抑郁对 8 年后随访的 2 型糖尿病患者死亡率的影响。DIADEMA 研究。

Effect of depression on mortality in type 2 diabetes mellitus after 8 years of follow-up. The DIADEMA study.

机构信息

Subdirección General de Investigación Sanitaria, Consejería de Sanidad de Madrid, Spain; Fundación de Investigación e Innovación Biosanitaria de Atención Primaria, Madrid, Spain; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain; Grupo de Investigación en Envejecimiento y Fragilidad, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain.

Grupo de Investigación en Envejecimiento y Fragilidad, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain; Fundación de Investigación Biomédica del Hospital Universitario La Paz, Madrid, Spain.

出版信息

Diabetes Res Clin Pract. 2021 Jun;176:108863. doi: 10.1016/j.diabres.2021.108863. Epub 2021 May 14.

DOI:10.1016/j.diabres.2021.108863

PMID:33992707

Abstract

AIM

To assess the effect of depression on all-cause mortality in patients with type 2 diabetes mellitus (T2DM) followed up during 8 years in primary care in Spain.

METHODS

Depression was diagnosed according to MINI 5.0.0 questionnaire, physician-diagnosis or following antidepressant therapy for at least two months in 3923 people with T2DM. We analyzed mortality-rates/10,000 person-years. We compared survival according to baseline depression with Kaplan-Meier estimates and the log-rank test. We performed Cox proportional hazard model analyses.

RESULTS

Baseline depression was diagnosed in 22.1% of participants. Mortality was higher in patients with depression (31.9% vs. 26.9%; p = 0.003), who had a significantly poorer survival (median survival = 7.4 vs. 7.8 years, respectively; Log Rank = 15.83; p < 0.001). Depression showed an adjusted mortality hazard ratio (HR) = 1.40 (95%CI:1.20-1.65; p < 0.001). The strongest predictive factors were: age >75 years (HR = 6.04; 95%CI:4.62-7.91; p < 0.001), insulin use (HR = 2.37; 95%CI:1.86-3.00; p < 0.001), lower limb amputation (HR = 1.99; 95%CI:1.28-3.11; p = 0.002), heart failure (HR = 1.94; 95%CI:1.63-2.30; p < 0.001), and male gender (HR = 1.90; 95%CI:1.59-2.27).

CONCLUSION

In a Spanish cohort of older T2DM patients, depression was associated with a higher mortality risk. More efforts are needed to minimize the influence of depression on mortality in people with T2DM and to implement measures that allow its early diagnosis and effective treatment.

摘要

目的

评估西班牙初级保健中，2 型糖尿病（T2DM）患者在 8 年随访期间抑郁对全因死亡率的影响。

方法

根据 MINI 5.0.0 问卷、医生诊断或至少两个月的抗抑郁治疗，对 3923 名 T2DM 患者进行抑郁诊断。我们分析了死亡率/每 10000 人年。我们根据基线抑郁情况比较了生存率，使用 Kaplan-Meier 估计和对数秩检验。我们进行了 Cox 比例风险模型分析。

结果

基线时诊断出患有抑郁的患者占 22.1%。抑郁患者的死亡率更高（31.9%比 26.9%；p=0.003），生存率明显更差（中位生存时间分别为 7.4 年和 7.8 年；Log Rank=15.83；p<0.001）。抑郁显示调整后的死亡率风险比（HR）为 1.40（95%CI：1.20-1.65；p<0.001）。最强的预测因素是：年龄>75 岁（HR=6.04；95%CI：4.62-7.91；p<0.001）、使用胰岛素（HR=2.37；95%CI：1.86-3.00；p<0.001）、下肢截肢（HR=1.99；95%CI：1.28-3.11；p=0.002）、心力衰竭（HR=1.94；95%CI：1.63-2.30；p<0.001）和男性（HR=1.90；95%CI：1.59-2.27）。