Increasing prevalence of type 2 diabetes in Chinese adults in Shanghai

OBJECTIVE

Our objective was to determine the secular trend in prevalence of type 2 diabetes in Shanghai, China.

RESEARCH DESIGN AND METHODS

Two consecutive population-based surveys for type 2 diabetes were conducted in randomly selected adults aged 35–74 years in Shanghai in 2002–2003 (n = 12,329) and in 2009 (n = 7,423). Diagnosed type 2 diabetes was determined based on self-report, whereas those undiagnosed were identified by measured fasting and postload glucose according to 2009 American Diabetes Association criteria.

RESULTS

Age-standardized prevalence of diagnosed and undiagnosed type 2 diabetes increased from 5.1 and 4.6% in 2002–2003 to 7.4 and 5.2% in 2009. The prevalence of type 2 diabetes increased with age and was higher among men and in urban residents in both surveys (P < 0.001). Between the two surveys, the increase in the prevalence was more evident in the rural population (P < 0.001) and appeared more rapid in younger birth cohorts (P < 0.05).

CONCLUSIONS

Our results suggest that Shanghai has experienced an increasing burden of type 2 diabetes.Type 2 diabetes is a major global health problem that affects over 285 million individuals worldwide (1). Over past decades, a continuous increase in prevalence of type 2 diabetes, which parallels a marked lifestyle transition and a worldwide epidemic of obesity, has been observed in both developed and developing countries (2). Unlike the gradual transition in most Western countries, these changes in China have occurred over a very short time (3). This may have led to a more rapidly increasing burden of type 2 diabetes. In this study, we evaluated the trend of type 2 diabetes in Chinese adults using the data derived from two population-based surveys in Shanghai.     

Headache, anxiety and depressive disorders: the HADAS study

The objective of this paper was to assess prevalence and characteristics of anxiety and depression in migraine without aura and tension-type headache, either isolated or in combination. Although the association between headache and psychiatric disorders is undisputed, patients with migraine and/or tension-type headache have been frequently investigated in different settings and using different tests, which prevents meaningful comparisons. Psychiatric comorbidity was tested through structured interview and the MINI inventory in 158 adults with migraine without aura and in 216 persons with tension-type headache or migraine plus tension-type headache. 49 patients reported psychiatric disorders: migraine 10.9%, tension-type headache 12.8%, and migraine plus tension-type headache 21.4%. The MINI detected a depressive episode in 59.9, 67.0, and 69.6% of cases. Values were 18.4, 19.3, and 18.4% for anxiety, 12.7, 5.5, and 14.2%, for panic disorder and 2.3, 1.1 and 9.4% (p = 0.009) for obsessive–compulsive disorder. Multivariate analysis showed panic disorder prevailing in migraine compared with the other groups (OR 2.9; 95% CI 1.2–7.0). The association was higher (OR 6.3; 95% CI 1.4–28.5) when migraine (with or without tension-type headache) was compared to pure tension-type headache. This also applied to obsessive–compulsive disorder (OR 4.8; 95% CI 1.1–20.9) in migraine plus tension-type headache. Psychopathology of primary headache can reflect shared risk factors, pathophysiologic mechanisms, and disease burden.     

抑郁症与焦虑症脑血流灌注SPECT显像对照研究

目的：探讨抑郁症、焦虑症患者局部脑血流量（rCBF）的特点及脑单光子计算机断层扫描（SPECT）对抑郁症的诊断价值。方法：对21例抑郁症患者、17例焦虑症患者和20例正常对照者进行脑SPECT显像,并比较检查结果。结果：抑郁症组与正常对照组比较,双侧前额叶、颞叶前部、双侧扣带回前部、双侧顶叶、枕叶以及尾状核rCBF明显低于正常对照组（P＜0.05或0.01）。焦虑症组与正常对照组比较,额叶、部分颞叶和丘脑的rCBF明显低于正常对照组（P＜0.05或0.01）。抑郁症组与焦虑症组相比较,抑郁症组在双侧扣带回前部、右顶叶及尾状核的rCBF明显低于焦虑症组（P＜0.05或0.01）。结论：抑郁症和焦虑症对脑血流灌注均有重要影响,抑郁症患者在双侧扣带回前部、右顶叶及尾状核的脑血流灌注明显低于焦虑症组。SPECT脑灌注显像在抑郁症和焦虑症的诊断与鉴别诊断中具有重要价值。     

Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes

OBJECTIVE: To investigate the frequency of depressive and anxiety disorders in patients with chronic daily headache. BACKGROUND: There is a lack of data in the literature on the extent of psychiatric comorbidity in patients with different subtypes of chronic daily headache. METHODS: We recruited consecutive patients with chronic daily headache seen in a headache clinic from November 1998 to December 1999. The subtypes of chronic daily headache were classified according to the criteria proposed by Silberstein et al. A psychiatrist evaluated the patients according to the structured Mini-International Neuropsychiatric Interview to assess the comorbidity of depressive and anxiety disorders. RESULTS: Two hundred sixty-one patients with chronic daily headache were recruited. The mean age was 46 years, and 80% were women. Transformed migraine was diagnosed in 152 patients (58%) and chronic tension-type headache in 92 patients (35%). Seventy-eight percent of patients with transformed migraine had psychiatric comorbidity, including major depression (57%), dysthymia (11%), panic disorder (30%), and generalized anxiety disorder (8%). Sixty-four percent of patients with chronic tension-type headache had psychiatric diagnoses, including major depression (51%), dysthymia (8%), panic disorder (22%), and generalized anxiety disorder (1%). The frequency of anxiety disorders was significantly higher in patients with transformed migraine after controlling for age and sex (P =.02). Both depressive and anxiety disorders were significantly more frequent in women. CONCLUSION: Psychiatric comorbidity, especially major depression and panic disorders, was highly prevalent in patients with chronic daily headache seen in a headache clinic. These results demonstrate that women and patients with transformed migraine are at higher risk of psychiatric comorbidity.     

老年2型糖尿病患者焦虑情绪障碍危险因素的分析

目的了解老年2型糖尿病患者焦虑情绪障碍的患病情况及其危险因素。方法对156例老年2型糖尿病患者进行一般情况、代谢指标等检查,并对患者的心理状态、影响病情变化的相关精神因素进行问卷调查。采用焦虑自评量表评价受试者的焦虑状态,采用Logistic回归模型分析老年2型糖尿病患者的焦虑情绪障碍与相关影响因素的关系。结果本组患者中有48例有焦虑情绪障碍,占30．77％。单因素分析发现,吸烟史、糖化血红蛋白、眼底病变、家族史、并发症数目、担心无法根治、担心会导致并发症、因控制饮食痛苦、担心长期依赖胰岛素是本组患者焦虑情绪障碍的危险因素;多因素分析结果显示,糖化血红蛋白、眼底病变、并发症数目、担心长期依赖胰岛素与老年2型糖尿病患者焦虑情绪障碍存在显著的统计学联系。结论焦虑情绪障碍在老年2型糖尿病患者中患病率较高,糖尿病治疗应将心理治疗视为临床治疗的一部分。     

舍曲林联合振源胶囊治疗2型糖尿病患者伴发抑郁症状对照研究

目的：探讨舍曲林联合振源胶囊治疗2型糖尿病患者伴发抑郁症状的临床疗效和安全性。方法将66例2型糖尿病伴发抑郁症状患者随机分成两组,每组33例,研究组口服舍曲林联合振源胶囊治疗,对照组口服舍曲林治疗,观察6周。治疗前后采用汉密顿抑郁量表评定临床疗效,副反应量表评定不良反应。结果治疗6周末研究组抑郁症状改善显效率72．7％、总有效率87．9％,对照组分别为42．4％、60．6％,研究组显著高于对照组（χ^2＝4．06、6．42,P＜0．05）;研究组糖脂代谢各项指标及失眠、胸痹、心悸、肝功能异常、心电图异常发生率均显著低于对照组（ P＜0．05或0．01）。结论舍曲林联合振源胶囊治疗2型糖尿病患者伴发抑郁症状疗效显著,安全性高,依从性好,显著优于单用舍曲林治疗。     

2型糖尿病患者常见心理障碍患病情况的调查

2型糖尿病被认为是一种心身疾病[1],严重影响着人们的身心健康。目前,我国的2型糖尿病患者正以每年1‰的速度增加。近年来,世界卫生组织已把糖尿病(DM)归为与生活方式有关的非传染性慢性疾病,并强调心理应激在其发病中的重要作用。研究表明,各种应激、心理创伤等可促使DM的发生     

抑郁症和糖尿病共病患者的临床特征对照研究

目的探讨抑郁症和糖尿病共病患者的临床特征。方法使用自制调查表,收集30例抑郁症和糖尿病共病患者和30例单纯抑郁症患者的社会人口学资料和病情资料。结果抑郁症和糖尿病共病患者的平均病程、平均发病次数和平均住院日均显著高于单纯抑郁症患者;抑郁症和糖尿病共病患者的临床症状显著重于单纯抑郁症患者;抑郁症和糖尿病共病患者的出院疗效显著差于单纯抑郁症患者。结论抑郁症和糖尿病共病患者的临床症状重、治疗难度大。     

Pain and the onset of depressive and anxiety disorders

Patients with pain may be at increased risk of developing a first episode of depressive or anxiety disorder. Insight into possible associations between specific pain characteristics and such a development could help clinicians to improve prevention and treatment strategies. The objectives of this study were to examine the impact of pain symptomatology on depression and anxiety onset and to determine whether these associations are independent of subthreshold depressive and anxiety symptoms. Data from the Netherlands Study of Depression and Anxiety, collected between 2004 and 2011, were used. A total of 614 participants with no previous history and no current depression or anxiety at baseline were followed up for 4 years. Onset of depressive or anxiety disorder was assessed at 2- and 4-year follow-up by Composite International Diagnostic Interview. Baseline pain characteristics were location, duration, and severity, as assessed by chronic pain grade. Onset of depressive or anxiety disorder occurred in 15.5% of participants. Using Cox survival analyses, onset of depression and anxiety was associated with 6 pain locations (neck, back, head, orofacial area, abdomen, and joints; hazard ratio [HR] = 1.96 to 4.02; P < .05), increasing number of pain locations (HR = 1.29; P < .001), and higher severity of pain (HR = 1.57; P < .001). By contrast, there was no association with duration of pain symptoms (HR = 1.47; P = .12). Independent of subthreshold affective symptoms, only joint pain and increasing number of pain locations were still significantly associated with depression and anxiety onset. Clinicians should be aware that regardless of affective symptoms, pain, particularly at multiple locations, is a risk indicator for developing depressive and anxiety disorders.     

Food insecurity and glycemic control among low-income patients with type 2 diabetes

OBJECTIVE

To determine whether food insecurity—the inability to reliably afford safe and nutritious food—is associated with poor glycemic control and whether this association is mediated by difficulty following a healthy diet, diabetes self-efficacy, or emotional distress related to diabetes.

RESEARCH DESIGN AND METHODS

We used multivariable regression models to examine the association between food insecurity and poor glycemic control using a cross-sectional survey and chart review of 711 patients with diabetes in safety net health clinics. We then examined whether difficulty following a diabetic diet, self-efficacy, or emotional distress related to diabetes mediated the relationship between food insecurity and glycemic control.

RESULTS

The food insecurity prevalence in our sample was 46%. Food-insecure participants were significantly more likely than food-secure participants to have poor glycemic control, as defined by hemoglobin A_1c ≥8.5% (42 vs. 33%; adjusted odds ratio 1.48 [95% CI 1.07–2.04]). Food-insecure participants were more likely to report difficulty affording a diabetic diet (64 vs. 49%, P < 0.001). They also reported lower diabetes-specific self-efficacy (P < 0.001) and higher emotional distress related to diabetes (P < 0.001). Difficulty following a healthy diet and emotional distress partially mediated the association between food insecurity and glycemic control.

CONCLUSIONS

Food insecurity is an independent risk factor for poor glycemic control in the safety net setting. This risk may be partially attributable to increased difficulty following a diabetes-appropriate diet and increased emotional distress regarding capacity for successful diabetes self-management. Screening patients with diabetes for food insecurity may be appropriate, particularly in the safety net setting.The epidemic of type 2 diabetes has hit the poor particularly hard. Low socioeconomic status is associated with a higher prevalence of diabetes and a greater risk for diabetes complications (1–3). There are likely many specific elements of poverty that predispose adults to diabetes and poor diabetes control, but a great number of these potentially predisposing factors have not been fully investigated.Food insecurity has been postulated as one mechanism by which poverty might predispose adults of low socioeconomic status to poor diabetes control (4). Food insecurity refers to going hungry or being at risk for going hungry because of the inability to afford food. It exists “whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways [e.g., without resorting to emergency food supplies, scavenging, stealing, or other coping strategies] is limited or uncertain” (5). In 2010, 14.5% of U.S. households were food-insecure, representing 32 million adults (6).A recent study conducted with a nationally representative sample (National Health and Nutrition Examination Survey) of low-income adults found that among patients with a known diagnosis of diabetes, 69% of food-insecure and 49% of food-secure adults were unable to achieve a hemoglobin A_1c (HbA_1c) ≤7% (7). Studies among children with type 2 diabetes have demonstrated higher HbA_1c values among children living in food-insecure households compared with children living in food-secure households (8). However, the association between food insecurity and glycemic control has not been evaluated in clinical populations of adult patients with diabetes, and mechanisms for a relationship between food insecurity and glycemic control remain unclear.Food insecurity is a multidimensional concept, encompassing reductions in food quantity and food quality. Other studies suggest that food insecurity may increase patients’ difficulty following a diabetes-appropriate diet because they shift their dietary intake toward inexpensive, calorically dense foods, which generally include a high proportion of added fats, added sugars, and other refined carbohydrates, to maintain caloric needs (9). These foods generally make glycemic control more difficult to achieve. However, we hypothesized that additional mechanisms existed by which food insecurity may directly influence glycemic control. For example, food insecurity may reduce self-efficacy, defined as confidence in one’s ability to successfully manage all of the things necessary to take care of one’s own health, or it may increase emotional distress regarding diabetes management. Reduced self-efficacy and emotional distress related to diabetes may both interfere with patients’ ability to manage their diabetes (10–13).Our objective was to determine whether food insecurity was independently associated with poor glycemic control in a clinical population of low-income adults with diabetes. We hypothesized that the association between food insecurity and glycemic control would be mediated by increased difficulty following a healthy diet, decreased diabetes-specific self-efficacy, and greater emotional distress related to diabetes among the food-insecure participants.     

Lipid disorders in type 1 and type 2 diabetes

Atherosclerotic cardiovascular disease is the most important cause of morbidity and mortality in diabetic subjects. Abnormalities in circulating lipids and lipoproteins are considered to be important risk factors for cardiovascular disease because they occur with increased frequency in diabetic individuals. Because reversal of these abnormalities carries the potential for preventing or ameliorating cardiovascular disease, their identification and management with other cardiovascular disease risk factors deserve equal importance to the management of hyperglycemia and frequently are complementary to it.     

Profiles of self-rated health in midlife adults with chronic illnesses

BACKGROUND: Self-rated health (SRH), an important indicator of cognitive appraisal of health, consistently predicts mortality, morbidity, and health services utilization. However, few explanations account for how these cognitive appraisals of health might differ within a population of midlife adults with chronic illnesses who may be at risk for further illnesses over time. OBJECTIVES: The purpose of this study was two-fold: (a) to uncover classes of chronically ill midlife adults who shared unique profiles of characteristics that predicted SRH over time and (b) to reveal the predictive factors of SRH for each class over time. METHODS: Using 5 waves of data (1992-2000) from the Health and Retirement Study, the sample included 6,335 respondents (ages 51 to 61 at baseline) who reported at least one chronic illness. Selected components of the Interaction Model of Client Health Behavior guided the inclusion of relevant predictors of SRH from the literature. Latent class regression was employed to simultaneously classify respondents and identify factors that predicted SRH for each class over time. RESULTS: The final model reflected 3 distinct profiles of SRH over time: positive health, average health, and negative health. Four time-varying predictors differed significantly across the 3 classes: overweight, work limitation, depressed mood, and living with a partner. Three time-varying predictors--comorbidity, vigorous activity less than 3 times per week, and current smoking--had the same influence on all 3 classes. DISCUSSION: The differential effects of these predictors on SRH over time distinguish these results from prior research. In future studies, profiles of SRH that are unique to each class could be used to develop class-specific targeted interventions to improve cognitive appraisal of health, whereas generic interventions would be based on the class-independent predictors of SRH.     

Use of case studies to teach diabetes and other chronic illnesses to nursing students

Nursing students frequently have difficulty understanding diabetes mellitus and other chronic illnesses. Using the active learning technique of the case study method enables students to understand the difficulty in taking care of clients with chronic illnesses. Three forms of the case study method are shared. The students are enlightened about clients' difficulty in taking care of themselves after the diagnosis of a chronic illness. The case study method is leveled and used to develop critical thinking by focusing on the client's needs and collaborating to solve problems. This enables students to develop a clearer understanding of the disease, how it affects clients and their needs, and responses to studies of the disease.     

Carbohydrate-induced memory impairment in adults with type 2 diabetes

OBJECTIVE: Memory impairment is observed in adults with type 2 diabetes. The focus of this study was to determine whether acute carbohydrate consumption contributes to or exacerbates memory dysfunction. RESEARCH DESIGN AND METHODS: The impact of consuming 50 g of rapidly absorbed carbohydrate (one half bagel and white grape juice) at breakfast was examined in 19 adults with type 2 diabetes. Subjects (mean age 63 +/- 9 years, mean BMI 26.1 +/- 4.5 kg/m(2)) were tested, under fed and fasted conditions, on verbal declarative memory using both word list and paragraph recall tests (immediate and delayed [7-min] recall), Trails Test Part B as a measure of general brain function, and mood (subjectively monitoring global vigor and affect). RESULTS: Under baseline (fasting) conditions, elevated blood HbA(1c) was negatively associated with immediate and delayed paragraph recall performance (R(2) = 0.30; P = 0.024) and higher fasting blood glucose trended toward poorer word list recall (R(2) = 0.09; P = 0.102). Carbohydrate ingestion influenced measures of delayed, but not immediate, recall in a time-dependent fashion (time x food) (word list, P = 0.046; paragraph, P = 0.044) such that delayed recall was improved at 15 min postingestion but was impaired at 30 min. Neither Trails Test scores (P = 0.17) nor mood (affect, P = 0.68 and vigor, P = 0.45) were influenced by food ingestion. CONCLUSIONS: In adults with type 2 diabetes, poorer glycemic control is associated with lower performance on tests of declarative memory. Acute ingestion of high glycemic index carbohydrate foods further contributes to the underlying memory impairment.     

Psychometric testing of the depressive cognition scale in women with type 2 diabetes

Depression is prevalent in young and middle-aged diabetic women. Although cognitive depressive symptoms precede the development of depression, there is no screening instrument to measure these symptoms in diabetic patients. This study tested the psychometric properties of the Depressive Cognition Scale (DCS) in a convenience sample of 83 women with Type 2 diabetes. Alpha coefficient for the 8-item scale was .85, and the average inter-item correlation coefficient was .42. Construct validity was supported by correlations in the expected directions between the DCS and measures of learned resourcefulness, depressive symptoms, and health practices. Factor analysis presented a single dimension of 8 items. These findings suggest that the DSC will be useful in identifying patients with chronic conditions such as diabetes who are at risk for the development of clinical depression.     

帕罗西汀治疗2型糖尿病抑郁焦虑患者疗效分析

目的评价帕罗西汀对伴抑郁、焦虑情绪的2型糖尿病患者的治疗效果。方法 46例伴抑郁、焦虑情绪的2型糖尿病患者采用随机数字表法分为研究组及对照组各23例,研究组除糖尿病常规药物治疗外,辅以帕罗西汀20mg每天早餐后顿服,对照组仅进行糖尿病常规药物治疗,治疗前后行焦虑自评量表(SAS)和抑郁自评量表(SDS)评分,并分别测定空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(GHbA1 c)、甘油三酯(TG)、胆固醇(TC)、低密度脂蛋白(LDL)水平。结果两组治疗后SAS、SDS、FPG、2hPG、GHbA1 c均有所下降,但研究组较对照组下降更显著(P0.05);两组TG、TC、LDL改变无统计学意义(P0.05)。结论帕罗西汀可以改善2型糖尿病患者的抑郁、焦虑症状,有助于血糖的控制。