Psychosomatic department, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan Provincial Center for Mental Health, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, 610072, Chengdu, People's Republic of China.
Mental Health Center, West China University Hospital, Sichuan University, 610041, Chengdu, People's Republic of China.
BMC Psychiatry. 2022 Nov 8;22(1):689. doi: 10.1186/s12888-022-04315-1.
Using bipolar disorder (BD) as a control, we explored the possible developmental process of impaired glucose metabolism rhythm.
In total, 441 subjects (77, 162, 134, 54, and 14 in the pre-diabetes [pre-DM], DM, BD, BD + pre-DM, and BD + DM groups, respectively) and 160 controls were included. All subjects were assessed using the Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI). The hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axes were measured.
Cluster analysis showed that the BD, BD + DM, and DM groups were classified as the 'disease group, the BD + pre-DM group as the 'mixed period group', and the pre-DM group as the 'pre-disease group'. The conscientiousness factor scores of the NEO-FFI in the 'disease group' were higher than the norm but lower than the norm in the 'pre-disease group'. The scores of neurotic factors in the 'pre-disease' and 'mixed period' groups were both significantly higher than that in the 'disease group' (corrected p < 0.001). The incidences of the abnormal HPA axis decreased gradually from the 'pre-disease group' to the 'mixed period group' then to the 'disease group', while those of the HPT axis slightly increased at first and then significantly decreased. The overall prediction rate of the multiple logistic regression model was 92.7%.
This study suggests that progression of pre-diabetes to DM is a continuous process from local abnormalities to rhythm disorder of glucose metabolism. This understanding can be applied to the whole course management and early intervention of DM and to the future development of optimised treatment based on rhythm regulation.
Clinical trial registration number: ChiCTR1800019064. Name of trial registration: Identify and the optimization of treatment for non-infectious chronic diseases under the "stress-dysrhythmia" theory hypothesis (Registration date: 24/10/2018). The full trial protocol can be accessed at the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ).
以双相情感障碍（BD）为对照，探讨葡萄糖代谢节律受损的可能发展过程。
共纳入 441 例受试者（分别为糖尿病前期[pre-DM]组 77 例、DM 组 162 例、BD 组 134 例、BD+pre-DM 组 54 例和 BD+DM 组 14 例）和 160 例对照。所有受试者均采用神经症-外向性-开放性五因素人格量表（NEO-FFI）进行评估。测量下丘脑-垂体-肾上腺（HPA）和下丘脑-垂体-甲状腺（HPT）轴。
聚类分析显示，BD、BD+DM 和 DM 组为“疾病组”，BD+pre-DM 组为“混合期组”，pre-DM 组为“前期疾病组”。NEO-FFI 的尽责因子评分在“疾病组”高于正常值，但低于“前期疾病组”。“前期疾病”和“混合期”组的神经质因子评分均明显高于“疾病组”（校正后 p<0.001）。HPA 轴异常的发生率从“前期疾病组”逐渐降低到“混合期组”，再到“疾病组”，而 HPT 轴的发生率先略有升高，然后明显降低。多因素逻辑回归模型的总体预测率为 92.7%。
本研究提示，从局部异常到葡萄糖代谢节律紊乱，糖尿病前期向糖尿病的进展是一个连续的过程。这种认识可以应用于糖尿病的全程管理和早期干预，以及基于节律调节的优化治疗的未来发展。
临床试验注册号：ChiCTR1800019064。试验注册名称：基于“应激-节律失调”理论假说识别和优化非传染性慢性病治疗（注册日期：2018 年 10 月 24 日）。完整的试验方案可在中国临床试验注册中心（http://www.chictr.org.cn/）查阅。
