Depression and Advanced Complications of Diabetes
Depression and Advanced Complications of Diabetes
复制标题
抑郁症和糖尿病晚期并发症
作者：
E. Lin;C. Rutter;W. Katon;S. Heckbert;Paul S. Ciechanowski;Malia M Oliver;E. Ludman;B. Young;L. Williams;D. Mcculloch;M. Von Korff
目的前瞻性研究2型糖尿病患者抑郁与进展性大血管和微血管并发症的关系。研究设计与方法在2000-2002年间登记了4623名2型糖尿病初级保健患者的纵向队列，并在2005-2007年间进行了跟踪调查。晚期微血管并发症包括失明、终末期肾病、截肢和肾功能衰竭死亡。晚期大血管并发症包括心肌梗死、中风、心血管手术和死亡。病历回顾、ICD-9诊断和程序代码以及死亡证明数据被用来确定5年随访的结果。比例风险模型分析了基线抑郁和不良后果风险之间的关系。结果在调整了既往并发症以及人口统计学、临床和糖尿病自我护理变量后，抑郁症患者的微血管预后不良风险(风险比1.36[95%可信区间1.05~1.75])和大血管预后不良风险(1.24[1.0~1.54])显著增加。结论：在2型糖尿病患者中，即使在调整了糖尿病的严重程度和自我护理活动后，重度抑郁也与随后5年内临床上显著的微血管和大血管并发症的风险增加有关。随着2型糖尿病发病率的飙升，这些发现的临床和公共卫生意义也越来越大。需要进一步的研究来阐明这种关联的潜在机制，并测试降低合并抑郁症患者的糖尿病并发症风险的干预措施。
OBJECTIVE To prospectively examine the association of depression with risks for advanced macrovascular and microvascular complications among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A longitudinal cohort of 4,623 primary care patients with type 2 diabetes was enrolled in 2000–2002 and followed through 2005–2007. Advanced microvascular complications included blindness, end-stage renal disease, amputations, and renal failure deaths. Advanced macrovascular complications included myocardial infarction, stroke, cardiovascular procedures, and deaths. Medical record review, ICD-9 diagnostic and procedural codes, and death certificate data were used to ascertain outcomes in the 5-year follow-up. Proportional hazard models analyzed the association between baseline depression and risks of adverse outcomes. RESULTS After adjustment for prior complications and demographic, clinical, and diabetes self-care variables, major depression was associated with significantly higher risks of adverse microvascular outcomes (hazard ratio 1.36 [95% CI 1.05–1.75]) and adverse macrovascular outcomes (1.24 [1.0–1.54]). CONCLUSIONS Among people with type 2 diabetes, major depression is associated with an increased risk of clinically significant microvascular and macrovascular complications over the ensuing 5 years, even after adjusting for diabetes severity and self-care activities. Clinical and public health significance of these findings rises as the incidence of type 2 diabetes soars. Further research is needed to clarify the underlying mechanisms for this association and to test interventions to reduce the risk of diabetes complications among patients with comorbid depression.
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影响因子：
16.2
作者：
Egede, LE;Zheng, D;Simpson, K
通讯作者：
Simpson, K
影响因子：
120.7
作者：
Golden, Sherita Hill;Lazo, Mariana;Lyketsos, Constantine
通讯作者：
Lyketsos, Constantine
影响因子：
16.2
作者：
Katon, W;Von Korff, M;Young, B
通讯作者：
Young, B
影响因子：
120.7
作者：
Whooley, Mary A.;de Jonge, Peter;Vittinghoff, Eric;Otte, Christian;Moos, Rudolf;Carney, Robert M.;Ali, Sadia;Dowray, Sunaina;Na, Beeya;Feldman, Mitchell D.;Schiller, Nelson B.;Browner, Warren S.
通讯作者：
Browner, Warren S.
影响因子：
16.2
作者：
Toobert, DJ;Hampson, SE;Glasgow, RE
通讯作者：
Glasgow, RE