Diabetes mellitus, glycemic control, and incident depressive symptoms among 70-to 79-year-old persons
Diabetes mellitus, glycemic control, and incident depressive symptoms among 70-to 79-year-old persons
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DOI：
10.1001/archinte.167.11.1137
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发表时间：
2007-06-11
影响因子：
--
通讯作者：
Pahor, Marco
中科院分区：
文献类型：
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作者：
Maraldi, Cinzia;Volpato, Stefano;Pahor, Marco
背景：横断面研究发现糖尿病（DM）患者抑郁症患病率升高。这种关联的因果机制和时间顺序尚未明确描述。本研究调查了糖尿病和抑郁症状之间的前瞻性关系。方法：健康，老龄化和身体成分研究是一项队列研究，在孟菲斯，田纳西州和匹兹堡，宾夕法尼亚州的大都市地区进行。该分析包括2522名社区居民，年龄在70至79岁之间，没有基线抑郁症状。事件性抑郁情绪定义为随访时使用抗抑郁药或存在抑郁症状（流行病学研究中心抑郁量表10项评分>= 10）。在连续2次年度门诊访视中出现抑郁情绪事件定义了复发性抑郁情绪的发生率。在基线时评估糖尿病状态、糖化血红蛋白（HbA 1c）水平和DM相关合并症。糖尿病状态进一步表征为不存在、控制（HbA 1c水平< 7%）或不控制（HbA 1c水平>= 7%）。离散时间生存分析被用来估计抑郁事件risk.Results：在平均5.9年的随访中，与无糖尿病的患者相比，糖尿病患者的抑郁情绪（23.5%vs19.0%）（P = 0.02）和复发性抑郁情绪（8.8%vs4.3%）（P <0.001）的年龄、性别、种族和地点调整的发病率更高。糖尿病与抑郁情绪事件风险增加30%相关（比值比[ OR]，1.31; 95%置信区间[ CI]，1.07-1.61），在校正DM相关合并症后，该风险减弱（OR，1.20; CI，0.97-1.48）。DM和复发性抑郁情绪（OR，1.91; CI，1.32-2.76），特别是在参与者血糖控制不佳之间观察到更强的关系：在功能良好的老年人，DM与抑郁症状的风险增加。
Background: Cross-sectional studies find an elevated prevalence of depression among subjects with diabetes mellitus ( DM). The causal mechanisms and temporal sequence of this association have not been clearly delineated. This study investigated the prospective relationship between DM and depressive symptoms.Methods: The Health, Aging, and Body Composition Study was a cohort study conducted in the metropolitan areas of Memphis, Tenn, and Pittsburgh, Pa. The analysis included 2522 community-dwelling subjects, aged 70 to 79 years, without baseline depressive symptoms. Incident depressed mood was defined as use of antidepressants at follow-up visits or presence of depressive symptoms ( score >= 10 on the 10-item Center for Epidemiological Studies Depression scale). Presence of incident depressed mood at 2 consecutive annual clinic visits defined the incidence of recurrent depressed mood. Diabetes mellitus status, glycosylated hemoglobin ( HbA1c) level, and DM-related comorbidities were assessed at baseline. Diabetes mellitus status was further characterized as absent, controlled ( HbA1c level < 7%), or uncontrolled ( HbA1c level >= 7%). Discrete time survival analysis was used to estimate depressive events risk.Results: During a mean follow-up of 5.9 years, participants with DM had a higher age-, sex-, race-, and site-adjusted incidence of depressed mood ( 23.5% vs 19.0%) ( P = .02) and recurrent depressed mood ( 8.8% vs 4.3%) ( P < .001) than those without DM. Diabetes mellitus was associated with a 30% increased risk of incident depressed mood ( odds ratio [ OR], 1.31; 95% confidence interval [ CI], 1.07-1.61), which was attenuated after adjustment for DM-related comorbidities ( OR, 1.20; CI, 0.97-1.48). A stronger relationship was observed between DM and recurrent depressed mood ( OR, 1.91; CI, 1.32-2.76), particularly among participants with poor glycemic control.Conclusion: Among well-functioning older adults, DM is associated with increased risk of depressive symptoms.