Clinical Research in Comorbid Diabetes and Depression

NIDDK K24奖被要求为帕特里克J.卢斯特曼博士提供支持，加强糖尿病和抑郁症共病的研究和指导计划。糖尿病影响着1600万美国人。另有2100万人葡萄糖耐量受损，有患2型糖尿病（T2 DM）的风险。即使在控制了其他风险因素后，重度抑郁症也会使T2 DM的风险增加一倍以上。20%患有糖尿病（1型或2型）的患者也存在重度抑郁症，与高血糖症有关，并且会显着增加代谢障碍每种主要并发症的风险。申请人研究的总体目标是：1）阐明抑郁症影响糖尿病风险进程和结局的机制; 2）确定抑郁症治疗是否以及如何改善血糖控制和糖尿病的长期进程。该提案描述了申请人目前的研究，未来研究的一些想法，以及计划在K24的5年间隔内进行的职业发展和指导活动。两项NIH（NIDDK）支持的试验正在进行中。一个是确定糖尿病患者的抗抑郁维持治疗是否会预防或延迟抑郁复发，并产生持久的血糖控制改善。第二是确定糖尿病患者的血糖抑制治疗是否会改善血糖控制，从而降低孕产妇和新生儿的发病率。受训者将参与这些项目，参加临床研究的教学课程，并在两年的培训间隔内完成研究提案。还描述了一系列职业发展活动（PI），包括使用SAS进行结构方程建模的额外培训，以及使用最小模型分析进行和解释静脉葡萄糖耐量试验的培训。K24支持将为申请人提供所需的保护时间，以确定抑郁症治疗在糖尿病患者日常管理中的效用，并在此过程中增加对行为糖尿病临床研究者的指导。

An NIDDK K24 award is requested to provide support for Patrick J. Lustman, Ph.D., to enhance a program of research and mentoring in Comorbid Diabetes and Depression. Diabetes affects 16 million Americans. Another 21 million have impaired glucose tolerance and are at risk for developing type 2 diabetes (T2DM). Major depression more than doubles the risk of T2DM even after controlling for other risk factors. Major depression is also present in 20% of patients with existing diabetes (type 1 or type 2), is associated with hyperglycemia, and conveys a significantly increased risk for each of the major complications of the metabolic disorder. The overall goals of the applicant's research are: 1) to elucidate the mechanisms by which depression affects the risk course, and outcome of diabetes; and 2) to determine whether and how depression treatment may improve glycemic control and the long-term course of diabetes. The proposal describes the applicant's current research, some ideas for future studies, and the career development and mentoring activities that are planned over the 5-year interval of the K24. Two NIH (NIDDK)-supported trials are ongoing. One is to determine if maintenance antidepressant treatment in diabetes will prevent or delay depression recurrence and produce durable improvements in glycemic control. The second is to establish if treatment of prepartum depression in diabetes will improve glycemic control and thereby decrease maternal and neonatal morbidity. Trainees will engage in these projects, take didactic coursework in clinical investigation, and complete a research proposal over the two-year training interval. A series of career development activities (for the PI) are also described that include additional training in structural equation modeling using SAS, and training in performing and interpreting intravenous glucose tolerance tests using minimal model analysis. K24 support will provide the applicant with the protected time needed to determine the utility of depression treatment in the everyday management of those living with diabetes and, in the process, to increase the mentoring of beginning clinical investigators in behavioral diabetes.