社区综合性心理行为干预对糖尿病伴抑郁患者糖代谢的影响

Effect of Community Comprehensive Psychological and Behavioral Intervention on Glucose Metabolism of Type 2 Diabetes Patients Complicated with Depression

目的探讨社区综合性心理、行为干预对2型糖尿病伴抑郁患者糖代谢的影响。方法采用Zung自评抑郁量表(SDS)对华南师范大学社区150例2型糖尿病患者进行调查,筛选并进入本试验2型糖尿病伴抑郁者62例,再按抑郁程度分层随机抽样将其分为综合性心理、行为干预组(干预组)和对照组。对照组患者采用降血糖、降血脂药物治疗,干预组在此基础上辅以综合性心理、行为干预。分别在干预前、干预3个月后及2个月追踪期后对两组患者空腹血糖(FBG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)和抑郁指数进行测定并比较。结果(1)华南师范大学社区2型糖尿病患者抑郁症检出率高达42·7%,明显高于全国常模组(P<0·01);(2)经心理、行为干预3个月后,两组患者FBG、2hPG、HbA1c、抑郁指数间差别有统计学意义(P<0·05);(3)在追踪期末,干预组患者FBG、HbA1c及抑郁指数较干预后有所回升(P<0·01)。结论(1)抑郁在2型糖尿患者中有较高患病率;(2)社区综合性心理、行为干预能改善2型糖尿病患者的抑郁症状及糖代谢,但需要长期坚持。

Objective To investigate the effect of community comprehensive psychological and behavioral intervention on glucose metabolism of type 2 diabetes patients complicated with depression. Methods 150 patients with type 2 diabetes were assessed with Self- reporting Depression Scale （SDS） and 64 patients were found of depression, the 62 patients were randomly divided into the psychological and behavioral intervening group and the control group. The control group was treated only with conventional therapies. While the psychological intervening group received comprehensive psychological and behavioral intervention in addition to conventional therapies. All patients were assessed according to SDS, and fasting blood glucose （FBG） level, two hour post- meal blood glucose （2PG） level, haemaglobin A1c （HbA1c） level, which were measured before the treatment and at the third , the fifth month after treatment. Results （ 1 ） The ratio of depression in patients with type 2 diabetes in the Southern China Normal University Community was 42. 67%, which was significantly higher than that in the healthy people （ P 〈 0. 01 ） ; （2） There were significant differences in FBG, 2PG, HbA1c and depressive indexes between the two groups three moths after the treatment （ P 〈0.05） ; （3） FBG, 2PG, HbA1c and depressive indexes went up during the follow - up period. Conclusions （ 1 ） Depression occurs frequently in patients with type 2 diabetes. （2） Community comprehensive psychological and behavioral intervention can improve clinical outcome, and lessen the depression of patients with type 2 diabetes, but must be persisted in for a long time.