目的:探讨2型糖尿病患者发生重度抑郁和痴呆的风险。包括抑郁症导致的痴呆症,以及它们对糖尿病相关并发症和死亡率的影响。
方法:我们进行了一项基于人群的回顾性队列研究,包括2015-2017年的11,441例糖尿病事件,随访至2022年。在具有15个转变的七态模型上进行了多状态生存分析,以捕获疾病进展和精神障碍的发作。
结果:八年抑郁症的概率,痴呆症,糖尿病相关并发症,死亡率为9.7%(95%CI8.7-10.7),0.9%(95%CI0.5-1.3),10.4%(95%CI9.5-11.4),和14.8%(95%CI13.9-15.7),分别。抑郁症增加痴呆的风险高达3.7%(95%CI2.0-5.4),如果伴有糖尿病并发症,则高达10.3%(95%CI0.3-20.4)。抑郁症后的八年死亡率为37.5%(95%CI33.1-42.0),抑郁加并发症后74.1%(95%CI63.7-84.5),痴呆后76.4%(95%CI68.8-83.9),和98.6%(95%CI96.1-100.0)后痴呆加并发症。
结论:在整个抑郁症中观察到的相互联系,痴呆症,并发症,和死亡率强调了糖尿病管理的全面和综合方法的必要性.抑郁症的早期筛查,其次是及时和有针对性的干预措施,可以减轻痴呆症的风险并改善糖尿病的预后。
OBJECTIVE: To investigate the risk of major depression and dementia in patients with type 2 diabetes, including dementia resulting from depression, and their impact on diabetes-related complications and mortality.
METHODS: We conducted a population-based retrospective cohort study including 11,441 incident cases of diabetes in 2015-2017, with follow-up until 2022. A multi-state survival analysis was performed on a seven-state model with 15 transitions to capture disease progression and onset of mental disorders.
RESULTS: Eight-year probabilities of depression, dementia, diabetes-related complications, and death were 9.7% (95% CI 8.7-10.7), 0.9% (95% CI 0.5-1.3), 10.4% (95% CI 9.5-11.4), and 14.8% (95% CI 13.9-15.7), respectively. Depression increased the risk of dementia up to 3.7% (95% CI 2.0-5.4), and up to 10.3% (95% CI 0.3-20.4) if coupled with diabetes complications. Eight-year mortality was 37.5% (95% CI 33.1-42.0) after depression, 74.1% (95% CI 63.7-84.5) after depression plus complications, 76.4% (95% CI 68.8-83.9) after dementia, and 98.6% (95% CI 96.1-100.0) after dementia plus complications.
CONCLUSIONS: The interconnections observed across depression, dementia, complications, and mortality underscore the necessity for comprehensive and integrated approaches in managing diabetes. Early screening for depression, followed by timely and targeted interventions, may mitigate the risk of dementia and improve diabetes prognosis.