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J Diabetes. 2015 Nov;7(6):800-8. doi: 10.1111/1753-0407.12238. Epub 2015 Feb 19.

Depression in Chinese patients with type 2 diabetes: associations with hyperglycemia, hypoglycemia, and poor treatment adherence.

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  • 1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
  • 2Asia Diabetes Foundation, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
  • 3Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
  • 4Department of Endocrinology and Metabolism, China-Japan Friendship Hospital, Beijing, China.
  • 5Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
  • 6Department of Endocrinology and Metabolism, Peking Union Medical College Hospital, Beijing, China.
  • 7Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
  • 8Department of Endocrinology and Metabolism, Peking University First Hospital, Beijing, China.
  • 9Department of Psychiatry, The Chinese University of Hong Kong, Shatin Hospital, Shatin, Hong Kong SAR, China.
  • 10Association for the Improvement of Mental Health Programmes, Geneva, Switzerland.
  • 11University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, USA.
  • 12School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
  • 13Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.



We hypothesize that depression in type 2 diabetes might be associated with poor glycemic control, in part due to suboptimal self-care. We tested this hypothesis by examining the associations of depression with clinical and laboratory findings in a multicenter survey of Chinese type 2 diabetic patients.


2538 patients aged 18-75 years attending hospital-based clinics in four cities in China underwent detailed clinical-psychological-behavioral assessment during a 12-month period between 2011 and 2012. Depression was diagnosed if Patient Health Questionnaire-9 (PHQ-9) score ≥10. Diabetes self-care and medication adherence were assessed using the Summary of Diabetes Self-care Activities and the 4-item Morisky medication adherence scale respectively.


In this cross-sectional study (mean age: 56.4 ± 10.5[SD] years, 53% men), 6.1% (n = 155) had depression. After controlling for study sites, patients with depression had higher HbA(1c) (7.9 ± 2.0 vs. 7.7 ± 2.0%, P = 0.008) and were less likely to achieve HbA(1c) goal of <7.0% (36.2% vs 45.6%, P = 0.004) than those without depression. They were more likely to report hypoglycemia and to have fewer days of being adherent to their recommended diet, exercise, foot care and medication. In logistic regression, apart from young age, poor education, long disease duration, tobacco use, high body mass index, use of insulin, depression was independently associated with failure to attain HbA(1c) target (Odds Ratio [OR] = 1.56, 95%CI:1.05-2.32, P = 0.028). The association between depression and glycemic control became non-significant after inclusion of adherence to diet, exercise and medication (OR = 1.48, 95% CI 0.99-2.21, P = 0.058).


Depression in type 2 diabetes was closely associated with hyperglycemia and hypoglycemia, which might be partly mediated through poor treatment adherence.


depression; hyperglycemia; hypoglycemia; treatment adherence; type 2 diabetes; 关键词:抑郁、高血糖、低血糖、治疗依从性、2型糖尿病

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