Martino Gabriella, Catalano Antonino, Bellone Federica, Russo Giuseppina Tiziana, Vicario Carmelo Mario, Lasco Antonino, Quattropani Maria Catena, Morabito Nunziata
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy.
Front Psychol. 2019 Jul 31;10:1779. doi: 10.3389/fpsyg.2019.01779. eCollection 2019.
Age-related medical conditions are increasing worldwide. Type 2 Diabetes mellitus (T2DM) represents a chronic disease, which affects a large amount of general population, accounting for over 90% of diabetes mellitus (DM) cases.
As psychopathological symptoms frequently occur in medical conditions, our study aimed at exploring whether psychological factors and metabolic control may affect health related quality of life (HRQoL).
Forty five patients with T2DM were consecutively recruited and assessed with a psychodiagnostic battery: Hamilton Anxiety Rating Scale (HAM-A), Beck Depression Inventory II edition (BDI-II) and the 36-Item Short Form Health Survey (SF-36), including indexes Physical and Mental Component Summary (PCS, MCS). Moreover, time since DM diagnosis and glycated hemoglobin (HbA1c) values were detected.
Participants (mean age 65.3 ± 5.9 years) had a mean time since diagnosis of 11.6 ± 6.7 years, and showed a good metabolic control as highlighted by mean HbA1c values 7.1 ± 0.9%. Median HAM-A score [25(20.7-30.6)], represented high prevalence of anxious symptoms. A moderate expression of depressive symptoms was observed [BDI-II score: 13(8.3-21.4)]. A multiple regression analysis, after correcting for age, BMI, HbA1c value and BDI-II score, showed the perceived quality of life relative to PCS was significantly related to both disease duration (β = -0.55, = 0.03, = 0.25) and HAM-A scores (β = -0.52, = 0.04, = 0.24). Moreover, both HAM-A (β = -0.67, = 0.01, = 0.26) and BDI-II (β = -0.48, = 0.02, = 0.20) scores were independently predictive of MCS. Metabolic control, instead, was not a significant predictor.
Our study suggests a predictive role of both anxiety levels and time since diagnosis in perceived HRQoL in T2DM patients. PCS was associated with anxiety and time since diagnosis and MCS was associated with anxiety and depressive symptoms but not with diabetes duration or metabolic control. These data could be useful to plan T2DM training programs focused on psychological health concerns, possibly leading to a healthy self-management and a better perceived HRQoL, even assisting patients in reducing the negative effect due to the chronicization of T2DM.
全球范围内与年龄相关的医疗状况正在增加。2型糖尿病（T2DM）是一种慢性病，影响着大量普通人群，占糖尿病（DM）病例的90%以上。
由于心理病理症状在医疗状况中经常出现，我们的研究旨在探讨心理因素和代谢控制是否会影响健康相关生活质量（HRQoL）。
连续招募了45名T2DM患者，并使用一套心理诊断量表进行评估：汉密尔顿焦虑评定量表（HAM - A）、贝克抑郁量表第二版（BDI - II）以及36项简短健康调查（SF - 36），包括身体和心理成分总结指数（PCS、MCS）。此外，还检测了自糖尿病诊断以来的时间以及糖化血红蛋白（HbA1c）值。
参与者（平均年龄65.3±5.9岁）自诊断以来的平均时间为11.6±6.7年，平均HbA1c值为7.1±0.9%，表明代谢控制良好。HAM - A评分中位数[25(20.7 - 30.6)]表明焦虑症状的高患病率。观察到抑郁症状的中度表达[BDI - II评分：13(8.3 - 21.4)]。在对年龄、体重指数、HbA1c值和BDI - II评分进行校正后的多元回归分析显示，相对于PCS的生活质量感知与疾病持续时间（β = -0.55，p = 0.03，r = 0.25）和HAM - A评分（β = -0.52，p = 0.04，r = 0.24）均显著相关。此外，HAM - A（β = -0.67，p = 0.01，r = 0.26）和BDI - II（β = -0.48，p = 0.02，r = 0.20）评分均独立预测MCS。相反，代谢控制不是一个显著的预测因素。
我们的研究表明焦虑水平和自诊断以来的时间在T2DM患者的HRQoL感知中具有预测作用。PCS与焦虑和自诊断以来的时间相关，MCS与焦虑和抑郁症状相关，但与糖尿病持续时间或代谢控制无关。这些数据可能有助于规划关注心理健康问题的T2DM培训项目，可能导致健康的自我管理和更好的HRQoL感知，甚至帮助患者减少T2DM慢性化带来的负面影响。
