2 型糖尿病患者严重低血糖与抑郁症状的相关性：福冈糖尿病登记研究。
Association of severe hypoglycemia with depressive symptoms in patients with type 2 diabetes: the Fukuoka Diabetes Registry.
机构信息
Department of Medicine and Clinical Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan.
Department of Medicine and Clinical Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan ; Diabetes Center, Hakujyuji Hospital , Fukuoka , Japan.
出版信息
BMJ Open Diabetes Res Care. 2015 May 16;3(1):e000063. doi: 10.1136/bmjdrc-2014-000063. eCollection 2015.
OBJECTIVE
Although many studies have investigated the clinical characteristics of patients with diabetes with depression in Western populations, there is a lack of information regarding other ethnicities. We studied the association between clinical characteristics and depressive symptoms in Japanese patients with type 2 diabetes.
METHODS
A total of 4218 Japanese patients with type 2 diabetes who were not taking antidepressants were divided into four groups according to the Center for Epidemiologic Studies Depression Scale (CES-D) score. The relationship between the severity of depressive symptoms and clinical parameters was examined cross-sectionally.
RESULTS
After multivariate adjustments, the severity of depressive symptoms was significantly associated with body mass index, leisure-time physical activity, current smoking, sleep duration, sucrose intake, skipping breakfast, insulin use, severe hypoglycemia, dysesthesia of both feet, history of foot ulcer, photocoagulation, ischemic heart disease, and stroke. ORs for severe hypoglycemia increased significantly with the CES-D score in 2756 sulfonylurea and/or insulin-treated patients after multivariate adjustment including age, sex, duration of diabetes, glycated hemoglobin, insulin use, self-monitoring of blood glucose, leisure-time physical activity, skipping breakfast, dysesthesia of both feet, ischemic heart disease, and stroke (CES-D score ≤9, referent; 10-15, OR 1.64; 16-23, OR 2.09; ≥24, OR 3.66; p for trend <0.01).
CONCLUSIONS
Severe hypoglycemia was positively associated with the severity of depressive symptoms in Japanese patients with type 2 diabetes independent of glycemic control, insulin therapy, lifestyle factors, and diabetic complications. As both severe hypoglycemia and depression are known risk factors for morbidity and mortality in patients with diabetes, clinicians should be aware of this association.
UMIN CLINICAL TRIAL REGISTRY
目的
尽管许多研究已经调查了西方人群中患有糖尿病和抑郁症的患者的临床特征，但对于其他种族的信息却很缺乏。我们研究了日本 2 型糖尿病患者的临床特征与抑郁症状之间的关系。
方法
共纳入 4218 名未服用抗抑郁药的日本 2 型糖尿病患者，根据中心流行病学研究抑郁量表（CES-D）评分将其分为四组。通过横断面研究，考察了抑郁症状严重程度与临床参数之间的关系。
结果
在进行多变量调整后，抑郁症状的严重程度与体质指数、闲暇时间体力活动、当前吸烟、睡眠时间、蔗糖摄入量、不吃早餐、胰岛素使用、严重低血糖、双脚感觉异常、足部溃疡史、光凝治疗、缺血性心脏病和中风显著相关。在包括年龄、性别、糖尿病病程、糖化血红蛋白、胰岛素使用、自我监测血糖、闲暇时间体力活动、不吃早餐、双脚感觉异常、缺血性心脏病和中风在内的多变量调整后，2756 例接受磺脲类药物和/或胰岛素治疗的患者中，严重低血糖的 OR 随着 CES-D 评分的增加而显著升高（CES-D 评分≤9，参照；10-15，OR 1.64；16-23，OR 2.09；≥24，OR 3.66；趋势检验 p<0.01）。
结论
在日本 2 型糖尿病患者中，严重低血糖与抑郁症状的严重程度呈正相关，与血糖控制、胰岛素治疗、生活方式因素和糖尿病并发症无关。由于严重低血糖和抑郁均是糖尿病患者发病率和死亡率的已知危险因素，临床医生应意识到这一关联。
UMIN 临床研究注册：000002627。
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