Rodríguez-Ramírez Alejandra Monserrat, Alcántara-Garcés María Teresa, Hernández-Jiménez Sergio, García-Ulloa Ana Cristina, Arcila-Martínez Denise, Velázquez-Jurado Héctor, Arizmendi-Rodríguez Rodrigo Eduardo
Centro de Atención Integral del Paciente con Diabetes (CAIPaDi) Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Neuropsychiatr Dis Treat. 2023 Jan 23;19:197-207. doi: 10.2147/NDT.S392672. eCollection 2023.
Anxiety disorders (AXD) are among the most prevalent mental health conditions in patients with type 2 diabetes (T2D). Previous data have established an association of other psychiatric conditions with poor metabolic control and increased odds of diabetes-related complications. Nonetheless, follow-up information about the effects of AXD on the metabolic control of patients with TD2 is still limited.
Evaluate the effects of AXD on the metabolic parameters of patients with T2D over 12 months of follow-up in a multidisciplinary comprehensive care model.
Prospective study of T2D subjects enrolled in a comprehensive care program with follow-up at 3 and 12 months of treatment. Patients were assessed using the Mini-International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale (HADS). We registered clinical and metabolic characteristics from each visit. Metabolic parameters over time were analyzed with a mixed model of repeated measures using AXD and time as interaction variables.
Our sample included 2703 patients at baseline, and 1161 (43%) subjects continued the follow-up at 12 months. The AXD group had more females, lower age, and fewer years of formal education compared with subjects without AXD at baseline, 3 and 12 months. Patients with AXD also reported higher mean fasting glucose at three months, and higher HbA1c at three and 12 months. Our MMRM for HbA1c reported significant differences over time in subjects with and without AXD. The differences in means between groups increased from 0.17% at three months to 0.31% at 12 months. The variables from the HADS anxiety score, sex, age, years of diagnosis, and insulin treatment were also associated with HbA1c parameters over time.
Patients with AXD had the worst glycemic control at 3 and 12 months of follow-up. HbA1c differences in patients with AXD compared with non-AXD subjects increases over time in association with anxiety symptoms.
焦虑症（AXD）是2型糖尿病（T2D）患者中最常见的心理健康问题之一。先前的数据已经证实了其他精神疾病与代谢控制不佳以及糖尿病相关并发症几率增加之间的关联。尽管如此，关于AXD对TD2患者代谢控制影响的随访信息仍然有限。
在多学科综合护理模式下，评估AXD对T2D患者12个月随访期间代谢参数的影响。
对参加综合护理项目的T2D受试者进行前瞻性研究，在治疗3个月和12个月时进行随访。使用迷你国际神经精神访谈和医院焦虑抑郁量表（HADS）对患者进行评估。我们记录每次就诊时的临床和代谢特征。使用AXD和时间作为交互变量，通过重复测量的混合模型分析随时间变化的代谢参数。
我们的样本在基线时有2703名患者，1161名（43%）受试者在12个月时继续随访。与基线、3个月和12个月时无AXD的受试者相比，AXD组女性更多、年龄更小、正规教育年限更少。AXD患者在3个月时还报告平均空腹血糖更高，在3个月和12个月时HbA1c更高。我们针对HbA1c的重复测量混合模型报告，有和没有AXD的受试者随时间存在显著差异。组间均值差异从3个月时的0.17%增加到12个月时的0.31%。HADS焦虑评分、性别、年龄、诊断年限和胰岛素治疗等变量也与随时间变化的HbA1c参数相关。
AXD患者在随访3个月和12个月时血糖控制最差。与无AXD的受试者相比，AXD患者的HbA1c差异随时间增加，且与焦虑症状相关。
