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，反映出心理行为和代谢功能障碍的综合表现。抑郁症可能导致2型糖尿病的发生，也可能导致管理困难；我们发现许多患有糖尿病的非裔美国人也有抑郁症，抑郁是不坚持的一个因素，不坚持会导致血糖控制不佳--并发症的一个主要原因。(1)建立流行率、社会生态相关者和。为了研究抑郁症的降糖影响，我们将研究到Grady糖尿病诊所就诊的患者；评估社会经济状况、识字能力和获得护理的机会；并将抑郁症与这些因素和代谢控制联系起来，无论是在就诊时还是在一年的护理之后。(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)逆调节激素；(C)免疫炎症细胞因子；(D)胰岛素抵抗。(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、安慰剂对照的双盲试验：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)患者对处方饮食/运动计划、药物使用和预定的返回预约的依从性；与目标2中定义的(C)抑郁症状和(D)神经代谢功能有关。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团队来解决。这项建议的目标是使用最先进的心理生物学技术来确定患有2型糖尿病和抑郁症的城市非裔美国人的神经行为和神经代谢异常及其对治疗的反应，以提高对这一患者群体中代谢紊乱的基本了解，并帮助缓解他们在健康方面的差异。

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.