Department of Biostatistics, University of Michigan, Ann Arbor, MI.
Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
Diabetes Care. 2024 Sep 1;47(9):1638-1646. doi: 10.2337/dc24-0818.
To determine bidirectional associations between the timing of chronic diabetes complications (CDCs) and mental health disorders (MHDs) in individuals with type 1 or type 2 diabetes.
We used a nationally representative health care claims database to identify matched individuals with type 1 or 2 diabetes or without diabetes using a propensity score quasirandomization technique stratified by age (0-19, 20-39, 40-59, and ≥60 years). CDCs and MHDs were identified using ICD-9/10 codes. We fit Cox proportional hazards models with time-varying diagnoses of CDCs or MHDs to investigate their association with the hazard of developing MHDs or CDCs, respectively.
From 2001 to 2018, a total of 553,552 individuals were included (44,735 with type 1 diabetes, 152,187 with type 2 diabetes, and 356,630 without diabetes). We found that having a CDC increased the hazard of developing an MHD (hazard ratio [HR] 1.9-2.9; P < 0.05, with higher HRs in older age strata), and having an MHD increased the hazard of developing a CDC (HR 1.4-2.5; P < 0.05, with the highest HR in age stratum 0-19 years). In those aged <60 years, individuals with type 1 diabetes were more likely to have CDCs, whereas individuals with type 2 diabetes were more likely to have MHDs. However, the relationship between CDCs and MHDs in either direction was not affected by diabetes type (P > 0.05 for interaction effects).
We found a consistent bidirectional association between CDCs and MHDs across the life span, highlighting the important relationship between CDCs and MHDs. Prevention and treatment of either comorbidity may help reduce the risk of developing the other.
确定 1 型或 2 型糖尿病患者的慢性糖尿病并发症 (CDC) 和精神健康障碍 (MHD) 的发生时间之间的双向关联。
我们使用全国代表性的医疗保健索赔数据库，通过倾向评分拟随机化技术，根据年龄（0-19 岁、20-39 岁、40-59 岁和≥60 岁）对 1 型或 2 型糖尿病或无糖尿病的匹配个体进行分层，来确定匹配个体。使用 ICD-9/10 代码确定 CDC 和 MHD。我们使用时变诊断的 Cox 比例风险模型来分别研究它们与发生 MHD 或 CDC 的风险之间的关联。
2001 年至 2018 年期间，共纳入 553552 人（44735 人患有 1 型糖尿病，152187 人患有 2 型糖尿病，356630 人无糖尿病）。我们发现，患有 CDC 会增加发生 MHD 的风险（风险比[HR]1.9-2.9；P<0.05，年龄较高的分层中 HR 更高），而患有 MHD 会增加发生 CDC 的风险（HR 1.4-2.5；P<0.05，年龄分层 0-19 岁中 HR 最高）。在<60 岁的人群中，1 型糖尿病患者更有可能患有 CDC，而 2 型糖尿病患者更有可能患有 MHD。然而，无论是在哪个方向上，CDC 和 MHD 之间的关系都不受糖尿病类型的影响（交互作用效应 P>0.05）。
我们在整个生命周期内发现了 CDC 和 MHD 之间一致的双向关联，突出了 CDC 和 MHD 之间的重要关系。预防和治疗任何一种合并症都可能有助于降低发生另一种合并症的风险。
