Reciprocal Relationships between Diabetes and Depression

描述(申请人提供)：该项目的目标是更好地了解糖尿病和抑郁症之间错综复杂的相互关系，以便为患有这两种慢性疾病的1600亿美国人提供更有效的临床护理。这个为期四年的项目有三个具体目标(1)了解成人糖尿病如何影响临床显著抑郁症的发生和治疗，(2)了解临床显著抑郁症如何影响成人糖尿病的管理、进展和结果，以及(3)比较抑郁症对糖尿病和糖尿病对抑郁的影响的相对强度。该项目由明尼苏达州的Health Partners Medical Group进行，并利用了已经在17.5万成年人中明确定义的初级保健人口中已经到位的复杂的慢性病监测系统。1,000名成人糖尿病患者的事件队列和3,000名糖尿病患者的流行队列分别与非糖尿病研究对象的年龄、性别和临床/预约日期相匹配。这些队列在4年的时间内被跟踪，以实现时间关系的规范。我们使用线性回归、Logistic回归和结构方程模型来检验七个具体的假设，这将促进我们对如何改善对这两种疾病患者的护理的理解。这项研究的优势包括：(A)一支经验丰富的研究团队，在糖尿病、抑郁症、质量改进和卫生服务研究方面拥有经过证实的研究记录；(B)具有良好的研究人群特征；(C)先前开发了确认糖尿病和抑郁症的有效方法，并利用自动化数据测量共病、药物治疗、用药依从性和护理的利用；以及(D)使用一套类似的策略改善糖尿病护理质量的先前成功。该项目将提供改善世界各地数百万因糖尿病和抑郁症而遭受毁灭性后果的人的护理所需的重要缺失信息。

DESCRIPTION (provided by applicant): The objective of this project is to provide a better understanding of the intricate and complex reciprocal relationship between diabetes and depression, in order to provide more effective clinical care to the 1,600,000 million Americans who suffer from both these chronic conditions. This four-year project has three specific aims (1) To understand how diabetes mellitus in adults affects the onset and management of clinically significant depression, (2) To understand how clinically significant depression affects the management, progression, and outcomes of diabetes mellitus in adults, and (3) To compare the relative strength of influence of depression on diabetes and diabetes on depression. The project is conducted at Health Partners Medical Group in Minnesota, and takes advantage of sophisticated chronic disease surveillance systems already in place in a well-defined primary care population of 175,000 adults. An incident cohort of 1,000 adults with diabetes and a prevalence cohort of 3,000 patients with diabetes are each age-, gender-, and clinic/appointment date matched to a study subject without diabetes. These cohorts are tracked over a 4-year period to enable specification of temporal relationships. Linear regression, logistic regression, and structural equation modeling are used to test seven specific hypotheses, which will advance our understanding of how to improve the care provided to patients with both conditions. Strengths of the study include the following: (a) an experienced research team with a proven research record in diabetes, depression, quality improvement, and health services research; (b) a well-characterized study population; (c) prior development of validated methods to identify diabetes and depression, and measures of comorbidity, pharmaceutical treatment, medication adherence, and utilization of care using automated data, and (d) prior success improving diabetes quality of care using a similar set of strategies. This project will provide important missing information needed to improve the care of millions of people worldwide who suffer the devastating consequences of comorbid diabetes and depression.