Relationship Among Depression And Anxiety Co-morbidity In Patients With Type 2 Diabetes,Insulin Resistance And Cortisol

Objectives:Patients with type 2 diabetes are prone to depression,anxiety and depression and anxiety co-morbidity and other psychiatric symptoms.Depression or anxiety can lead to elevated cortisol levels and more severe insulin resistance,which has an adverse effect on the development and prognosis of diabetes..However,there has not been any concern about the symptoms of depression and anxiety co-morbidity in patients with type 2 diabetes.The aim of this study was to investigate depression,anxiety and cortisol and insulin resistance in patients with type 2 diabetes(T2DM),and explore the correlation between depression or anxiety with cortisol and insulin resistance.And further to explore whether cortisol plays a mediating role between depression or anxiety and insulin resistance.Based on the results above,evidences are provided for making comprehensive strategy to reduce symptoms of depression and anxiety,and improve insulin resistance.Methods:Convenience sampling method was used to select 132 patients with type 2diabetes from a tertiary-level hospital in Changchun from April to November 2017.The survey tools including the general demographic scale,HAMD,HAMA and laboratory data(lipid metabolism,blood glucose control,insulin resistance and cortisol).Epidata 3.1 software was used to establish a database.statistical analysis were carried out in SPSS 21.0.Mean,standard deviation,frequency,percentage were used to depict the general demographic characteristics.According to the score of HAMD and HAMA,the participants was divide into four groups: type 2 diabetes,diabetes with depression,diabetes with anxiety,diabetes with depression and anxiety.2 test was used to compare demographic characteristics,lipid metabolism,blood glucose control,fasting insulin,insulin resistance and cortisol.Logistic regression analysis was used to investigate the risk of insulin resistance and hypercortisolemia.SPSS was used to explore the mediating role of cortisol plays between depression or anxiety and insulin resistance by process procedure.Results:1.T2 DM accounts for 15.15% of the total number of people,28.79% T2 DM patients were with depression,19.70% T2 DM patients were with anxiety,36.36% of them were depression and anxiety co-morbidity.In the group of depression and anxiety co-morbidity,the score of depression and anxiety was the highest(p<0.05).2.The data of fat metabolism showed: the group of T2 DM with depression and depression and anxiety co-morbidity had lower level of total cholesterol.Diabetes in mental state had high level of high density lipoprotein and lower level of low-density lipoprotein.3.Compared to diabetes,T2 DM with depression and anxiety co-morbidity have higher level of fasting blood glucose,fasting insulin,2h postprandial blood glucose and HbA1c(p<0.05);Diabetes in mental state had higher level of fasting C-Peptide(p<0.05).4.T2 DM with depression and anxiety co-morbidity had worse HOMA-IR and ISI(p<0.05).The incidence of insulin resistance of T2 DM with depression and anxiety co-morbidity was 47.9%.T2 DM with depression and anxiety co-morbidity had the risk of insulin resistance was 8.236 times than of type 2 diabetes.5.T2 DM with depression/anxiety had higher level of cortisol(p<0.05),especially in the group of depression and anxiety co-morbidity had the highest level of cortisol(p<0.05).The incidence of hypercortisolemia of T2 DM with depression and anxiety co-morbidity was 37.6%.T2 DM with depression and anxiety co-morbidity had the risk of hypercortisolemia was 35.729 times than of type 2diabetes.6.In the group of diabetes with depression and anxiety co-morbidity,depression and anxiety were used as independent variables to detect the mediating effect of cortisol on depression and anxiety comorbidity and insulin resistance,the mediating effects were 0.0485 and 0.0894 respectively,indicating that cortisol played the only mediating role in depression and anxiety comorbidity and insulin resistance in type 2diabetes.Conclusions:1.The prevalence of depression and anxiety in T2 DM were high,especially in the form of depression and anxiety co-morbidity.2.T2 DM with depression and anxiety co-morbidity had abnormal lipid metabolism and glucose metabolism.3.T2 DM with depression and anxiety co-morbidity had severer insulin resistance and the highest level of cortisol.4.Cortisol played a mediating role in T2 DM with depression and anxiety co-morbidity and insulin resistance.5.Nurses should pay attention to T2 DM patients with depression and anxiety co-morbidity,and provide psychological counseling to reduce the level of depression and anxiety.At the same time,health care professionals should reasonably control the level of blood glucose,insulin resistance and cortisol in T2 DM patients with depression and anxiety co-morbidity,and have important implications for improving the development and prognosis of diabetes.