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首页> 外文期刊>Psychosomatic Medicine: Journal of the American Psychosomatic Society >Diabetes and poor disease control: is comorbid depression associated with poor medication adherence or lack of treatment intensification?
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Diabetes and poor disease control: is comorbid depression associated with poor medication adherence or lack of treatment intensification?

机译：糖尿病和疾病控制不佳：合并性抑郁症是否与药物依从性差或缺乏治疗强化相关？

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OBJECTIVE: To hypothesize that patients with comorbid depression and diabetes and poor disease control will have poorer adherence to disease control medication and less likelihood of physician intensification of treatment. Many patients with diabetes fail to achieve American Diabetes Association Guidelines for glycemic, blood pressure and lipid control. Depression is a common comorbidity and may affect disease control through adverse effects on adherence and physician intensification of treatment. METHODS: In a cohort of 4117 patients with diabetes, depression was measured at baseline with the Patient Health Questionnaire-9 (PHQ-9). Patient adherence and physician intensification of treatment were measured in those who had evidence of poor disease control (HbA(1c) >or=8.0%, LDL >or=130 mg/dL, systolic blood pressure >or=140 mm Hg) over this 5-year period. Poor adherence was defined as having medication refill gaps for >or=20% of days covered for medications prescribed for each of these conditions. Treatment intensification was defined as an increased medication dosage in a class, an increase in the number of medication classes, or a switch to a different class within 3-month periods before and after notation of above target levels. RESULTS: Among patients with diabetes and poor disease control, depression was associated with an increased likelihood of poor adherence to diabetes control medications (odds ratio [OR] = 1.98; 95% Confidence Interval [CI] = 1.31, 2.98), antihypertensives (OR = 2.06; 95% CI = 1.47, 2.88), and LDL control medications (OR = 2.43; 95% CI = 1.19, 4.97). In patients with poor disease control who were adherent to medication or not yet started on a medication, depression was not associated with differences in likelihood of physician intensification of treatment. CONCLUSIONS: In patients with diabetes and poor disease control, depression is an important risk factor for poor patient adherence to medications, but not lack of treatment intensification by physicians.
机译：目的：假设患有抑郁症和糖尿病的合并症和疾病控制不佳的患者对疾病控制药物的依从性较差，医师加强治疗的可能性较小。许多糖尿病患者未能达到美国糖尿病协会的血糖，血压和血脂控制指南。抑郁症是一种常见的合并症，可能通过对依从性和医生强化治疗的不良影响而影响疾病的控制。方法：在4117名糖尿病患者队列中，使用“患者健康问卷9（PHQ-9）”在基线时对抑郁进行了测量。在此期间，对那些证据表明疾病控制不佳（HbA（1c）>或= 8.0％，LDL>或= 130 mg / dL，收缩压>或= 140 mm Hg）的患者进行了患者依从性和医师强化治疗的测量。 5年期限。依从性差被定义为在每种情况下开具的药物补给间隙的天数大于或等于20％。强化治疗的定义是：在表示高于目标水平的前后三个月内，增加一类药物的剂量，增加类药物的数量或切换到另一类药物。结果：在患有糖尿病且疾病控制不佳的患者中，抑郁症与糖尿病控制药物依从性差的可能性增加（几率[OR] = 1.98; 95％置信区间[CI] = 1.31、2.98），降压药（OR = 2.06; 95％CI = 1.47，2.88）和LDL对照药物（OR = 2.43; 95％CI = 1.19，4.97）。在坚持药物治疗或尚未开始药物治疗的疾病控制不佳的患者中，抑郁与医师加强治疗的可能性不相关。结论：在糖尿病和疾病控制不佳的患者中，抑郁症是患者依从性差的重要危险因素，但并非缺乏医生的强化治疗。

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