University College Cork, School of Medicine, Cork, Ireland.
Southlake Regional Health Centre, Newmarket, Ontario, Canada; University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.
Can J Diabetes. 2020 Aug;44(6):455-460. doi: 10.1016/j.jcjd.2020.03.013. Epub 2020 May 13.
Patients with type 1 and type 2 diabetes mellitus (DM) are 2 times as predisposed to developing mood disorders, such as major depressive disorder (MDD), compared with patients without diabetes. Management of comorbid MDD and DM remains a challenge because patients often suffer from poor medication compliance, lifestyle factors and refractory depression. Integration of psychiatric care into diabetes education clinics (DECs) has been suggested as an effective method of managing the comorbid conditions. As this strategy is being implemented into clinical care, its effectiveness in practice warrants further research.
A retrospective chart review of 24 patients (10 men and 14 women) followed by an integrated psychiatry-DEC in Newmarket, Ontario, Canada, between April 2016 and July 2019 was performed. Depressive symptom severity at each appointment was assessed with the Patient Health Questionnaire-9 (PHQ-9) depression rating scale.
There was no significant change in PHQ-9 depression rating scale scoring between the first and most recent appointments (paired t test, p=0.356); however, patients who had improved PHQ-9 scoring were more likely to have more clinic visits (analysis of variance, p=0.0271). A significant negative correlation was found between both number of visits (Pearson coefficient, -0.56; p=0.005) and overall time the patients were followed by DEC (Pearson coefficient, -0.42; p=0.040) and PHQ-9 score changes between the first and most recent appointments. PHQ-9 change between individual appointments also displayed a positive correlation with time between appointments (Pearson coefficient, 0.26; p=0.027).
Regular follow up in a psychiatry-DEC service might be beneficial in managing MDD symptom severity for comorbid MDD and DM.
与无糖尿病患者相比，1 型和 2 型糖尿病（DM）患者发生心境障碍（如重度抑郁症（MDD））的风险高 2 倍。合并 MDD 和 DM 的治疗仍然是一个挑战，因为患者常常存在药物依从性差、生活方式因素和难治性抑郁等问题。将精神科护理纳入糖尿病教育诊所（DEC）被认为是管理合并症的有效方法。随着这一策略被纳入临床护理，其在实践中的有效性需要进一步研究。
对加拿大安大略省纽马克特的 24 名患者（10 名男性和 14 名女性）进行回顾性图表审查，这些患者在 2016 年 4 月至 2019 年 7 月期间接受了整合精神科-DEC 治疗。每次就诊时，使用患者健康问卷-9（PHQ-9）抑郁评分量表评估抑郁症状严重程度。
PHQ-9 抑郁评分量表评分在首次和最近就诊之间没有显著变化（配对 t 检验，p=0.356）；然而，PHQ-9 评分改善的患者更有可能就诊次数更多（方差分析，p=0.0271）。就诊次数（皮尔逊系数，-0.56；p=0.005）和 DEC 随访时间（皮尔逊系数，-0.42；p=0.040）与首次和最近就诊之间 PHQ-9 评分变化之间均发现显著负相关。个别就诊之间 PHQ-9 评分变化也与就诊间隔时间呈正相关（皮尔逊系数，0.26；p=0.027）。
在精神科-DEC 服务中进行定期随访可能有助于管理合并 MDD 和 DM 的 MDD 症状严重程度。
