Langberg Joshua, Mueller Anna, Rodriguez de la Vega Pura, Castro Grettel, Varella Marcia
Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Medical and Population Health Sciences Research, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Cureus. 2022 Feb 28;14(2):e22688. doi: 10.7759/cureus.22688. eCollection 2022 Feb.
Diabetes mellitus is linked to a decreased health-related quality of life, including poor mental health. Glycated hemoglobin/hemoglobin A1c (HbA1c) is an important marker in the diagnosis and management of diabetes mellitus. The main objective of this study was to assess the association between HbA1c levels (adequate control of serum glucose levels) and depression status among people with diabetes mellitus in the United States.
We performed a secondary analysis of data from participants of the National Health and Nutrition Examination Survey (NHANES) 2017-2018. The main exposure was HbA1c levels dichotomized into ≤ 7 and > 7. The primary outcome was Patient Health Questionnaire (PHQ-9) scores, dichotomized into no depression (scored 0-4 points) and depression regardless of severity (scored 5-27). Logistic regression was used to assess independent associations.
Our sample included 429 adults with diabetes in the United States. About 41.5% had HbA1c > 7 and 26.8% presented some level of depression. The unadjusted analysis indicated that compared to adults with diabetes with HbA1c > 7, those with HbA1c ≤ 7 had 1.5 times greater odds of having some level of depression (OR = 1.5, 95% CI: 1.04-2.1, p-value = 0.033). However, in the analyses adjusted for sex, race/ethnicity, poverty, BMI, and sedentary lifestyle, the association between HbA1c levels and depression was no longer significant (OR = 1.2, 95% CI: 0.9-1.8, p-value = 0.256). Other factors increasing the odds of depression included lower income to poverty ratio ≤ 1.3 (OR 2.9, 95% CI: 1.0-8.5, p-value = 0.048) and sedentary lifestyle of 5-10 hours and >10 hours (OR = 2.7, 95% CI: 1.6-4.5, p-value = 0.001 and OR = 5.2, 95% CI: 1.7-15.4, p-value = 0.006, respectively).
Our study found no evidence for an association between HbA1c levels and depression. Due to limitations in power and the potential selection and measurement bias, further prospective studies in this field are needed. Implementation of depression screenings in people with diabetes may allow for timely treatment to those affected, improving the mental health of this population.
糖尿病与健康相关生活质量下降有关，包括心理健康不佳。糖化血红蛋白/血红蛋白A1c（HbA1c）是糖尿病诊断和管理中的一个重要指标。本研究的主要目的是评估美国糖尿病患者中HbA1c水平（血清葡萄糖水平的充分控制）与抑郁状态之间的关联。
我们对2017 - 2018年国家健康与营养检查调查（NHANES）参与者的数据进行了二次分析。主要暴露因素是将HbA1c水平分为≤7和>7。主要结局是患者健康问卷（PHQ - 9）得分，分为无抑郁（得分0 - 4分）和无论严重程度的抑郁（得分5 - 27）。采用逻辑回归评估独立关联。
我们的样本包括429名美国成年糖尿病患者。约41.5%的患者HbA1c>7，26.8%的患者有一定程度的抑郁。未调整分析表明，与HbA1c>7的糖尿病成年人相比，HbA1c≤7的成年人有一定程度抑郁的几率高1.5倍（OR = 1.5，95%CI：1.04 - 2.1，p值 = 0.033）。然而，在对性别、种族/民族、贫困、体重指数和久坐生活方式进行调整的分析中，HbA1c水平与抑郁之间的关联不再显著（OR = 1.2，95%CI：0.9 - 1.8，p值 = 0.256）。增加抑郁几率的其他因素包括收入与贫困比≤1.3（OR 2.9，95%CI：1.0 - 8.5，p值 = 0.048）以及5 - 10小时和>10小时的久坐生活方式（OR分别为2.7，95%CI：1.6 - 4.5，p值 = 0.001和OR = 5.2，95%CI：1.7 - 15.4，p值 = 0.006）。
我们的研究未发现HbA1c水平与抑郁之间存在关联的证据。由于样本量、潜在的选择和测量偏倚的限制，该领域需要进一步的前瞻性研究。对糖尿病患者实施抑郁筛查可能使受影响者得到及时治疗，改善该人群的心理健康。
