糖尿病とうつ病との関連に関する横断研究―糖尿病診療の実態に関する前向き調査（DIACET）を用いた解析―

抄録

Objective: To investigate the incidence and severity of depression, and its association with diabetic complications, among Japanese patients with type 1 and type 2 diabetes.

Methods: This was a single-center cross-sectional study, performed as a part of the Diabetes Study from the Center of Tokyo Women's Medical University (DIACET), established in 2012 by the DIACET committee. All subjects received self-administered questionnaires which included questions regarding the diabetic condition, subjective symptoms associated with diabetic micro- and macroangiopathy, frequency of clinical visits due to vascular diseases, and the Patient Health Questionnaire-9 (PHQ-9), a measure of depression. We extracted data for patients with type 1 and type 2 diabetes. The incidence and severity of depression in patients with type 1 and type 2 diabetes, and the associations between the severity of depression and diabetic complications were examined using logistic regression analysis.

Results: A total of 7,036 patients with type 1 and type 2 diabetes were studied. The mean (±SD) age was 61±15 years, 1,196 patients had type 1 diabetes, and 3,009 patients were women. According to the PHQ-9 scores, patients were classified into the following 3 categories: 0-4 points, no depression (n=4,687); 5-9 points, mild depression (n=2,349); and 10 or more points, moderate or severe depression (n=823). Accordingly, 2,349 patients (33.4 %) of the patients with diabetes had depressive symptoms as indicated by a PHQ-9 score of 5 or more. Although frequency of depressive symptoms were significantly greater among patients with type 1 diabetes, the significance disappeared after adjustment for age and gender using multiple logistic regression analysis, yielding odds ratio (OR) of mild depression=0.94, 95 % confidence interval (CI) =0.78-1.12 (p=0.482) and OR of moderate or severe depression=0.89, 95 %CI=0.71-1.11 (p=0.293). Higher PHQ-9 scores were associated with increased ORs for retinopathy, neuropathy, and end-stage kidney disease requiring dialysis after adjustment for age, gender, and HbA1c in both type 1 and type 2 diabetes patients (p<0.001).

Conclusion: There were no differences in likelihood or severity of depression between type 1 and type 2 diabetes. Significant relationships were found between depression severity and chronic diabetic complications among patients with both type 1 and type 2 diabetes.