Background: We hypothesize that depression in type 2 diabetes might be associated with poor glycemic control, in part due to suboptimal self-care. We tested this hypothesis by examining the associations of depression with clinical and laboratory findings in a multicenter survey of Chinese type 2 diabetic patients.
Method: 2538 patients aged 18-75 years attending hospital-based clinics in four cities in China underwent detailed clinical-psychological-behavioral assessment during a 12-month period between 2011 and 2012. Depression was diagnosed if Patient Health Questionnaire-9 (PHQ-9) score ≥10. Diabetes self-care and medication adherence were assessed using the Summary of Diabetes Self-care Activities and the 4-item Morisky medication adherence scale respectively.
Results: In this cross-sectional study (mean age: 56.4 ± 10.5[SD] years, 53% men), 6.1% (n = 155) had depression. After controlling for study sites, patients with depression had higher HbA(1c) (7.9 ± 2.0 vs. 7.7 ± 2.0%, P = 0.008) and were less likely to achieve HbA(1c) goal of <7.0% (36.2% vs 45.6%, P = 0.004) than those without depression. They were more likely to report hypoglycemia and to have fewer days of being adherent to their recommended diet, exercise, foot care and medication. In logistic regression, apart from young age, poor education, long disease duration, tobacco use, high body mass index, use of insulin, depression was independently associated with failure to attain HbA(1c) target (Odds Ratio [OR] = 1.56, 95%CI:1.05-2.32, P = 0.028). The association between depression and glycemic control became non-significant after inclusion of adherence to diet, exercise and medication (OR = 1.48, 95% CI 0.99-2.21, P = 0.058).
Conclusion: Depression in type 2 diabetes was closely associated with hyperglycemia and hypoglycemia, which might be partly mediated through poor treatment adherence.
方法：: 本研究纳入2538名年龄为18‐75岁的门诊2型糖尿病患者，来自中国4个城市的6家合作医院，入组时间为2011‐2012年。患者接受详细的临床‐心理‐行为评估。使用患者健康量表（Patient Health Questionnaire‐9，PHQ‐9）评估抑郁状况，PHQ‐9≥10分定义为抑郁。使用糖尿病自护行为量表（Summary of Diabetes Self‐care Activities，SDSCA）评估自我照顾情况以及4个项目的Morisky评分评估药物依从性。
结果：: 本研究为横断面研究，患者平均年龄是56.4 ± 10.5[SD]岁，53%为男性，其中6.1% (n = 155) 有抑郁。在校正研究中心后，抑郁患者较非抑郁患者的HA1c显著增高 (7.9 ± 2.0 vs. 7.7 ± 2.0%，P = 0.008) ，HbA1c达标（<7.0%）率差（36.2% vs 45.6%，P = 0.004）。与非抑郁患者相比，抑郁患者低血糖显著多发，饮食、运动、足部护理以及药物依从性差，差别均有统计学意义。根据logistic回归分析，除了年龄小、教育程度差、病程长、吸烟、体重指数更高和使用胰岛素外，抑郁与血糖不达标显著呈正相关（OR = 1.56, 95%CI：1.05‐2.32，P = 0.028），但在进一步校正治疗饮食、运动和药物依从性后，该相关性变得不显著（OR = 1.48，95% CI： 0.99‐2.21，P = 0.058）。
Keywords: depression; hyperglycemia; hypoglycemia; treatment adherence; type 2 diabetes; 关键词：抑郁、高血糖、低血糖、治疗依从性、2型糖尿病.
© 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.