Depression and glycemic control in hispanic primary care patients with diabetes
Depression and glycemic control in hispanic primary care patients with diabetes
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DOI：
10.1111/j.1525-1497.2005.30003.x
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发表时间：
2005-05-01
影响因子：
5.7
通讯作者：
Weissman, MM
中科院分区：
文献类型：
--
作者：
Gross, R;Olfson, M;Weissman, MM
背景：维持最佳血糖控制是糖尿病患者治疗的重要目标。西班牙裔患者的糖尿病发病率较高且血糖控制 (PGC) 较差。虽然抑郁症在成人糖尿病患者中很常见，但其与血糖控制的关系仍不清楚，尤其是在西班牙裔美国人中。 目的：评估西班牙裔美国人中抑郁症与 PGC 的关系。设计：来自初级保健的横断面心理健康调查的数据与医院的计算机化实验室数据库交叉链接。地点：一所教学医院的城市普通医学实践。患者：209 名患者（平均[标准差]年龄，57.1[10.3]岁； 68% 女性）最近进行了国际疾病分类第九版 (ICD-9) 糖尿病编码，并进行了 1 项或多项血红蛋白 A(1c) (HbA(1c)) 测试。主要结果指标：PGC 概率 (HbA(1c)>= 8%)。结果：随着抑郁症的严重程度，PGC 概率稳步增加。 70 名重性抑郁患者中，有 39 名 (55.7%) 的 HbA(1c)>= 8%，而轻度至轻度抑郁组的这一比例为 39/92 (42.4%)，无抑郁组的比例为 15/47 (31.9%)（P 趋势=.01；调整后优势比，3.27；95% 置信区间，1.23 至 1.23）。 8.64，中度或重度抑郁症与无抑郁症）。只有 29 名 (41.4%) 重度抑郁症患者在前一年接受过心理健康治疗。结论：在西班牙裔糖尿病患者的初级保健样本中，我们发现抑郁症严重程度增加与 PGC 之间存在显着关联。然而，只有不到一半的中度或重度抑郁症患者在上一年接受过心理健康治疗。改善这一高危人群抑郁症的识别和治疗可能对糖尿病结局产生有利影响。
CONTEXT: Maintaining optimal glycemic control is an important goal of therapy in patients with diabetes mellitus. Patients of Hispanic ancestry have been shown to have high rates of diabetes and poor glycemic control (PGC). Although depression is common in adults with diabetes, its relationship to glycemic control remains unclear, especially among Hispanics.OBJECTIVE: To assess the association of depression with PGC in Hispanics.DESIGN: Data from a cross-sectional mental health survey in primary care were crosslinked to the hospital's computerized laboratory database.SETTING: Urban general medicine practice at a teaching hospital.PATIENTS: Two hundred and nine patients (mean [standard deviation] age, 57.1 [10.3] years; 68% females) with recent International Classification of Diseases, Ninth Revision (ICD-9) codes for diabetes mellitus, and 1 or more hemoglobin A(1c) (HbA(1c)) tests.MAIN OUTCOME MEASURE: Probability of PGC (HbA(1c)>= 8%).RESULTS: Probability for PGC steadily increased with severity of depression. Thirty-nine (55.7%) of the 70 patients with major depression had HbA(1c)>= 8%, compared with 39/92 (42.4%) in the minimal to mild depression group, and 15/47 (31.9%) in the no depression group (P-trend=.01; adjusted odds ratio, 3.27; 95% confidence interval, 1.23 to 8.64, for moderate or severe depression vs no depression). Only 29 (41.4%) of the patients with major depression received mental health treatment in the previous year.CONCLUSIONS: In this primary care sample of Hispanic patients with diabetes, we found a significant association between increasing depression severity and PGC. Yet, less than one half of the patients with moderate or severe depression received mental health treatment in the previous year. Improving identification and treatment of depression in this high-risk population might have favorable effects on diabetic outcomes.