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Hemoglobin A1c Variability Predicts Symptoms of Depression in Elderly Individuals With Type 2 Diabetes
Diabetes Care ( IF 16.2 ) Pub Date : 2017-09-01 , DOI: 10.2337/dc16-2754
Ramit Ravona-Springer 1, 2 , Anthony Heymann 3 , James Schmeidler 4 , Erin Moshier 4 , Elizabeth Guerrero-Berroa 4 , Laili Soleimani 4 , Mary Sano 4 , Derek Leroith 5 , Rachel Preiss 6 , Ruth Tzukran 1 , Jeremy M. Silverman 4 , Michal Schnaider Beeri 1, 4
Affiliation  

OBJECTIVE This study aimed to analyze the relationship of variability in hemoglobin A1c (HbA1c) over years with subsequent depressive symptoms.

RESEARCH DESIGN AND METHODS Subjects (n = 837) were participants of the Israel Diabetes and Cognitive Decline (IDCD) study, which aimed to examine the relationship of characteristics of long-term type 2 diabetes with cognitive decline. All pertain to a diabetes registry established in 1998, which contains an average of 18 HbA1c measurements per subject. The results presented here are based on the IDCD baseline examination. Symptoms of depression were assessed using the 15-item version of the Geriatric Depression Scale (GDS). To quantify the association between variability in glycemic control (measured as the SD of HbA1c measurements [HbA1c-SD]) since 1998 with the number of depression symptoms at IDCD baseline, incidence rate ratios (IRRs) and corresponding 95% CIs were estimated via negative binomial regression modeling and used to account for the overdispersion in GDS scores.

RESULTS Subjects’ ages averaged 72.74 years (SD 4.63 years), and the mean number of years in the diabetes registry was 8.7 (SD 2.64 years). The mean GDS score was 2.16 (SD 2.26); 10% of subjects had a GDS score ≥6, the cutoff for clinically significant depression. Mean HbA1c significantly correlated with HbA1c-SD (r = 0.6625; P < 0.0001). The SD, but not the mean, of HbA1c measurements was significantly associated with the number of subsequent depressive symptoms. For each additional 1% increase in HbA1c-SD, the number of depressive symptoms increased by a factor of 1.31 (IRR = 1.31 [95% CI 1.03–1.67]; P = 0.03).

CONCLUSIONS Variability in glycemic control is associated with more depressive symptoms.



中文翻译:

血红蛋白A 1c变异性预测患有2型糖尿病的老年人的抑郁症状

目的本研究旨在分析多年来血红蛋白A 1c(HbA 1c)变异与随后的抑郁症状之间的关系。

研究设计与方法研究对象(n = 837)是以色列糖尿病和认知衰退(IDCD)研究的参与者,该研究旨在研究长期2型糖尿病的特征与认知能力下降之间的关系。所有这些都与1998年建立的糖尿病注册机构有关,每个受试者平均包含18个HbA 1c测量值。此处显示的结果基于IDCD基线检查。抑郁症状使用15项老年抑郁量表(GDS)进行评估。为了量化血糖控制变异之间的关联(以HbA 1c测量值[HbA 1c-SD]),自1998年以来,根据IDCD基线的抑郁症状数量,通过负二项式回归模型估算了发生率比(IRR)和相应的95%CI,并用于解释GDS得分的过度分散。

结果受试者的平均年龄为72.74岁(标准差4.63岁),糖尿病登记的平均年限为8.7年(标准差2.64岁)。GDS平均得分为2.16(SD 2.26);10%的受试者的GDS评分≥6,这是临床上明显的抑郁症的临界值。平均HbA 1c与HbA 1c -SD显着相关(r = 0.6625; P <0.0001)。HbA 1c测量值的SD(而非平均值)与后续抑郁症状的数量显着相关。HbA 1c -SD每增加1%,抑郁症状的数量增加1.31倍(IRR = 1.31 [95%CI 1.03-1.67];P = 0.03)。

结论血糖控制的变异性与抑郁症症状有关。

更新日期:2017-09-08
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