Emotional Problems And Its Influencing Factors In Adults With Type 1 Diabetes Mellitus

Objective:This study is aimed to explore the clinical characteristics and depression and anxiety status of adult patients with type 1 diabetes,to analyze the risk factors of depression and anxiety of adult patients with type 1 diabetes,and to provide diabetes clinicians with appropriate psychotherapy methods for T1DM patients and scientific basis for alleviating the emotional problems of this population.Methods:（1）The adult patients in this study were collected from adults with type 1 diabetes who visited the Type 1 Diabetes General Clinic of the Second Xiangya Hospital of Central South University from October 2018 to July 2021.A self-made questionnaire and a diabetes related form were used to investigate the general conditions of the subjects,such as gender,age,height,weight,education level,marital status,occupation,and place of birth,course of disease,history of severe hypoglycemia,fasting C-peptide（FCP）,HbA1c and other diabetes related data.,and the Beck Depression Inventory-II（BDI-II）and the State-Trait Anxiety Inventory（STAI-S）were used to evaluate the the emotional state of adult patients with type 1 diabetes and healthy controls.The socioeconomic level of all subjects was assessed using the Chinese version of the Subjective Economic Status Scale（CSSS）.The social support rating scale（SSRS）compiled by Xiao Shuiyuan was used to evaluate the social support of the research subjects;the Chinese version of the Eysenck Personality Questionnaire Short Form（EPQ-RSC）was used to evaluate personality traits.（2）Descriptive analysis was performed on the collected data using mean±standard deviation,quartile and frequency（constituent ratio）;χ²test and Fisher exact probability method were used to analyze the difference in multi-groups of the age onset,disease duration,major socioeconomic status,BMI,severe hypoglycemia History,HbA1c,fasting C-peptide,social support,personality characteristics.A binary logistic regression model was used to analyze the main influencing factors of depression and anxiety in adult patients with type 1 diabetes.Results:（1）There were 149 adult patients with type 1 diabetes,the ratio of male to female was 1:1.04;The average age was 26.57±8.19years,and 95.3%of the patients were aged 18～44 years;71.81%of the patients were above high school;Patients with body mass index between18.5 and 24.0 kg/m²accounted for 45.6%;The age onset of the patients over 18 years old accounted for 61.7%;64.4%of the patients had a disease course of 3 years or less;71 patients（47.7%）had a history of severe hypoglycemia;Patients with HbA1c of 6.0～8.0%accounted for45.0%,Patients with fasting C-peptide value of 19.4～75.4pmol/l accounted for 25.6%.（2）Among the 149 adults with type 1 diabetes,The score of anxiety symptom was 38.61±10.04,64 had anxiety symptoms,accounting for43.0%.The score of depressive symptom was 9.45±7.65,There were 49people with mild depressive symptoms,accounting for 32.9%,16 people with moderate depressive symptoms,accounting for 10.7%,and 3 people with severe depressive symptoms,accounting for 2%.There were 47people with both depressive symptoms and anxiety symptoms,accounting for 31.5%.（3）The results of univariate analysis indicated that:HbA_1clevel,CSSS level,neuroticism N dimension,extroversion E dimension were correlated with anxiety state in adult patients with type 1 diabetes（P<0.05）;history of severe hypoglycemia,HbA_1c,CSSS,total social support score,extraversion E dimension,neuroticism N dimension and psychoticism P dimension were associated with depression in adult patients with type 1 diabetes（P<0.05 for both）（4）After two-factor multi-factorial unconditional logistic regression analysis,the main influencing factors of anxiety in patients type I diabetes were:neurotic N-latitude score greater than 5 points（OR=2.629,95%CI:1.161～6.244）.The subjective socioeconomic status score greater than12 points（OR=0.313,95%CI:0.123～0.793）.The subjective support score greater than 8（OR=0.384,95%CI:0.152～0.970）.The HbA_1cvalue greater than 7.4（OR=3.470,95%CI:1.522～7.913）.The main influencing factors of depression in patients with type I diabetes were neuroticism N dimension score greater than 5points（OR=15.776,95%CI:4.508～55.209）,extroversion E dimension score greater than 7 points（OR=0.315,95%CI:0.108～0.917）,mental quality P dimension score greater than 3points（OR=7.375,95%CI:2.408～22.582）,subjective socioeconomic status score greater than 12 points（OR=0.222,95%CI:0.069～0.716）,T1DM adults with a history of severe hypoglycemia（OR=6.654,95%CI:2.159～20.503）.Conclusion:（1）The positive detection rate of anxiety symptoms in adult patients with T1DM was 43.0%（95%CI:34.9%-51.0%）,The positive detection rate of depressive symptoms was 45.6%（95%CI:37.5%-53.7%）,The positive detection rate of anxiety and depression was31.5%（95%CI:24.0%-39.1%）。（2）High neuroticism n-dimension score,low subjective socio-economic status,low subjective support and high glycosylated hemoglobin level are the main influencing factors of anxiety in adult patients with type 1 diabetes.（3）High neuroticism N dimension score,low extroversion and extroversion e dimension score,high psychoticism P dimension score,low subjective socio-economic status,and history of severe hypoglycemia are the main influencing factors of depression in adult patients with type 1 diabetes..