| Research background With the aging of the population,the prevalence of depression and type 2 diabetes in the elderly population is rising rapidly.There is a complex twoway relationship between depression and type 2 diabetes.The coexistence of two diseases in clinical practice increases the difficulty of clinical treatment,reduces the quality of life of patients,and directly leads to the increase of clinical disability and mortality.In recent years,it has been found that glucose fluctuation is an evaluation index of blood glucose control independent of glycated hemoglobin.Glucose fluctuation is not only one of the factors that cause target organ damage,but also can induce depression,which affects blood glucose control and emotional stability of patients.By understanding the characteristics of glucose fluctuations in late life depression and type 2 diabetes,and exploring the relationship between influencing factors and glucose fluctuations,the aim is to provide a basis for clinical prevention and treatment.Research objectives 1.Describe the characteristics of glucose fluctuation in late life depression complicated with type 2 diabetes;2.To explore the influencing factors of blood glucose fluctuation in late life depression complicated with type 2 diabetes.Research Methods From January 2020 to December 2022,86 patients(40 males and 46 females)with late life depression complicated with type 2 diabetes mellitus were selected from the Department of Geriatric Psychology,Psychological Hospital of Anhui Medical University,aged(70.73 ± 8.22)years old,as the study group(LLD group).At the same time,89 patients with type 2 diabetes mellitus(44 males and 45 females),aged(70.82 ± 8.11)years,were selected as the control group(T2DM group).General clinical data collection,laboratory examination and dynamic glucose measurement were completed in both groups.The degree of depressive symptoms in the two groups was assessed by 24-item Hamilton Depression Rating Scale(HAMD-24).1.Differences in general clinical data,glucose fluctuation level and HAMD score between the LLD group and T2 DM group.2.Patients in the LLD group were divided into groups according to different clinical characteristics,and glucose fluctuations and depressive symptoms of patients with different clinical characteristics were compared respectively.3.According to the average blood glucose fluctuation range(MAGE)< 3.9mmol/L and low blood glucose index(LBGI)< 2.5 as the normal reference value of blood glucose fluctuation,compare the difference in the detection rate of abnormal blood glucose fluctuation in LLD groups with different clinical characteristics.4.Correlation analysis of influencing factors of glucose fluctuation in LLD group.5.Multivariate analysis of influencing factors of glucose fluctuation in LLD group.Research results 1.Comparison of glucose fluctuation indexes and clinical symptoms between the LLD group and the T2 DM group: CV,SDBG,MAGE,HBGI and HAMD scores in the LLD group were significantly higher than those in the T2 DM group,and the differences were statistically significant(all P < 0.05).2.The LLD patients were grouped according to different characteristics such as gender,age,glycosylated hemoglobin level,duration of diabetes,and severity of depressive symptoms,and the glucose fluctuation was different.The mean absolute difference in daily blood glucose(MODD)was higher in females than in males(P < 0.05).The difference of age showed that low blood glucose index(LBGI)was increased in elderly patients(P < 0.05).Glycemic variability(MBG,CV,SDBG,MAGE,MODD,HBGI)was higher in the Hb A1 c level ≥7.0% group than in the Hb A1 c level < 7.0% group(P <0.05).LBGI increased with the duration of diabetes(P < 0.05).The variability of blood glucose(CV,SDBG,MAGE)in patients with severe depression was higher than that in patients with mild to moderate depression(P < 0.05).However,there was no difference in glucose fluctuation between first-episode and recurrent depressive disorders.3.The detection rate of abnormal blood glucose fluctuation in LLD group was analyzed : the detection rate of abnormal MAGE in ≥ 80 years old was higher than that in 70-79 years old(P < 0.05);with the prolongation of the course of diabetes,the detection rate of abnormal LBGI increased gradually(P < 0.05).There was no significant difference in the detection rate of abnormal blood glucose fluctuation among different genders,Hb A1 c levels,severity of depression and forms of depression(all P > 0.05).4.Pearson correlation analysis showed that MBG,CV,SDBG,MAGE,MODD,HBGI were positively correlated with Hb A1c(r=0.990,0.385,0.804,0.761,0.645,0.877,P < 0.05).CV,SDBG,MAGE,MODD,HBGI,LBGI were positively correlated with HAMD score(r=0.470,0.413,0.403,0.339,0.375,0.378,P < 0.05).CV and LBGI were positively correlated with anxiety/somatization factor score of HAMD(r=0.289,0.381,P < 0.05).CV,SDBG,MAGE,HBGI were positively correlated with sleep disorder factor score of HAMD(r=0.298,0.288,0.267,0.240,P < 0.05).MBG,CV,SDBG,MAGE,MODD,HBGI were positively correlated with HAMD desperation factor scores(r=0.215,0.273,0.322,0.329,0.234,0.324,P < 0.05).CV,SDBG,MAGE and LBGI were positively correlated with HAMD retardation factor scores(r=0.280,0.221,0.225,0.327,P < 0.05).CV and MAGE were positively correlated with HAMD diurnal variation factor scores(r=0.299,0.254,P < 0.05).MODD was positively correlated with HAMD cognitive impairment factor score(r=0.237,P < 0.05).There was no significant correlation between CGM indexes and HAMD weight factor scores.5.Multiple linear regression analysis showed that Hb A1 c level,anxiety/somatization symptom group and mood fluctuation were the influencing factors of glucose fluctuation (CV,SDBG and MAGE)in the LLD group,with explanations of 30.4%,70.9% and 64.8%,respectively(P < 0.05).Hb A1 c level and anxiety/somatization symptom group were the influencing factors of HBGI in LLD group,and the explanation was 80.8%(P < 0.05).However,the cognitive disorder symptom group,block symptom,sleep disorder symptom and hopelessness symptom had no significant influence on glucose fluctuation(P > 0.05).Research conclusion 1.The overall blood glucose control level of late life depression and type 2 diabetes is poor,and the bl ood glucose fluctuation is obvious.2.The influencing factors of blood glucose fluctuation in elderly patients with depressive disorder complicated with type 2 diabetes include Hb A1 c level,anxiety / somatization symptom group and emotional fluctuation.In clinical treatment,the synergistic treatment of depressive disorder and type 2 diabetes can improve Hb A1 c level and actively alleviate anxiety / somatization symptoms and emotional fluctuation,which may help to improve blood glucose control and outcome. |
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