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Longitudinale Assoziationen zwischen depressiven Symptomen und Typ-2-Diabetes sowie deren Auswirkung auf die Mortalität von Hausarztpatienten

Longitudinal associations between depressive symptoms and type 2 diabetes and their impact on mortality in primary care patients

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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Es gibt widersprüchliche Befunde darüber, ob depressive Symptome Risikofaktoren für die Neumanifestation eines Diabetes sind oder ob umgekehrt auch Diabetes ein Risikofaktor für depressive Zustände ist. Daher untersuchen wir die längsschnittlichen wechselseitigen Assoziationen zwischen depressiven Symptomen und Typ-2-Diabetes (T2D) sowie die Auswirkungen des gemeinsamen Auftretens beider Erkrankungen auf die Mortalität anhand einer Stichprobe von Hausarztpatienten im Verlauf eines im Mittel 3,5-jährigen Beobachtungszeitraums. Die depressive Symptomatik wurde anhand des Depression Screening Questionnaire (DSQ) kategorial sowie dimensional betrachtet. Die Einteilung in Patienten mit normalem Nüchternblutzucker (NBZ), erhöhtem NBZ sowie T2D (unbehandelt, medikamentös, mit Insulin/kombiniert behandelt) erfolgte nach Arztangaben beziehungsweise nach Laborbefunden zur Baseline-Untersuchung. Die Inzidenz des T2D bei Patienten mit beziehungsweise ohne depressive Symptome betrug 25,6 und 20,9 pro 1000 Personenjahre. Bei dimensionaler Betrachtung des DSQ erhöhte sich das T2D-Risiko (unadjustiert) um das 1,03-Fache [KI (95%): 1,01–1,06] bei punktweisem Anstieg des DSQ. Die Inzidenz depressiver Symptome per 1000 Personenjahre betrug 30,5 für Patienten mit normalem, 34,2 für Patienten mit erhöhtem NBZ, 36,4 für unbehandelte, 32,3 für oral behandelte und 47,8 für insulinbehandelte T2D-Patienten. Verglichen mit Patienten mit einem normalen NBZ hatten insulinbehandelte Patienten ein höheres Risiko für depressive Symptome [HR: 1,71; KI (95%): 1,03–2,83] und oral behandelte T2D-Patienten ein niedrigeres Risiko [HR: 0,58; KI (95%): 0,36–0,96]. Verglichen mit Patienten ohne T2D und depressiver Symptomatik ist das Vorliegen beider Erkrankungen mit einer erhöhten Mortalität assoziiert [HR: 2,49; KI (95%):1,45–4,28]. Die Ergebnisse deuten an, dass vor allem eine Insulinbehandlung bei T2D-Patienten mit inzidenten depressiven Symptomen assoziiert ist.

Abstract

It is unclear whether depressive symptoms are a risk factor for incident diabetes or diabetes is a risk factor for depressive conditions. Therefore, we examined the longitudinal bidirectional associations between depressive symptoms and type 2 diabetes (T2D) as well as the impact of both diseases on (all cause) mortality in a sample of primary care patients over a 3.5-years follow-up period on average. Depressive symptomatology, defined by the Depression Screening Questionnaire (DSQ), was examined both categorically and dimensionally. Patients were categorized as normal fasting glucose (NFG), impaired fasting glucose (IFG), and T2D (untreated, oral antidiabetics, insulin/combined treatment) according to physician ratings and baseline lab values. Incidence rates of T2D were 25.6 and 20.9 per 1000 person–years for those with and without depressive symptoms, respectively. The unadjusted risk of incident type 2 diabetes was 1.03 times higher (CI(95%): 1.01–1.06) for each 1-point increment in DSQ score. The incidence rates of elevated depressive symptoms per 1000 person–years were 30.5 for NFG, 34.2 for IFG, 36.4 for untreated T2D, 32.3 for oral treated T2D, and 47.8 for insulin/combined-treated T2D patients. Compared to NFG patients, insulin-treated patients had a higher risk of incident depressive symptoms (HR: 1.71; CI(95%): 1.03–2.83) and oral-treated patients had a lower risk (HR: 0.58; CI(95%): 0.36–0.96). Higher mortality rates were associated with both diseases compared to patients without T2D or depressive symptoms at baseline (HR: 2.49; CI(95%):1.45–4.28). Results indicate that especially insulin treatment in T2D patients is associated with incident depressive symptoms.

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Authors and Affiliations

  1. Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Deutschland

    L. Pieper, J. Klotsche, C. Thurau & H.-U. Wittchen

  2. Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland

    J. Dirmaier & U. Koch

  3. Institut für Klinische Pharmakologie, Technische Universität Dresden, Dresden, Deutschland

    D. Pittrow

  4. Medizinische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    H. Lehnert

  5. Synlab, Heidelberg, Deutschland

    W. März

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  1. L. Pieper
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  2. J. Dirmaier
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  3. J. Klotsche
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  4. C. Thurau
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  5. D. Pittrow
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  7. W. März
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  8. U. Koch
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  9. H.-U. Wittchen
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Corresponding author

Correspondence to L. Pieper.

Additional information

___Hinweis_____

DETECT (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment) is a cross-sectional and prospective longitudinal, nationwide clinical epidemiological study. DETECT is supported by an unrestricted educational grant of Pfizer GmbH, Karlsruhe, Germany. Principal investigator: Prof. Dr. H.-U. Wittchen; Staff members: Dipl.-Psych. L. Pieper, Dipl.-Math. J. Klotsche, Dr. T. Eichler, Dr. H. Glaesmer, E. Katze. Steering Committee: Prof. Dr. H. Lehnert (Lübeck), Prof. Dr. G.K. Stalla (München), Prof. Dr. A.M. Zeiher (Frankfurt); Advisory Board: Prof. Dr. W. März (Heidelberg/Graz), Prof. Dr. S. Silber (München), Prof. Dr. Dr. U. Koch (Hamburg), Prof. Dr. D. Pittrow (München/Dresden), Prof. Dr. M. Wehling (Mannheim), Dr. D. Leistner (Frankfurt), Dr. H.J. Schneider (München), Dr. C. Sievers (München).

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Pieper, L., Dirmaier, J., Klotsche, J. et al. Longitudinale Assoziationen zwischen depressiven Symptomen und Typ-2-Diabetes sowie deren Auswirkung auf die Mortalität von Hausarztpatienten. Bundesgesundheitsbl. 54, 98–107 (2011). https://doi.org/10.1007/s00103-010-1181-1

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  • DOI: https://doi.org/10.1007/s00103-010-1181-1

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