Prospective associations between emotional distress and poor outcomes in type 2 diabetes.
Prospective associations between emotional distress and poor outcomes in type 2 diabetes.
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DOI：
10.2337/dc12-0181
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发表时间：
2012-12
期刊：
影响因子：
16.2
通讯作者：
Aikens JE
中科院分区：
文献类型：
--
作者：
Aikens JE
横断面研究将抑郁症状（DS）和糖尿病相关的痛苦（DRD）与糖尿病自我管理和/或血糖控制联系起来。然而，这些变量的纵向研究是罕见的，他们的结果有些矛盾。研究目的是比较DS和DRD作为2型糖尿病患者药物依从性、自我护理行为和血糖控制的纵向预测因子。研究了2型糖尿病初级保健患者在基线时报告的DS、DRD和其他变量。6个月后评估药物依从性、自我护理行为（饮食、体力活动和血糖检测）和血糖控制（HbA 1c）（n = 253）。采用横断面和纵向回归分析来模拟行为和医疗结果作为基线混杂因素、DS和DRD的函数。调整后的横截面和纵向分析产生了非常相似的结果。在后者中，只有DS与未来的饮食行为（P = 0.049），体力活动（P = 0.001）和葡萄糖测试（P = 0.018）显著相关。相反，只有DRD预测未来血糖控制（P < 0.001）和药物依从性（P = 0.011）。痛苦-结果的关联似乎因所考虑的痛苦类型而异。只有DS预测未来的生活方式为导向的自我管理行为。相反，只有DRD预测血糖控制，可能是通过减少药物依从性。临床评估和干预应该包括这两种类型的痛苦，除非目标是狭隘地针对一个高度具体的结果。
Cross-sectional studies link both depressive symptoms (DS) and diabetes-related distress (DRD) to diabetes self-management and/or glycemic control. However, longitudinal studies of these variables are rare, and their results are somewhat conflicting. The study objective was to compare DS and DRD as longitudinal predictors of medication adherence, self-care behavior, and glycemic control in type 2 diabetes. Primary care patients with type 2 diabetes reported DS, DRD, and other variables at baseline were studied. Medication adherence, self-care behaviors (diet, physical activity, and glucose testing), and glycemic control (HbA1c) were assessed 6 months later (n = 253). Cross-sectional and longitudinal regression analyses were used to model behavioral and medical outcomes as a function of baseline confounders, DS, and DRD. Adjusted cross-sectional and longitudinal analyses yielded very similar results. In the latter, only DS were significantly associated with future diet behavior (P = 0.049), physical activity (P = 0.001), and glucose testing (P = 0.018). In contrast, only DRD predicted future glycemic control (P < 0.001) and medication adherence (P = 0.011). Distress-outcome associations seem to vary by type of distress under consideration. Only DS predicts future lifestyle-oriented self-management behaviors. In contrast, only DRD predicts glycemic control, perhaps by decreasing medication adherence. Clinical assessment and intervention should encompass both types of distress, unless the goal is to narrowly target a highly specific outcome.
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影响因子：
8.2
作者：
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作者：
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