School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
Diabetes Metab. 2020 Jun;46(3):223-229. doi: 10.1016/j.diabet.2019.08.003. Epub 2019 Aug 28.
Patients with diabetes have higher rates of depression than does the general population, but diabetes management mainly aims to maintain glucose stability. For this reason, our study assessed the relationship between 1-year variations in fasting plasma glucose (FPG) and risk of depression in Chinese patients with type 2 diabetes (T2D).
This retrospective cohort study was conducted on 32,829 patients aged ≥30 years who were diagnosed with T2D and who participated in the National Diabetes Case Management Program in Taiwan. Their 1-year FPG variation as a predictor was determined by coefficient of variation (CV), whereas depressive events were analyzed by Cox's proportional hazards models.
During a mean 8.23 years of follow-up, 1041 new cases of depression were diagnosed. When patients were grouped based on quartiles of FPG-CV, incidence rates were 3.23, 3.49, 3.96 and 4.80 per 1000 person-years in the first, second, third and fourth quartile subgroups, respectively. After adjusting for traditional risk factors, baseline fasting glucose and HbA levels, and diabetes complications, FPG-CV was independently linked with incident depression. Hazard ratios of depression for FPG-CV in the fourth vs first quartile subgroups was 1.33 (95% CI: 1.11-1.59), respectively.
Patients whose 1-year FPG variations were>42.6% had an increased risk of depression, thus suggesting that FPG variations may be a predictor of depression in patients with T2D. Also, glucose variation during outpatient visits may be an indicator for individualized diabetes management in clinical practice.
糖尿病患者的抑郁发生率高于一般人群，但糖尿病管理主要旨在维持血糖稳定。基于此，我们评估了中国 2 型糖尿病（T2D）患者空腹血糖（FPG）1 年变化与抑郁风险的关系。
这项回顾性队列研究纳入了 32829 名年龄≥30 岁、确诊为 T2D 并参加了台湾国家糖尿病病例管理计划的患者。FPG 变化的 1 年预测值由变异系数（CV）确定，而抑郁事件则通过 Cox 比例风险模型进行分析。
在平均 8.23 年的随访期间，新诊断出 1041 例抑郁症。当根据 FPG-CV 的四分位区间将患者分组时，第一、二、三、四分位区间亚组的发生率分别为每 1000 人年 3.23、3.49、3.96 和 4.80。在调整了传统危险因素、基线空腹血糖和糖化血红蛋白水平以及糖尿病并发症后，FPG-CV 与新发抑郁独立相关。FPG-CV 四分位区间与第一四分位区间相比，第四分位区间的抑郁发生风险比为 1.33（95%CI：1.11-1.59）。
1 年内 FPG 变化>42.6%的患者发生抑郁的风险增加，这提示 FPG 变化可能是 T2D 患者抑郁的预测指标。此外，门诊就诊时的血糖波动可能是临床实践中个体化糖尿病管理的一个指标。
