Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.
Division of Endocrinology and Fleischer Institute for Diabetes and Metabolism, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.
Diabetes Care. 2024 Apr 1;47(4):610-619. doi: 10.2337/dc23-2459.
We evaluated whether adding basal insulin to metformin in adults with early type 2 diabetes mellitus (T2DM) would increase emotional distress relative to other treatments.
The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) of adults with T2DM of <10 years' duration, HbA1c 6.8-8.5%, and taking metformin monotherapy randomly assigned participants to add insulin glargine U-100, sulfonylurea glimepiride, the glucagon-like peptide-1 receptor agonist liraglutide, or the dipeptidyl peptidase 4 inhibitor sitagliptin. The Emotional Distress Substudy enrolled 1,739 GRADE participants (mean [SD] age 58.0 [10.2] years, 32% female, 56% non-Hispanic White, 18% non-Hispanic Black, 17% Hispanic) and assessed diabetes distress and depressive symptoms every 6 months. Analyses examined differences at 1 year and over the 3-year follow-up.
Across treatments, diabetes distress (-0.24, P < 0.0001) and depressive symptoms (-0.67, P < 0.0001) decreased over 1 year. Diabetes distress was lower at 1 year for the glargine group than for the other groups combined (-0.10, P = 0.002). Diabetes distress was also lower for liraglutide than for glimepiride or sitagliptin (-0.10, P = 0.008). Over the 3-year follow-up, there were no significant group differences in total diabetes distress; interpersonal diabetes distress remained lower for those assigned to liraglutide. No significant differences were observed for depressive symptoms.
Contrary to expectations, this randomized trial found no evidence for a deleterious effect of basal insulin on emotional distress. Glargine lowered diabetes distress modestly at 1 year rather than increasing it. Liraglutide also reduced diabetes distress at 1 year. Results can inform treatment decisions for adults with early T2DM.
我们评估了在病程＜10 年、糖化血红蛋白（HbA1c）6.8-8.5%、正在接受二甲双胍单药治疗的 2 型糖尿病（T2DM）成人患者中，加用基础胰岛素对比其他治疗方案是否会导致更严重的情绪困扰。
血糖控制达标治疗的比较和评估研究（GRADE）纳入了病程＜10 年、HbA1c 6.8-8.5%、正在接受二甲双胍单药治疗的 T2DM 成人患者，随机分组后分别接受甘精胰岛素 U-100、格列美脲、胰高血糖素样肽-1 受体激动剂利拉鲁肽或二肽基肽酶-4 抑制剂西格列汀治疗。情绪困扰亚研究纳入了 1739 例 GRADE 参与者（平均[标准差]年龄 58.0[10.2]岁，32%为女性，56%为非西班牙裔白人，18%为非西班牙裔黑人，17%为西班牙裔），每 6 个月评估一次糖尿病困扰和抑郁症状。分析比较了治疗 1 年和 3 年随访期间的差异。
在所有治疗组中，糖尿病困扰（-0.24，P＜0.0001）和抑郁症状（-0.67，P＜0.0001）在 1 年内逐渐减轻。与其他治疗组相比，甘精胰岛素组治疗 1 年后的糖尿病困扰程度更低（-0.10，P=0.002）。与格列美脲或西格列汀相比，利拉鲁肽组的糖尿病困扰程度也更低（-0.10，P=0.008）。在 3 年随访期间，各组间的总体糖尿病困扰程度无显著差异；与接受利拉鲁肽治疗的患者相比，接受其他治疗的患者的人际间糖尿病困扰程度仍较低。两组间的抑郁症状也无显著差异。
与预期相反，这项随机试验并未发现基础胰岛素会对情绪困扰产生有害影响的证据。甘精胰岛素在 1 年内适度降低了糖尿病困扰，而不是增加了它。利拉鲁肽也降低了 1 年内的糖尿病困扰。这些结果可以为病程早期的 T2DM 成人患者的治疗决策提供信息。
