OBJECTIVE Severe hyperglycemia and hypoglycemia (“severe dysglycemia”) are serious complications of type 1 diabetes (T1D). Depression has been associated with severe dysglycemia in type 2 diabetes but has not been thoroughly examined specifically in T1D. We evaluated bidirectional associations between depression and severe dysglycemia among older people with T1D.

RESEARCH DESIGN AND METHODS We abstracted depression and severe dysglycemia requiring emergency room visit or hospitalization from medical health records in 3,742 patients with T1D during the study period (1996–2015). Cox proportional hazards models estimated the associations between depression and severe dysglycemia in both directions, adjusting for demographics, micro- and macrovascular complications, and HbA_1c.

RESULTS During the study period, 41% had depression and 376 (11%) and 641 (20%) had hyperglycemia and hypoglycemia, respectively. Depression was strongly associated with a 2.5-fold increased risk of severe hyperglycemic events (hazard ratio [HR] 2.47 [95% CI 2.00, 3.05]) and 89% increased risk of severe hypoglycemic events (HR 1.89 [95% CI 1.61, 2.22]). The association was strongest within the first 6 months (HR_{hyperglycemia} 7.14 [95% CI 5.29, 9.63]; HR_hypoglycemia 5.58 [95% CI 4.46, 6.99]) to 1 year (HR_{hyperglycemia} 5.16 [95% CI 3.88, 6.88]; HR_hypoglycemia 4.05 [95% CI 3.26, 5.04]) after depression diagnosis. In models specifying severe dysglycemia as the exposure, hyperglycemic and hypoglycemic events were associated with 143% (HR 2.43 [95% CI 2.03, 2.91]) and 74% (HR 1.75 [95% CI 1.49, 2.05]) increased risk of depression, respectively.

CONCLUSIONS Depression and severe dysglycemia are associated bidirectionally among patients with T1D. Depression greatly increases the risk of severe hypoglycemic and hyperglycemic events, particularly in the first 6 months to 1 year after diagnosis, and depression risk increases after severe dysglycemia episodes.

目的严重的高血糖症和低血糖症（“严重的血糖异常”）是1型糖尿病（T1D）的严重并发症。抑郁症与2型糖尿病的严重血糖异常有关，但尚未在T1D中进行彻底检查。我们评估了患有T1D的老年人抑郁与严重血糖异常之间的双向关联。

研究设计和方法我们在研究期间（1996年至2015年）从3,742例T1D患者的医疗健康记录中提取了需要急诊或住院的抑郁症和严重血糖异常。考克斯比例风险模型估计了抑郁症和严重血糖异常在两个方向上的关联，并根据人口统计学，微血管和大血管并发症以及HbA _{1c进行了调整}。

结果在研究期间，分别有41％的人患有抑郁症，376例（11％）和641例（20％）患有高血糖症和低血糖症。抑郁症与严重高血糖事件的风险增加2.5倍密切相关（危险比[HR] 2.47 [95％CI 2.00，3.05]）和89％导致严重低血糖事件的风险增加（HR 1.89 [95％CI 1.61、2.22] ]）。关联在前6个月（HR_高血糖7.14 [95％CI 5.29，9.63]； HR_低血糖5.58 [95％CI 4.46，6.99]）至1年（HR_高血糖5.16 [95％CI 3.88，6.88 ]）中最强。 HR_低血糖抑郁症诊断后为4.05 [95％CI 3.26，5.04]。在指定严重血糖异常为暴露的模型中，高血糖和低血糖事件与143％（HR 2.43 [95％CI 2.03，2.91]）和74％（HR 1.75 [95％CI 1.49，2.05]）的抑郁风险增加相关，分别。

结论抑郁症和严重的血糖异常在T1D患者之间是双向相关的。抑郁症会大大增加发生严重的低血糖和高血糖事件的风险，尤其是在诊断后的前6个月至1年，严重的血糖异常发作后，抑郁症的风险会增加。