DEPRESSION AND INSULIN RESISTANCE IN TYPE 2 DIABETES

2 型糖尿病中的抑郁和胰岛素抵抗

• 批准号: 7377203
• 负责人: PATRICK J LUSTMAN
• 金额: $ 2.42万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-01 至 2007-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7377203
• 关键词: DEPRESSION; INSULIN; RESISTANCE; TYPE; DIABETES

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The overall purpose of this study is to determine the impact of depression on insulin resistance (IR) in diabetes. IR characterized type 2 diabetes (T2DM) and is a predictor of diabetes complications, particularly coronary heart disease (CHD). (CHD), in turn, accounts for more than 50% of deaths and 75% of hospitalizations among diabetic patients. Because of this, potentially modifiable factors contributing to IR are being sought. There is evidence linking IR to depression in nondiabetic subjects, and IR may improve with depression treatment in these subjects. Depression is present in approximately 20% of patients with type 2 diabetes (T2DM), precedes the onset of diabetes diagnosis by more that 5 years on average, and may be responsible for some of the IR typifying T2DM and its CHD risk. In a 10-year prospective study of diabetic women with and without depression, we found that depression accelerated the development of (p<0.01) and increased the risk for CHD (OR 3.1, 95% CI 1.1-8.9) and was retained as an independent predictor of CHD in multivariate analysis. In the proposed study, we plan to recruit 160 untreated subjects with a provisional diagnosis of T2DM, 80 with and 80 without major depression (per DSM-IV) matched for gender and BMI. IR (from oral glucose tolerance tests), as well as measures of mood, glycemic control, HPA-axis activity, central adiposity, diet, and physical activity, will be determined at baseline for all subjects. Depressed subjects also will undergo frequently sampled intravenous glucose tolerance tests (FSIGTT) and more detailed analysis of activity, adiposity, and intramyocellular fat. Depressed subjects will be randomly assigned to 12 weeks of cognitive behavior therapy or usual depression care; nondepressed subjects will be observed for comparison. All baseline measures (including FSIGTT and the additional test the initially-depressed) will be repeated after intervention/observation. Univariate tests, analyses of covariance, and least squares regression techniques will be used to assess the independent effects of depression adn change in the severity of depression symptoms on IR and change in IR over time. The effect of depression treatment and of depression remission on IR (controlling for baseline differences) and potential mediators of a depression-IR relationship also will be determined in the initially-depressed subjects. We hypothesize that depression is associated with increased IR in untreted T2DM and that IR improves with successful depression treatment. The findings from this study could identify a potentially modifiable factor for improving the course and outcome of those living with T2DM

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子弹和调查员（PI）可能已经从其他NIH来源获得了主要资金，因此可以在其他清晰的条目中代表。列出的机构适用于该中心，这不一定是调查员的机构。这项研究的总体目的是确定抑郁症对糖尿病中胰岛素抵抗（IR）的影响。 IR表征了2型糖尿病（T2DM），是糖尿病并发症，尤其是冠心病（CHD）的预测指标。 （冠心病）又占糖尿病患者死亡人数的50％以上，占住院治疗的75％。因此，正在寻找导致IR的可能修改的因素。有证据表明IR与非糖尿病患者的抑郁症联系起来，而IR可以通过这些受试者的抑郁治疗来改善。大约20％的2型糖尿病患者（T2DM）出现抑郁症，在糖尿病诊断开始之前，平均抑郁症的平均抑郁症平均要多5年，并且可能导致一些IR造成T2DM及其CHD风险的IR。在对患有和没有抑郁症的糖尿病妇女进行的10年前瞻性研究中，我们发现抑郁症加速了（P <0.01），并增加了CHD的风险（OR 3.1，95％CI 1.1-8.9），并保留为多变量分析中CHD的独立预测指标。在拟议的研究中，我们计划招募160名未经治疗的受试者，其临时诊断为T2DM，80，80和80没有重大抑郁症（Per DSM-IV）匹配性别和BMI。 IR（来自口服葡萄糖耐量测试）以及情绪，血糖控制，HPA轴活动，中央肥胖，饮食和体育活动的测量，将在所有受试者的基线下确定。抑郁受试者还将经常进行静脉内葡萄糖耐量测试（FSIGTT），并对活动，肥胖和细胞内脂肪进行更详细的分析。抑郁症受试者将被随机分配到认知行为疗法或常规抑郁症护理的12周；将观察到不抑郁的受试者进行比较。干预/观察后，将重复所有基线测量（包括FSIGTT和最初抑郁的其他测试）。单变量测试，协方差分析和最小二乘回归技术将用于评估抑郁症症状严重程度对IR的严重程度对IR和IR随着时间的变化的独立影响。抑郁治疗和抑郁缓解对IR的影响（控制基线差异）和抑郁症关系的潜在介体也将在最初抑郁的受试者中确定。我们假设抑郁症与未入学的T2DM中的IR增加有关，并且IR可以通过成功的抑郁症治疗改善。这项研究的发现可以确定一个可能改变的因素，以改善T2DM居住的人的过程和结果