Velázquez-Jurado Héctor, Flores-Torres Athena, Pérez-Peralta Liliana, Salinas-Rivera Edgar, Valle-Nava Marianne Daniela, Arcila-Martinez Denise, Hernández-Jiménez Sergio
Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico.
Postgraduate Studies Division, National Autonomous University of Mexico (UNAM), Mexico City, Mexico.
Health Psychol Behav Med. 2023 Feb 19;11(1):2179058. doi: 10.1080/21642850.2023.2179058. eCollection 2023.
Type 2 diabetes mellitus (T2DM) is a chronic disease that affects a person's general well-being. Current evidence sets an association between psychological well-being and controlled metabolic parameters. People newly diagnosed with T2DM show higher prevalence of depression and anxiety symptoms. Cognitive behavioral therapy (CBT) has effectively improved psychological adjustment, but most studies do not specifically address recently diagnosed people nor usually include long-term follow-up measures.
We sought to assess changes in psychological variables in people with newly diagnosed diabetes who received a cognitive-behavioral intervention, within a comprehensive care program.
1208 adults with T2DM (≤5 years) who attended a national health institute in Mexico received a cognitive-behavioral intervention aimed at improving quality of life and reducing emotional distress that often interferes with diabetes control, as well as evaluating cognitive and emotional resources and social support. Measures of quality of life, diabetes-related distress, anxiety and depression questionnaires were compared at pre-test, post-test and follow up using Friedman's ANOVAs. Multiple logistic regression models evaluated glycosylated hemoglobin (HbA1c) and triglycerides control at post-test and follow up.
Questionnaire measures and metabolic variables significantly decreased symptomatology at post-test and these changes maintained at follow-up. Significant associations were found between quality-of-life scores and HbA1c and triglycerides levels in post-test and follow-up. Diabetes-related distress scores increased the odds of having adequate HbA1c control at post-test.
This study contributes to the evidence on the importance of considering psychological factors as part of comprehensive diabetes care to improve quality of life and emotional burden and facilitate the achievement of metabolic goals.
2型糖尿病（T2DM）是一种影响个人总体健康的慢性疾病。目前的证据表明心理健康与代谢参数得到控制之间存在关联。新诊断出T2DM的人群中抑郁和焦虑症状的患病率较高。认知行为疗法（CBT）有效地改善了心理调适，但大多数研究并未专门针对新诊断的人群，也通常未纳入长期随访措施。
我们试图评估在综合护理项目中接受认知行为干预的新诊断糖尿病患者心理变量的变化。
1208名在墨西哥一家国家卫生机构就诊的T2DM成年患者（病程≤5年）接受了一项认知行为干预，旨在改善生活质量并减轻常干扰糖尿病控制的情绪困扰，同时评估认知和情感资源以及社会支持。使用弗里德曼方差分析对生活质量、糖尿病相关困扰、焦虑和抑郁问卷的测量结果在测试前、测试后和随访时进行比较。多元逻辑回归模型评估了测试后和随访时糖化血红蛋白（HbA1c）和甘油三酯的控制情况。
问卷测量结果和代谢变量在测试后症状显著减轻，且这些变化在随访时得以维持。在测试后和随访时，生活质量得分与HbA1c和甘油三酯水平之间发现了显著关联。糖尿病相关困扰得分增加了测试后HbA1c得到充分控制的几率。
本研究为将心理因素作为综合糖尿病护理的一部分以改善生活质量和减轻情绪负担并促进实现代谢目标的重要性提供了证据。
