Influencing Factors Of Depression In Patients With Type 2 Diabetes Mellitus

Background:Diabetes mellitus and depression are both complex public health issues and there is interaction between the two diseases.In recent years,it has been confirmed that vitamin D plays a role in improving the symptom of patients with major depressive disorder,and serum 5-hydroxytryptamine（5-HT）,brain derived neurotrophic factor（BDNF）,glial cell line-derived neurotrophic factor（GDNF）and human endogenous antimicrobial peptide（LL-37）are related to depression.However,there is few statistics data about whether vitamin D,5-HT,BDNF,GDNF and LL-37 paticipate in the pathogenesis and development of depression that occurs in patients with diabetes mellitus,so the results still stay uncertain.Therefore,in this study we explored the clinical features of patients with type 2 diabetes mellitus（T2DM）complicating depression,and evaluated the characteristics and function of vitamin D,5-HT,BDNF,GDNF and LL-37 in diabetes and depression comorbidity.Purpose:1.To analyze the characteristics of depression and diabetes comorbidity,and clinical and biochemical features of patients with diabetes mellitus complicating depression.2.To explore the relationship between serum 25-hydroxyvitamin D（25OHD）concentration and depression in patients with diabetes mellitus;3.To investigate the levels of 5-HT,BDNF,GDNF and LL-37 in comorbid depression and diabetes mellitus.Subjects and Methods:T2DM patients hospitalized in the Department of Endocrinology,the Second Hospital,Cheeloo College of Medicine,Shandong University from July 2019 to January 2020 were randomly selected.After the social demography and diabetes related clinical statistics of subjects were completed,and completed biochemical indexes such as blood routine,liver function,kidney function,blood glucose,glycosylated hemoglobin Alc（HbA1c）and 25OHD and 5-HT,BDNF,GDNF,LL-37 were measured by enzyme-linked immunosorbent assay（ELISA）;meanwhile diabetic complications were screened and dual energy X-ray absorptiometry examination was carried out;Self-Rating Depression Scale（SDS）and Hamilton Depression Scale（HAMD）were used to evaluate the depression degree of all subjects,Self-Rating Anxiety Scale（SAS）and Hamilton Anxiety Scale（HAMA）were used to evaluate the anxiety degree of all subjects.Results:1.In this study,211 patients with type 2 diabetes were included,SDS combined with HAMD was used to screen 75 patients with depression and the prevalence was 35.5%.Among them,72 cases were mild to moderate depression,accounting for 34.1%of the total,3 cases were severe depression,accounting for 1.4%of the total.2.The non-depression group and depression group was confirmed on the basis of scores of SDS combined HAMD.Compared with the patients in the non-depression group,the prevalence of diabetic retinopathy,diabetic nephropathy,ischemic cerebrovascular disease,osteoporosis and anxiety were higher in the depression group,and the duration of diabetes in the depression group was longer.HAMA score;leukocyte count,neutrophil count,FBG,HbA1c,urinary microalbumin/creatinine ratio（UACR）increased（P<0.05）in the depression group,while the serum concentrations of 25OHD,5-HT,BDNF and GDNF,femoral neck bone mineral density（BMD）and total hip BMD decreased（P<0.05）in the depression group;and no significant difference was found in LL-3 7 level between the two groups（P>0.05）.3.Logistic regression exhibited that BDNF[OR=0.309,95%CI（0.141-0.676）,P=0.003],25OHD[OR=0.328,95%CI（0.147-0.731）,P=0.006]and GDNF[OR=0.330,95%CI（0.145-0.750）,P=0.008]were independently correlated with comorbid depression and T2DM,suggesting that serum 25OHD,BDNF and GDNF may be the protective factors of comorbid depression and T2DM;diabetic retinopathy[OR=3.821,95%CI（1.613-9.050）,P=0.002]was independently correlated with comorbid depression and T2DM,suggesting that diabetic retinopathy may be a risk factor of comorbid depression and T2DM.Conclusions:1.T2DM patients are prone to comorbid depression.The prevalence of depression in this study was 35.5%.2.In contrast to the subjects of the non-depression group,the prevalence of diabetic retinopathy,diabetic nephropathy,ischemic cerebrovascular disease,osteoporosis and anxiety were higher and the duration of diabetes was longer in the depression group.HAMA score,leukocyte count,neutrophil count,FBG,HbA1c,urinary microalbumin/creatinine ratio（UACR）increased（P<0.05）and the serum concentrations of 25OHD,5-HT,BDNF and GDNF,femoral neck BMD and total hip BMD decreased（P<0.05）in the depression group.3.The level of serum 25OHD,BDNF and GDNF in T2DM patients was independently negatively correlated with depression,and they may be protective factors of comorbid depression and T2DM;diabetic retinopathy was independently positively correlated with depression,which may be a risk factor of comorbid depression and T2DM.