ALGORITHM FOR SCREENING OF DEPRESSION IN INSULIN-DEPENDENT DIABETES

Objective: to evaluate the possible risk factors of development of depression in insulin-dependent diabetes and to develop a screening algorithm for this depression. Material and methods. The study involved 163 patients with insulin-dependent diabetes mellitus (DM), of them, 93 men and 70 women aged 18-65. The average age of the patients was 41,15 [34,65; 46,66], the experience of diabetes was 11.18 [4,28; 22,33] years. To identify the common risk factors of depression development, we conducted a survey according to a specially designed questionnare. For verification of depression, the Hospital Anxiety and Depression Scale (HADS) was used. Depression was diagnosed at 8-21 points according to the HADS. To diagnose hidden hypoglycaemia states, twenty-four-hour glycemia dynamics was studied within 72 hours with the help of diurnal glucose monitoring of intercellular fluid (CGMS) by «Medtronik MINIMED» (USA). The detection of homocysteine (HC) content in the blood serum was performed using sets of ARCHITECT Homocysteine Reagent Kit (1L71) on the biochemical analyzer «Architect c8000» («AVVOTT», USA). The data were statistically processed using «Statistica», 6.0 for Windows and SPSS «Statistics», 17.0. Results . The results of the survey using the HADS showed symptoms of depression in 28.2 % of the patients in the study group. Depression was detected in 30 women, or 18.4 %, and 16 men (9,8 %). The study revealed a statistically significant direct correlation between the HADS depression level and age (r = 0,17; r < 0,05), and it also found that the risk of depression in insulin-dependent diabetes is associated with age over 40 (OR = 1,06; p < 0,05; 95 % CI 0,99-1,13). It was ascertained that disability is a risk factor for depression (OR = 2,41; p = 0,01; 95 % CI 1,16-4,19). The assessment of the risk of depression development according to HbA1C level showed that the possible risk of depression is associated with the HbA1C level of 7,5 % or more (OR = 0,89; p = 0,03; 95 % CI 0,30-0,48). The risk of depression is also associated with DR (OR = 10,72; p < 0,001; 95 % CI 3,14-36,55) and with the presence of DN (OR = 3,79; p < 0,001; 95 % CI 1,84-7,82). The study found the dependence of the prevalence of hidden hypoglycemic reactions and the level of depression according to the scale of HADS (OR = 1,12; p = 0,0024; 95 % CI 1,02-1,24). It was also ascertained that the risk of depression in the patients with type I diabetes is associated with the level of more than 15.39 HС mmol/L (OR = 6,82; p = 0,001; 95 % CI 2,19-21,20). Conclusion . The risk for the development of depression in I type diabetes is associated with the female sex, age over 40, presence of disability, DR and/or НС serum level more than 15,39 mmol/L, and the HbA level of ≥ 7,5 %. In addition, the risk for the development of depression is associated with hidden hypoglycemic episodes. The developed algorithm for screening of depressive states in insulin-dependent DM can be used to diagnose depression as on both out-patient and in-patient phase of treatment of the patients with I type diabetes.

депрессивные переживания, факторы риска, сахарный диабет 1 типа, скрининг, depression, risk factors, I type diabetes mellitus, screening

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