Clinical Features And Follow-up Research Of The Type 2 Diabetes Mellitus Patients With Major Depression Disorder

Background and objective:Type 2 Diabetes mellitus (T2DM) and Major Depression Disorder (MDD) are two common public health issues, the comorbidity rate of which is high, and the relationship of which is bidirectional. Some researches began to study clinical features of their comorbidity in China. However, few study combined the DM-related distress to explore the comorbidity of these two disorders, and no research focused on the complex relationship of DM,MDD and glycemic control. Few study surveyed the prognosis of the MDD in T2DM outpatients and the characteristic of the help-seeking model, which was obtained from the psychiatric and psychological specialists. We will try to investigate the issues above in clinical practice.Method:We enrolled the T2DM patients with convenience sampling in the outpatient clinic of endocrinology, in Peking Union Medical College Hospital. We collected the data of social demographic and clinical disease, and did mental evaluation with the tool of M.I.N.I and HAMD scale. Patients were required to fulfill the scales of PHQ-9, WHO-5 and PAID. One year later, we did follow-up research, which involved the changes of clinical and psychological states.Results:1.200 patients were recruited. There were 26 cases with comorbid DM and MDD. They were mostly first-episode MDD patients (77%). Their depressive symptoms were not very severe (median score of HAMD=19), but their anxiety symptoms were remarkable, and the proportion of concurrent anxiety disorders was high (46.2%). The proportions of Peripheral neuropathy, heart problems, hypertension and hyperlipidemia were higher (all p<0.05), and the score of PAID scale was higher (p<0.001), too. In logistic regression analysis, peripheral neuropathy (OR=5.59,p=0.002), hyperlipidemia (OR=7.50, p=0.021), diabetes-related distress (OR=8.43, p=0.002) were risk factors for the comorbidity. The HbA1C concentration was the highest in comorbid patients with diabetes-related distress (p<0.05). MDD and diabetes-related distress had interaction effects on HbA1C concentration (p=0.04).2. In the follow-up periods, the comorbid patients of 17 at baseline, who completed the follow-up, still showed moderate depression (median score of follow-up HAMD=23)and more severe diabetes-related distress (p=0.008) and more complications (p=0.013). The percentage of their help-seeking behavior was low, as well as the MDD remission rate (both 29.4%). The new onset comorbid MDD patients had already minor depressive symptoms (median score of follow-up HAMD=11) at baseline time. They showed better help-seeking behavior (60%), but their MDD remission rate was low (40%), too.Conclusion:The comorbid patients had more complicated clinical condition. We should recognize the comorbid MDD in DM patients, and strengthen the management of the comorbidity.