Depression-Diabetes Mechanisms: Urban African Americans

描述（由申请人提供）：非裔美国人糖尿病和糖尿病并发症的患病率增加，反映了心理行为和代谢功能障碍。抑郁症可能导致2型糖尿病的发生和管理困难;我们发现许多患有糖尿病的非洲裔美国人也患有抑郁症，抑郁症是不依从的一个因素，而不依从导致血糖控制不良-并发症的主要原因。(1)确定患病率、社会生态学相关因素和。为了了解抑郁症的影响，我们将研究格雷迪糖尿病诊所的患者;评估社会经济状况，识字率和获得护理的机会;并将抑郁症与这些因素以及在就诊时和一年后的代谢控制联系起来。(2)为了确定抑郁症导致代谢失衡的途径，我们将研究暴露于进行性心理行为挑战（抑郁症和/或早期生活应激）的患者，并评估（a）下丘脑-垂体-肾上腺激活;（B）反调节激素;（c）免疫炎症细胞因子;与（d）胰岛素抵抗的关系。(3)为了确定治疗的心理行为和神经激素机制，我们将进行一项随机、安慰剂对照、双盲试验：抑郁症患者将接受压力管理录像带和安慰剂或选择性5-羟色胺再摄取抑制剂（SSRI）西酞普兰，我们将评估（a）总体血糖控制（HbAlc水平），和（B）患者依从性-对规定的饮食/锻炼计划、对药物的使用和对预定的复诊预约;与（c）抑郁症状和（d）如目标#2中定义的神经代谢功能相关。这些问题将由一个在神经内分泌分析、临床精神病学和糖尿病管理方面都有经验的多学科小组来解决。该提案的目标是使用最先进的心理生物学技术来定义城市非裔美国人2型糖尿病和抑郁症患者的神经行为和神经代谢异常及其对治疗的反应，以提高对该患者人群代谢紊乱的基本理解，并帮助缓解他们的健康差异。

DESCRIPTION (provided by applicant): African-Americans have increased prevalence of both diabetes and diabetes complications, reflecting combined psychobehavioral and metabolic dysfunction. Depression may contribute to both the genesis of Type 2 diabetes, and difficulties in management; we find that many African-Americans with diabetes also have depression, that depression is a factor in nonadherence, and that nonadherence leads to poor glycemic control- a major cause of complications. (1) To establish the prevalence, socioecoloqic associates, and. qlycemic impact of depression, we will study patients presenting to the Grady Diabetes Clinic; evaluate socioeconomic status, literacy, and access to care; and relate depression to these factors and to metabolic control both at presentation and after one year of care. (2) To define the pathways through which depression contributes to metabolic imbalance, we will study patients exposed to progressive psychobehavioral challenge (depression and/or early life stress), and assess (a) hypothalamic-pituitary-adrenal activation; (b) counter-regulatory hormones; and (c) immunoinflammatory cytokines; in relation to (d) insulin resistance. (3) To determine the psychobehavioral and neurohormonal mechanisms of treatment, we will conduct a randomized, placebo-controlled, double-blind trial: patients with depression will receive stress management videotapes and either placebo or the selective serotonin reuptake inhibitor (SSRI) citalopram, and we will assess (a) overall glycemic control (HbAlc levels), and (b) patient adherence -to a prescribed diet/exercise program, to use of medications, and to scheduled return appointments; in relation to (c) depressive symptoms and (d) neurometabolic function as defined in Aim #2. These questions will be addressed by a multidisciplinary team with experience in both neuroendocrine analysis, clinical psychiatry, and diabetes management. The goal of this proposal is to use state-of-the-art psychobiological techniques to define the neurobehavioral and neurometabolic abnormalities and their response to treatment in urban African-Americans with type 2 diabetes and depression, as needed to improve basic understanding of disordered metabolism in this patient population and to help relieve their disparity in health.