Yang Yang, Xing Zhenhua
Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China.
Depress Anxiety. 2024 Sep 27;2024:7115559. doi: 10.1155/2024/7115559. eCollection 2024.
Patients with type 2 diabetes mellitus (T2DM) face an increased risk of developing depression and metabolic dysregulation, which can lead to a higher risk of cardiovascular disease (CVD). However, the relationship between the severity of depression and metabolic dysregulation in patients with T2DM remains unclear. This study aimed to investigate this association using data from the ACCORD-health-related quality of life study. Patient Health Questionnaire-9 (PHQ-9) scores and medication regimens were assessed at baseline, 1, 3, and 4 years, and HbA1c, blood pressure, and lipid levels were monitored every 4 months over a 4-year period. The severity of depressive symptoms was categorized as none (0-4 points), mild (5-9 points), or moderate-severe (10-24 points) based on PHQ-9 scores. Among the participants, 62% developed depressive symptoms at some point during the 4-year follow-up period, with 21% experiencing persistent depressive symptoms. Participants with moderate-to-severe depression exhibited 0.18% (0.12, 0.24) higher levels of HbA1c, 1.11 mmHg (95% CI, 0.04, 2.15) of SBP, 0.90 mmHg (95% CI, 0.22,1.58) of DBP, and 2.12(95% CI, -0.03, 4.27) mg/dL of LDL, and 0.97 (95% CI, 0.38, 1.56) mg/dL lower levels of HDL compared to their counterparts without depressive symptoms. Moreover, as the severity of depressive symptoms increased, variability in HbA1c and blood pressure levels also increased. Furthermore, patients with more severe depressive symptoms demonstrated suboptimal adherence to medication regimens. Our study found a significant association between depressive symptoms severity and metabolic control in T2DM patients. Greater depressive severity correlated with poorer glycemic, blood pressure, and lipid control, alongside increased variability in these parameters. Additionally, patients with severe depressive symptoms showed suboptimal medication adherence. Addressing mental health in T2DM management is crucial to improve metabolic control and reduce CVD risks. ClinicalTrials.gov identifier: NCT00000620.
2型糖尿病（T2DM）患者患抑郁症和代谢失调的风险增加，这可能导致心血管疾病（CVD）风险更高。然而，T2DM患者中抑郁症严重程度与代谢失调之间的关系仍不清楚。本研究旨在利用ACCORD健康相关生活质量研究的数据调查这种关联。在基线、1年、3年和4年时评估患者健康问卷-9（PHQ-9）评分和药物治疗方案，并在4年期间每4个月监测糖化血红蛋白、血压和血脂水平。根据PHQ-9评分，抑郁症状的严重程度分为无（0-4分）、轻度（5-9分）或中度至重度（10-24分）。在参与者中，62%在4年随访期间的某个时间出现抑郁症状，21%经历持续性抑郁症状。与无抑郁症状的参与者相比，中度至重度抑郁症患者的糖化血红蛋白水平高0.18%（0.12，0.24），收缩压高1.11 mmHg（95%CI，0.04，2.15），舒张压高0.90 mmHg（95%CI，0.22，1.58），低密度脂蛋白高2.12（95%CI，-0.03，4.27）mg/dL，高密度脂蛋白低0.97（95%CI，0.38，1.56）mg/dL。此外，随着抑郁症状严重程度的增加，糖化血红蛋白和血压水平的变异性也增加。此外，抑郁症状更严重的患者对药物治疗方案的依从性欠佳。我们的研究发现T2DM患者抑郁症状严重程度与代谢控制之间存在显著关联。抑郁严重程度越高，血糖、血压和血脂控制越差，同时这些参数的变异性增加。此外，有严重抑郁症状的患者药物依从性欠佳。在T2DM管理中关注心理健康对于改善代谢控制和降低CVD风险至关重要。ClinicalTrials.gov标识符：NCT00000620。
