低有关。
