Presley Caroline A, Butera Nicole M, Krause-Steinrauf Heidi, Desouza Cyrus V, Hollander Priscilla A, Hoogendoorn Claire J, Lagari Violet S, Legowski Elizabeth A, Martin Catherine L, Rasouli Neda, Gonzalez Jeffrey S, Cherrington Andrea L
Department of Medicine (General Internal Medicine and Population Science), University of Alabama at Birmingham, Birmingham, Alabama.
The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland.
Sci Diabetes Self Manag Care. 2025 Aug;51(4):382-393. doi: 10.1177/26350106251361363. Epub 2025 Aug 1.
PurposeThe purpose of this study is to evaluate whether higher emotional distress (depressive symptoms or diabetes distress) was associated with a lower likelihood of basal or rapid-acting insulin initiation among participants enrolled in the GRADE Emotional Distress Substudy (EDS).MethodsIndividuals with type 2 diabetes <10 years duration on metformin alone were randomized to add 1 of 4 glucose-lowering drugs. Per protocol, participants were expected to start basal or rapid-acting insulin rescue therapy after reaching secondary or tertiary glycemic outcomes (A1C >7.5%). Depressive symptoms and diabetes distress were assessed ≤12 months prior to outcome confirmation. Multinomial and binomial logistic regression models examined associations of depressive symptoms and diabetes distress with basal insulin initiation and rapid-acting insulin initiation, respectively.ResultsOf the 525 participants expected to start basal insulin, 30.9% initiated ≤6 weeks, 35.2% initiated >6 weeks, and 33.9% never initiated. Of the 325 participants expected to start rapid-acting insulin, 67.4% never initiated. Neither depressive symptoms nor diabetes distress were associated with starting basal or rapid-acting insulin.ConclusionsIn the GRADE EDS, approximately one-third of participants did not start basal insulin, and two-thirds of participants did not start rapid-acting insulin. Emotional distress did not appear to play a role in insulin initiation among trial participants.
目的 本研究的目的是评估在参与血糖达标研究情绪困扰子研究（EDS）的参与者中，较高的情绪困扰（抑郁症状或糖尿病困扰）是否与基础胰岛素或速效胰岛素起始使用的可能性较低相关。 方法 仅使用二甲双胍治疗且2型糖尿病病程<10年的个体被随机分配添加4种降糖药物中的1种。根据方案，参与者在达到二级或三级血糖控制目标（糖化血红蛋白>7.5%）后应开始基础胰岛素或速效胰岛素挽救治疗。在确认结局前≤12个月评估抑郁症状和糖尿病困扰。多项和二项逻辑回归模型分别检验抑郁症状和糖尿病困扰与基础胰岛素起始使用和速效胰岛素起始使用之间的关联。 结果 在预期开始使用基础胰岛素的525名参与者中，30.9%在≤6周时开始使用，35.2%在>6周时开始使用，33.9%从未开始使用。在预期开始使用速效胰岛素的325名参与者中，67.4%从未开始使用。抑郁症状和糖尿病困扰均与开始使用基础胰岛素或速效胰岛素无关。 结论 在血糖达标研究情绪困扰子研究中，约三分之一的参与者未开始使用基础胰岛素，三分之二的参与者未开始使用速效胰岛素。情绪困扰似乎在试验参与者的胰岛素起始使用中未起作用。
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