| Background Type 2 diabetes is a kind of clinical syndrome,which chronic high blood sugar is considered to be the main manifestation.It always bring a lot of psychological problems,depression is the most common disease.In recent years,clinical research shows that the prevalence of depression in patients with diabetes is very high,up to 30%.World Health Organization(WHO)officially defined as diabetes: and personal habits related to non-infectious chronic diseases.Depression and diabetes are the two major public health problems in modern society.American Diabetes Association(ADA)made it clear that in2012: in the process of strengthening the management of patients with diabetes,we must pay attention to mental health.Clinical treatment of diabetes,rehabilitation of thetwo stages,must to make a regular and accurate assessment of the patient’s psychological state.The Chinese diabetes prevention and treatment guidelinesof type 2in 2013 pointed out that there may be a two-way causal relationship between diabetes and depression.Diabetic patients with depression are unable to be satisfied with the control of blood sugar.And the risk of microvascular and Primary vascular complications might be better than those people whole not in depression.In these years,clinicians pay more attention to type2 diabetes with depression,but it’smechanism is still not very clear.It may be the result of the combined action of many factors,such as neuroendocrine,nerve biochemistry,psychological stress,etc.One of the most commoncognizationis that diabetes and depression have some identical biological abnormalities,HPA axis dysfunction is one of them.Dysfunction of HPA axis,which may be a "node" of the pathological mechanism of diabetes linked to depression,is related to the occurrence of depression in patients with diabetes,and may be one of themost important pathological mechanisms of diabetes patients complicated with depression.Salivary cortisol is regarded to be one of the first indicators of adrenal function in recent years.Salivary cortisol is not only cheaper to diagnose than serum cortisol,but also provides information which is not readily available in serum testing.Objective The study measured cortisol levels in the saliva of patients with type 2 diabetes mellitus complicated with depression,to explore the correlation between salivary cortisol level and type 2 diabetes mellitus patients with depression,and try to provide a theoretical basis for the existence of a two-way causal relationship.Methods From January 1,2015 to January 1,2016,both patients with type 2diabetes mellitus and non-diabetes control group were selected from the Department of Endocrinology,Central Hospital of Zhumadian city.The subjects were divided into three groups: T2 DM with depression(220 cases),T2 DM without depression(280cases),and common group(200cases).Record the gender,age,duration of disease,height,body mass and so on.Fasting blood glucose(FPG,glucose oxidase method),glycosylated hemoglobin(Hb Alc,methods: ion exchange chromatography high pressure liquid phase separation),triglyceride(T method:G,GOD-PAP),total cholesterol(TC method:.GOD-PAP),high density lipoprotein(HDL-C,direct method)),Low density protein(LDL-C,direct method),detection of salivary cortisol,comparison between different group of salivary cortisol(SC,methods: enzyme-linked immunosorbent assay),logistic regression was used to screening for diabetes the risk factors associated with depression.Results Compared with the control group,FPG,Hb A1 c,TG,TC,LDL-C of type 2 diabetes mellitus and type 2 diabetes mellitus depression group were significantly increased(P<0.05),high density lipoprotein(HDL-C),no significant difference(P>0.05).Compared with type 2 diabetes mellitus,FPG、Hb A1c、TG 、TC、LDL-C and were significantly higher in type 2 diabetic group(P<0.05),but there were no significant difference between HDL-C(P>0.05).Compared with the control group,the salivary cortisol levels were significantly increased in type 2 diabetic patients with depression and type 2 diabetes mellitus(P<0.05).Compared with the control group and type 2 diabetes compared with non depression group,type 2 diabetes depression group HAMD scores were significantly higher(P<0.05).Pearson correlation analysis showed that salivary cortisol was positively correlated with HAMD and Hb A1 c.Logistic regression analysis,the results show that salivary cortisol is a risk factor for type 2 diabetes with depression.Conclusion Type 2 diabetes mellitus and the main neuroendocrine mechanisms of depression may be the abnormal activation of HPA,clinical examination index of salivary cortisol as a reliable,simple and easy to reflect the function of HPA,the effective indicators may be used as screening for type 2 diabetic patients of depression. |
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