| Objective:It is common for type 2 diabetic patients to be anxious and depressed. The negative mood as anxiety and depression, changes of neuroendocrine and immunization variables may be correlated to glucose metabolism. This study is to explore the neuroendocrine changes in depression in type 2 diabetes mellitus from the angles of hypothalamus-pituitary-adrenal axis(HPA) and hypothalamus pituitary-gonadal axis (HPG),then evaluating the effect of conventional treatment combined with fluoxetine (Prozac) in the treatment of type 2 diabetes combined with depression and the mechanism from the viewpoint of psychosomatic medicine.Method:Collect 35 patients with type 2 diabetes between the ages of 29-69 (among which 20 are with depression and 15 are without) and 10 healthy adults. Divide them into three groups:group A (patients with depression), group B (patients without depression) and group C (healthy people). Test every person's ACTH-COR, E2, T and PRL in their fasting serum when they are conscious at 8 o'clock in the morning, and make statistical analysis. Randomly divide group A into two subgroups:subgroup A1 and subgroup A2, respectively consisting of 10 patients. Treat subgroup A1 with conventional method plus fluoxetine (Treatment 1), and subgroup A2 with conventional method only (Treatment 2).Observe the glucose levels and the changes in ACTH-COR,E2,T,PRL,SAS,SDS six weeks later.Result:1) Through completely randomly designed analysis of the values of ACTH-COR of the three groups, namely group A, B and C, it is discovered that the ACTH-COR levels of group A are obviously higher than those of the other two groups(P<0.05); 2) Through completely randomly designed analysis of the values of E2,T,E2/T and PRL of the three groups it is discovered that the estrogen levels of menopausal female patients of type 2 diabetes combined with depression decreased significantly and at the same time their T values rised while their E2/T decreased; that the androgen levels of male patients of type 2 diabetes combined with depression decreased obviously compared with the group of healthy people, and at the same time their E2 and E2/T values both rised; that the PRL levels of group A (DM combined with depression) are obviously higher than the healthy people and has statistical significance (P<0.05).3) The blood glucose levels and insulin resistance index of group A are both higher than those of group B and have statistical significance (P<0.05).4) After treatment all the indicators decreased in varying degrees, among which the values of SAS,SDS,COR,FBG and 2hPG in the group Al are apparently lower than they were before the treatment, and have statistical significance (P<0.05).Conclusion:1) Anxiety and depression in patients with type 2 diabetes is closely related to the changes in a variety of neuroendocrine hormones and glucose metabolism. HPA axis and HPG axis dysfunction may be one of the biological mechanisms of type 2 diabetes combined with depression.2) It is common for type 2 diabetic patients to be anxious and depressed. To treat those patients with type 2 diabetes combined with depression, apart from conventional antidiabetic treatment, we should also use antidepressants to improve their mental condition and cut off the middle part through which depression affects glucose metabolism to help the antidiabetic drugs to exert their effect.
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