Kovacs M, Mukerji P, Iyengar S, Drash A
Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Diabetes Care. 1996 Apr;19(4):318-23. doi: 10.2337/diacare.19.4.318.
To investigate the longitudinal relationship between psychiatric diagnostic variables and metabolic control among youths with IDDM.
A group of 88 youths, 8 to 13 years old at onset of IDDM, were evaluated repeatedly during a 9-year follow-up period, on average, using a standardized psychiatric protocol. Levels of HbA1 were also assessed repeatedly. Psychiatric diagnoses were derived independently of HbA1 values.
In univariate longitudinal analyses, the psychiatric diagnosis of noncompliance with medical treatment was significantly related to HbA1 level. There was a trend of an association between any major psychiatric disorder, as well as nondepressive disorder, and HbA1. Interaction terms between IDDM duration (or age) and psychiatric variables were also significantly related to metabolic control. According to the final multivariate model of repeatedly assessed HbA1, noncompliance with medical treatment (irrespective of IDDM duration) and the interaction between nondepressive psychiatric disorder and IDDM duration contributed to worse metabolic control.
We found some support for the hypothesis that psychiatric morbidity negatively affects blood glucose regulation and that its consequences are more marked the longer young patients have had IDDM. We did not confirm the hypothesis that depressive illness has particularly deleterious consequences on metabolic control. Noncompliance with medical treatment and having had nondepressive psychiatric illness in interaction with IDDM duration account for a statistically significant but clinically modest amount of variability in HbA1 over time. The weak relationship among these variables may explain the inconsistent findings in the literature regarding psychiatric morbidity and metabolic control.
探讨青少年胰岛素依赖型糖尿病（IDDM）患者精神科诊断变量与代谢控制之间的纵向关系。
一组88名青少年，在IDDM发病时年龄为8至13岁，在平均9年的随访期内，平均使用标准化精神科诊疗方案进行多次评估。还多次评估糖化血红蛋白（HbA1）水平。精神科诊断独立于HbA1值得出。
在单变量纵向分析中，不遵医嘱的精神科诊断与HbA1水平显著相关。任何主要精神障碍以及非抑郁性障碍与HbA1之间存在关联趋势。IDDM病程（或年龄）与精神科变量之间的交互项也与代谢控制显著相关。根据多次评估的HbA1的最终多变量模型，不遵医嘱（无论IDDM病程长短）以及非抑郁性精神障碍与IDDM病程之间的交互作用导致代谢控制更差。
我们发现有一定证据支持以下假设，即精神疾病对血糖调节产生负面影响，且年轻患者患IDDM的时间越长，其后果越明显。我们未证实抑郁症对代谢控制有特别有害后果的假设。不遵医嘱以及患有非抑郁性精神疾病与IDDM病程的交互作用在统计学上可解释HbA1随时间变化的显著但临床上较小的变异性。这些变量之间的弱关系可能解释了文献中关于精神疾病与代谢控制的不一致研究结果。
