Clinical Research in Comorbid Diabetes and Depression

NIDDK K24奖被要求为Patrick J. Lustman博士提供支持，以加强共病糖尿病和抑郁症的研究和指导计划。糖尿病影响着1600万美国人。另有2100万人糖耐量受损，有患2型糖尿病（T2DM）的风险。即使在控制了其他危险因素后，重度抑郁症也会使2型糖尿病的风险增加一倍以上。20%的糖尿病患者（1型或2型）也存在重度抑郁，与高血糖有关，并且代谢紊乱的每种主要并发症的风险显著增加。申请人研究的总体目标是：1)阐明抑郁症影响糖尿病发病过程和转归的机制；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病程。该提案描述了申请人目前的研究，对未来研究的一些想法，以及K24计划在5年内的职业发展和指导活动。NIH （NIDDK）支持的两项试验正在进行中。一是确定糖尿病患者维持抗抑郁治疗是否能预防或延缓抑郁症复发，并在血糖控制方面产生持久的改善。第二是确定治疗糖尿病前期抑郁是否会改善血糖控制，从而降低孕产妇和新生儿的发病率。在两年的培训期间，学员将参与这些项目，在临床调查中学习教学课程，并完成一项研究计划。还描述了一系列（PI的）职业发展活动，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内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人员的指导。

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.