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Abstract：
UNASSIGNED: Psychosocial status and patient reported outcomes (PRO) [depression and health-related quality-of-life (HRQoL)] are major health determinants. We investigated the association between depression and clinical outcomes in Chinese patients with type 2 diabetes (T2D), adjusted for PRO.
UNASSIGNED: Using prospective data from Hong Kong Diabetes Register (2013-2019), we estimated the hazard-ratio (HR, 95%CI) of depression (validated Patient Health Questionnaire 9 (PHQ-9) score≥7) with incident cardiovascular disease (CVD), ischemic heart disease (IHD), chronic kidney disease (CKD: eGFR<60 ml/min/1.73m2) and all-cause mortality in 4525 Chinese patients with T2D adjusted for patient characteristics, renal function, medications, self-care and HRQoL domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression measured by EQ-5D-3L) in linear-regression models.
UNASSIGNED: In this cohort without prior events [mean ± SD age:55.7 ± 10.6, 43.7% women, median (IQR) disease duration of 7.0 (2.0-13.0) years, HbA1c, 7.2% (6.6%-8.20%), 26.4% insulin-treated], 537(11.9%) patients had depressive symptoms and 1923 (42.5%) patients had some problems with HRQoL at baseline. After 5.6(IQR: 4.4-6.2) years, 141 patients (3.1%) died, 533(11.8%) developed CKD and 164(3.6%) developed CVD. In a fully-adjusted model (model 4) including self-care and HRQoL, the aHR of depression was 1.99 (95% confidence interval CI):1.25-3.18) for CVD, 2.29 (1.25-4.21) for IHD. Depression was associated with all-cause mortality in models 1-3 adjusted for demographics, clinical characteristics and self-care, but was attenuated after adjusting for HRQoL (model 4- 1.54; 95%CI: 0.91-2.60), though HR still indicated same direction with important magnitude. Patients who reported having regular exercise (3-4 times per week) had reduced aHR of CKD [0.61 (0.41-0.89)]. Item 4 of PHQ-9 (feeling tired, little energy) was independently associated with all-cause mortality with aHR of 1.66 (1.30-2.12).
UNASSIGNED: Depression exhibits significant association with CVD, IHD, and all-cause mortality in patients with diabetes, adjusting for their HRQoL and health behaviors. Despite the association between depression and all-cause mortality attenuated after adjusting for HRQoL, the effect size remains substantial. The feeling of tiredness or having little energy, as assessed by item Q4 of the PHQ-9 questionnaire, was found to be significantly associated with an increased risk of all-cause mortality after covariate adjustments. Our findings emphasize the importance of incorporating psychiatric evaluations into holistic diabetes management.
UNASSIGNED: Using prospective data from Hong Kong Diabetes Register (2013-2019), we estimated the hazard-ratio (HR, 95%CI) of depression (validated Patient Health Questionnaire 9 (PHQ-9) score≥7) with incident cardiovascular disease (CVD), ischemic heart disease (IHD), chronic kidney disease (CKD: eGFR<60 ml/min/1.73m2) and all-cause mortality in 4525 Chinese patients with T2D adjusted for patient characteristics, renal function, medications, self-care and HRQoL domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression measured by EQ-5D-3L) in linear-regression models.
UNASSIGNED: In this cohort without prior events [mean ± SD age:55.7 ± 10.6, 43.7% women, median (IQR) disease duration of 7.0 (2.0-13.0) years, HbA1c, 7.2% (6.6%-8.20%), 26.4% insulin-treated], 537(11.9%) patients had depressive symptoms and 1923 (42.5%) patients had some problems with HRQoL at baseline. After 5.6(IQR: 4.4-6.2) years, 141 patients (3.1%) died, 533(11.8%) developed CKD and 164(3.6%) developed CVD. In a fully-adjusted model (model 4) including self-care and HRQoL, the aHR of depression was 1.99 (95% confidence interval CI):1.25-3.18) for CVD, 2.29 (1.25-4.21) for IHD. Depression was associated with all-cause mortality in models 1-3 adjusted for demographics, clinical characteristics and self-care, but was attenuated after adjusting for HRQoL (model 4- 1.54; 95%CI: 0.91-2.60), though HR still indicated same direction with important magnitude. Patients who reported having regular exercise (3-4 times per week) had reduced aHR of CKD [0.61 (0.41-0.89)]. Item 4 of PHQ-9 (feeling tired, little energy) was independently associated with all-cause mortality with aHR of 1.66 (1.30-2.12).
UNASSIGNED: Depression exhibits significant association with CVD, IHD, and all-cause mortality in patients with diabetes, adjusting for their HRQoL and health behaviors. Despite the association between depression and all-cause mortality attenuated after adjusting for HRQoL, the effect size remains substantial. The feeling of tiredness or having little energy, as assessed by item Q4 of the PHQ-9 questionnaire, was found to be significantly associated with an increased risk of all-cause mortality after covariate adjustments. Our findings emphasize the importance of incorporating psychiatric evaluations into holistic diabetes management.
摘要：
■心理社会状况和患者报告结果（PRO）[抑郁和健康相关生活质量（HRQoL）]是主要的健康决定因素。我们调查了中国2型糖尿病（T2D）患者抑郁与临床结局之间的关系，调整为PRO。
■使用香港糖尿病登记册(2013-2019)的前瞻性数据，我们估计了危险比(HR，95CI）的抑郁症（经过验证的患者健康问卷9（PHQ-9）评分≥7）与心血管疾病（CVD），缺血性心脏病（IHD），根据患者特征调整的4525例T2D中国患者的慢性肾脏病（CKD：eGFR<60ml/min/1.73m2）和全因死亡率，肾功能,药物,自我护理和HRQoL领域(移动性，自我照顾,平时的活动,疼痛/不适，线性回归模型中通过EQ-5D-3L)测量的焦虑/抑郁。
■在没有先前事件的队列中[平均±SD年龄：55.7±10.6，43.7％的女性，中位（IQR）病程7.0（2.0-13.0）年，HbA1c,7.2%（6.6%-8.20%），26.4％胰岛素治疗]，537例（11.9%）患者有抑郁症状，1923例（42.5%）患者在基线时存在一些HRQoL问题。5.6（IQR：4.4-6.2）年后，141例患者（3.1%）死亡，533（11.8%）发展为CKD，164（3.6%）发展为CVD。在包括自我护理和HRQoL的完全调整模型(模型4)中，抑郁症的aHR为1.99（95%置信区间CI）：1.25-3.18），IHD为2.29（1.25-4.21）。在人口统计校正的模型1-3中，抑郁与全因死亡率相关，临床特点和自我护理，但在调整HRQoL后减弱(模型4-1.54；95CI：0.91-2.60)，尽管HR仍然指示相同的方向，具有重要的幅度。报告有规律运动（每周3-4次）的患者CKD的aHR降低[0.61（0.41-0.89）]。PHQ-9第4项(感到疲倦,能量很少）与全因死亡率独立相关，aHR为1.66（1.30-2.12）。
■抑郁症与心血管疾病显著相关，IHD,糖尿病患者的全因死亡率，调整他们的HRQoL和健康行为。尽管在校正HRQoL后，抑郁症和全因死亡率之间的关联减弱，效果大小仍然很大。疲倦或几乎没有能量的感觉，根据PHQ-9问卷的第Q4项评估，在协变量调整后发现与全因死亡率风险增加显著相关.我们的发现强调了将精神病学评估纳入整体糖尿病管理的重要性。
■使用香港糖尿病登记册(2013-2019)的前瞻性数据，我们估计了危险比(HR，95CI）的抑郁症（经过验证的患者健康问卷9（PHQ-9）评分≥7）与心血管疾病（CVD），缺血性心脏病（IHD），根据患者特征调整的4525例T2D中国患者的慢性肾脏病（CKD：eGFR<60ml/min/1.73m2）和全因死亡率，肾功能,药物,自我护理和HRQoL领域(移动性，自我照顾,平时的活动,疼痛/不适，线性回归模型中通过EQ-5D-3L)测量的焦虑/抑郁。
■在没有先前事件的队列中[平均±SD年龄：55.7±10.6，43.7％的女性，中位（IQR）病程7.0（2.0-13.0）年，HbA1c,7.2%（6.6%-8.20%），26.4％胰岛素治疗]，537例（11.9%）患者有抑郁症状，1923例（42.5%）患者在基线时存在一些HRQoL问题。5.6（IQR：4.4-6.2）年后，141例患者（3.1%）死亡，533（11.8%）发展为CKD，164（3.6%）发展为CVD。在包括自我护理和HRQoL的完全调整模型(模型4)中，抑郁症的aHR为1.99（95%置信区间CI）：1.25-3.18），IHD为2.29（1.25-4.21）。在人口统计校正的模型1-3中，抑郁与全因死亡率相关，临床特点和自我护理，但在调整HRQoL后减弱(模型4-1.54；95CI：0.91-2.60)，尽管HR仍然指示相同的方向，具有重要的幅度。报告有规律运动（每周3-4次）的患者CKD的aHR降低[0.61（0.41-0.89）]。PHQ-9第4项(感到疲倦,能量很少）与全因死亡率独立相关，aHR为1.66（1.30-2.12）。
■抑郁症与心血管疾病显著相关，IHD,糖尿病患者的全因死亡率，调整他们的HRQoL和健康行为。尽管在校正HRQoL后，抑郁症和全因死亡率之间的关联减弱，效果大小仍然很大。疲倦或几乎没有能量的感觉，根据PHQ-9问卷的第Q4项评估，在协变量调整后发现与全因死亡率风险增加显著相关.我们的发现强调了将精神病学评估纳入整体糖尿病管理的重要性。
