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Li S, Yang D, Zhou X, Chen L, Liu L, Lin R, Li X, Liu Y, Qiu H, Cao H, Liu J, Cheng Q. Neurological and metabolic related pathophysiologies and treatment of comorbid diabetes with depression. CNS Neurosci Ther 2024; 30:e14497. [PMID: 37927197 PMCID: PMC11017426 DOI: 10.1111/cns.14497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The comorbidity between diabetes mellitus and depression was revealed, and diabetes mellitus increased the prevalence of depressive disorder, which ranked 13th in the leading causes of disability-adjusted life-years. Insulin resistance, which is common in diabetes mellitus, has increased the risk of depressive symptoms in both humans and animals. However, the mechanisms behind the comorbidity are multi-factorial and complicated. There is still no causal chain to explain the comorbidity exactly. Moreover, Selective serotonin reuptake inhibitors, insulin and metformin, which are recommended for treating diabetes mellitus-induced depression, were found to be a risk factor in some complications of diabetes. AIMS Given these problems, many researchers made remarkable efforts to analyze diabetes complicating depression from different aspects, including insulin resistance, stress and Hypothalamic-Pituitary-Adrenal axis, neurological system, oxidative stress, and inflammation. Drug therapy, such as Hydrogen Sulfide, Cannabidiol, Ascorbic Acid and Hesperidin, are conducive to alleviating diabetes mellitus and depression. Here, we reviewed the exact pathophysiology underlying the comorbidity between depressive disorder and diabetes mellitus and drug therapy. METHODS The review refers to the available literature in PubMed and Web of Science, searching critical terms related to diabetes mellitus, depression and drug therapy. RESULTS In this review, we found that brain structure and function, neurogenesis, brain-derived neurotrophic factor and glucose and lipid metabolism were involved in the pathophysiology of the comorbidity. Obesity might lead to diabetes mellitus and depression through reduced adiponectin and increased leptin and resistin. In addition, drug therapy displayed in this review could expand the region of potential therapy. CONCLUSIONS The review summarizes the mechanisms underlying the comorbidity. It also overviews drug therapy with anti-diabetic and anti-depressant effects.
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Affiliation(s)
- Sixin Li
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Dong Yang
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Xuhui Zhou
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Lu Chen
- Department of Gastroenterology, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of GastroenterologyBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Lini Liu
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Ruoheng Lin
- Department of Psychiatry, National Clinical Research Center for Mental DisordersThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Xinyu Li
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Ying Liu
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Huiwen Qiu
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Hui Cao
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Jian Liu
- Center for Medical Research and Innovation, The First Hospital, Hunan University of Chinese MedicineChangshaHunanChina
| | - Quan Cheng
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaHunanChina
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Liu CC, Lin CY, Liu CH, Chang KC, Wang SK, Wang JY. Bidirectional association between major depressive disorder and dementia: Two population-based cohort studies in Taiwan. Compr Psychiatry 2023; 127:152411. [PMID: 37722203 DOI: 10.1016/j.comppsych.2023.152411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) and dementia are both major contributors to the global burden of disease. Despite existing literature on the association between MDD and dementia, there is a lack of a nationwide longitudinal cohort study that considers the competing risk of death. Therefore, this study assessed the bidirectional associations between MDD and dementia over an 11-year period in population-based settings, accounting for death as a competing risk. METHODS We conducted two population-based retrospective cohort studies in Taiwan. We identified 80,742 patients diagnosed with MDD in 2009-2010 and matched them with patients without MDD by sex, age, and year of diagnosis to assess the relative risk of dementia. We also identified 80,108 patients diagnosed with dementia in 2009-2010 and matched them with patients without dementia by sex, age, and year of diagnosis to assess the relative risk of MDD. All patients were followed until they received a diagnosis of new onset MDD or new onset dementia, their death, or the end of 2019. Cause-specific hazards models were used to estimate adjusted hazard ratios (aHRs). RESULTS The incidence density (ID) of dementia was higher in patients with MDD than in patients without MDD (7.63 vs. 2.99 per 1000 person-years), with an aHR of 2.71 (95% confidence interval [CI]: 2.55-2.88). The ID of MDD was higher in patients with dementia than in patients without dementia (12.77 vs. 4.69 per 1000 person-years), with an aHR of 2.47 (95% CI: 2.35-2.59). CONCLUSIONS This population-based study found a bidirectional association between MDD and dementia. Our findings suggest the need to identify dementia in patients with MDD and vice versa.
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Affiliation(s)
- Chih-Ching Liu
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taiwan.
| | - Chih-Yuan Lin
- Department of Neurology, Taipei City Hospital, Linsen Chinese Medicine Branch, Taipei, Taiwan; Institute of Health and Welfare Policy, School of Medicine, National Yang Ming Chiao Tung University, Taiwan
| | - Chien-Hui Liu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taiwan; Division of Emergency Medical Service, New Taipei City Fire Department, New Taipei City, Taiwan
| | - Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Kai Wang
- Department of Pediatrics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taiwan.
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Hsieh HM, Lin CH, Weng SF, Lin PC, Liu TL, Huang CJ. Health-related quality of life, medical resource use and physical function in patients with diabetes mellitus and depression: A cross-sectional analysis from the National Health and Nutrition Examination Survey. J Affect Disord 2023; 327:93-100. [PMID: 36754091 DOI: 10.1016/j.jad.2023.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with either diabetes (DM) or depression (DP) are prone to developing other diseases and require more medical resources than do the general population. This study aimed to examine health-related quality of life, medical resource use, and physical function of patients with both diabetes mellitus and depression, and the magnitude of effects among patients with different combinations of comorbid diseases. METHODS A retrospective cross-sectional study was conducted using the National Health and Nutrition Examination Survey data from 2009 to 2014. Total 16,159 patients were studied and classified into one of 4 groups: both DM and DP(DM+/DP+), DM+/without DP(DP-), without DM (DM-)/DP+, and DM-/DP-, according to the perceived score in Patient Health Questionnaire and diabetes questionnaire in NHANES. Health-related quality of life (HRQoL), medical resource use, and physical function were measured as outcomes of interests. Multivariate logistic regression models were used. RESULTS Compared with DM-/DP- patients, the DM+/DP+ (adjusted odds ratio [AOR]: 2.59; 95 % CI: 1.77-3.80) and DM-/DP+ (AOR: 2.44; 95 % CI: 1.94-3.06) had greater likely to have worse health. In addition, the DM+/DP+ (AOR: 5.40; 95 % CI: 1.30-22.41) and DM+/DP- (AOR: 2.49; 95 % CI: 1.91-3.25) were more likely to have medical visits, and worse physical function. CONCLUSIONS This study found that both depression and diabetes mellitus worsen HRQoL, increase medical resource use, and decrease physical function. Depression status should be considered by clinicians treating diabetes mellitus patients in order to improve their HRQoL, reduce medical resource use, and improve physical function.
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Affiliation(s)
- Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Community Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Shih-Feng Weng
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pai-Cheng Lin
- Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Jen Huang
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan; Department of Psychiatry, School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Zhang C, Wu Z, Lopez E, Magboo RG, Hou K. Symptoms of depression, perceived social support, and medical coping modes among middle-aged and elderly patients with type 2 diabetes. Front Mol Biosci 2023; 10:1167721. [PMID: 37077200 PMCID: PMC10108626 DOI: 10.3389/fmolb.2023.1167721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/07/2023] [Indexed: 04/05/2023] Open
Abstract
Objective: To understand the prevalence of depression in diabetes population, explore the relationship between diabetes and depression, and the impact of comprehensive psychological and behavioral intervention on depression related to diabetes and glucose metabolism.Methods: 71 middle-aged and elderly patients with type 2 diabetes were investigated and evaluated with Self Rating Depression Scale (SDS), Medical Coping Scale (MCWQ) and Social Support Scale (PSSS). Patients who met the research criteria were randomly divided into an experimental group and a control group. The number of effective cases in the two groups was 36 and 35 respectively. In addition to conventional diabetes drug treatment, the experimental group was supplemented with comprehensive psychological and behavioral intervention, while the control group was only given conventional treatment. The fasting blood glucose, 2-h postprandial blood glucose, body weight and depression index were measured before and after treatment in the two groups.Results: The prevalence of depression in patients with diabetes was as high as 60%, and that in the elderly control group was 5%; In type 2 diabetes population, depression is negatively related to the total score of social support and medical coping surface, and positively related to avoidance, blood sugar, women, course of disease, education level below junior high school, body mass index, and number of complications in medical coping; The fasting blood glucose, 2-h postprandial blood glucose, body mass index, and depression index of the two groups decreased, and the range and speed of decline in the experimental group were higher than those in the control group; There were significant differences between the two groups in fasting blood glucose, 2-h postprandial blood glucose and depression index; During the follow-up period, the blood glucose and depression index of the experimental group increased.Conclusion: Depression has a high prevalence rate in middle-aged and elderly people with type 2 diabetes, and has a negative impact on blood sugar control in diabetes patients; Psychological and behavioral comprehensive intervention can improve the glucose metabolism and depressive symptoms of middle-aged and elderly patients with type 2 diabetes.
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Affiliation(s)
- Chuanyan Zhang
- School of Public Health, Shantou University, Shantou, China
- Department of Endocrine and Metabolic Diseases, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zezhen Wu
- School of Public Health, Shantou University, Shantou, China
- Department of Endocrine and Metabolic Diseases, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Graduate School of Shantou University Medical College, Shantou, Guangdong, China
| | - Elna Lopez
- Faculty of Graduate School, Lyceum of the Philippines University-Batangas, Manila, Philippines
| | - Romain G. Magboo
- Faculty of Graduate School, Lyceum of the Philippines University-Batangas, Manila, Philippines
| | - Kaijian Hou
- School of Public Health, Shantou University, Shantou, China
- Department of Endocrine and Metabolic Diseases, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Faculty of Graduate School, Lyceum of the Philippines University-Batangas, Manila, Philippines
- *Correspondence: Kaijian Hou,
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Actions of Metformin in the Brain: A New Perspective of Metformin Treatments in Related Neurological Disorders. Int J Mol Sci 2022; 23:ijms23158281. [PMID: 35955427 PMCID: PMC9368983 DOI: 10.3390/ijms23158281] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Metformin is a first-line drug for treating type 2 diabetes mellitus (T2DM) and one of the most commonly prescribed drugs in the world. Besides its hypoglycemic effects, metformin also can improve cognitive or mood functions in some T2DM patients; moreover, it has been reported that metformin exerts beneficial effects on many neurological disorders, including major depressive disorder (MDD), Alzheimer’s disease (AD) and Fragile X syndrome (FXS); however, the mechanism underlying metformin in the brain is not fully understood. Neurotransmission between neurons is fundamental for brain functions, and its defects have been implicated in many neurological disorders. Recent studies suggest that metformin appears not only to regulate synaptic transmission or plasticity in pathological conditions but also to regulate the balance of excitation and inhibition (E/I balance) in neural networks. In this review, we focused on and reviewed the roles of metformin in brain functions and related neurological disorders, which would give us a deeper understanding of the actions of metformin in the brain.
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Huang CJ, Weng SF, Wang JJ, Hsieh HM. Competing risk analysis of the association between dementia and major depressive disorder: a nationwide population-based study in Taiwan. Aging Ment Health 2021; 25:766-772. [PMID: 32009453 DOI: 10.1080/13607863.2020.1720598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To investigate the association between major depressive disorder (MDD) and the competing risk of Alzheimer's dementia (AD) and non-Alzheimer's dementia (NAD) using a nationwide population-based health insurance database.Methods: From Taiwan's National Health Insurance Research Database, we extracted claims data of 13,067 patients with MDD and 52,268 non-MDD controls matched by index date, age, sex, geographical area, monthly income, and selected comorbidities through propensity score matching. Follow-up durations in person-years were calculated for each person until dementia diagnosis, death, or the end of 2013. Competing incident risks of AD and NAD between patients with MDD and non-MDD.Results: In this study, 335 (2.6%) of the 13,067 MDD patients and 313 (0.6%) of the 52,268 non-MDDs developed AD. During the follow-up period, 73 (0.59%) of the 13,067 MDD patients developed NAD and 80 (0.15%) of the 52,268 non-MDD developed NAD. The patients with MDD had 4.73 and 3.69 times higher risks of AD (adjusted subdistribution hazard ratio [SHR] 4.73; 95% confidence interval [CI] 4.05-5.52) and NAD (adjusted SHR 3.69; 95% CI 2.68-5.08), respectively, than the controls.Conclusions: The patients with MDD had significantly higher incidence rates of AD and NAD than the controls, in particular among aged 65 and above. Additional studies are required to clarify the underlying pathophysiology between the MDD-dementia association and investigate whether prompt intervention in MDD can reduce the risk of dementia.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Hui-Min Hsieh
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Community Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Zhou C, Li J, Dong M, Ping L, Lin H, Wang Y, Wang S, Gao S, Yu G, Cheng Y, Xu X. Altered White Matter Microstructures in Type 2 Diabetes Mellitus: A Coordinate-Based Meta-Analysis of Diffusion Tensor Imaging Studies. Front Endocrinol (Lausanne) 2021; 12:658198. [PMID: 34012420 PMCID: PMC8127836 DOI: 10.3389/fendo.2021.658198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/07/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Type 2 diabetes mellitus (T2DM) is often accompanied by cognitive decline and depressive symptoms. Numerous diffusion tensor imaging (DTI) studies revealed microstructural white matter (WM) abnormalities in T2DM but the findings were inconsistent. The present study aimed to conduct a coordinate-based meta-analysis (CBMA) to identify statistical consensus of DTI studies in T2DM. METHODS We performed a systematic search on relevant studies that reported fractional anisotropy (FA) differences between T2DM patients and healthy controls (HC). The anisotropic effect size seed-based d mapping (AES-SDM) approach was used to explore WM alterations in T2DM. A meta-regression was then used to analyze potential influences of sample characteristics on regional FA changes. RESULTS A total of eight studies that comprised 245 patients and 200 HC, along with 52 coordinates were extracted. The meta-analysis identified FA reductions in three clusters including the left inferior network, the corpus callosum (CC), and the left olfactory cortex. Besides, FA in the CC was negatively correlated with body mass index (BMI) in the patients group. CONCLUSIONS T2DM could lead to subtle WM microstructural alterations, which might be associated with cognitive deficits or emotional distress symptoms. This provides a better understanding of the pathophysiology of neurodegeneration and complications in T2DM. SYSTEMATIC REVIEW REGISTRATION Registered at PROSPERO (http://www.crd.york.ac.uk/PROSPERO), registration number: CRD42020218737.
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Affiliation(s)
- Cong Zhou
- School of Mental Health, Jining Medical University, Jining, China
- *Correspondence: Cong Zhou,
| | - Jie Li
- Department of Psychiatry, Jining Psychiatric Hospital, Jining, China
| | - Man Dong
- School of Mental Health, Jining Medical University, Jining, China
| | - Liangliang Ping
- Department of Psychiatry, Xiamen Xianyue Hospital, Xiamen, China
| | - Hao Lin
- School of Mental Health, Jining Medical University, Jining, China
| | - Yuxin Wang
- School of Mental Health, Jining Medical University, Jining, China
| | - Shuting Wang
- School of Mental Health, Jining Medical University, Jining, China
| | - Shuo Gao
- School of Mental Health, Jining Medical University, Jining, China
| | - Ge Yu
- School of Mental Health, Jining Medical University, Jining, China
| | - Yuqi Cheng
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiufeng Xu
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Ferdinand AO, Akinlotan MA, Callaghan T, Towne SD, Bolin JN. Factors affecting the likelihood of a hospitalization following a diabetes-related emergency department visit: A regional and urban-rural analysis. J Diabetes 2020; 12:686-696. [PMID: 32436371 DOI: 10.1111/1753-0407.13066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The objective of this study is to examine place-based and individual-level predictors of diabetes-related hospitalizations that stem from emergency department (ED) visits. METHODS We conducted a pooled cross-sectional analysis of the National Inpatient Sample (NIS) for 2009 to 2014 to identify ED-initiated hospitalizations that were driven by the need for diabetes care. The odds of an ED-initiated diabetes-related hospitalization were assessed for the United States as a whole and separately for each census region. RESULTS Nationally, residents of noncore areas (odds ratio [OR] 1.10; CI 1.08, 1.12), the South (OR 8.03; CI 6.84, 9.42), Blacks (OR 2.49; CI 2.47, 2.52), Hispanics (OR 2.32; CI 2.29, 2.35), Asians or Pacific Islanders (OR 1.20; CI 1.16, 1.23), Native Americans (OR 2.18; CI 2.10, 2.27), and the uninsured (OR 2.14; CI 2.11, 2.27) were significantly more likely to experience an ED-initiated hospitalization for diabetes care. Census region-stratified models showed that noncore residents of the South (OR 1.17; CI 1.14, 1.20) and Midwest (OR 1.06; CI 1.02, 1.11) had higher odds of a diabetes-related ED-initiated hospitalization. CONCLUSIONS As continued efforts are made to reduce place-based disparities in diabetes care and management, targeted focus should be placed on residents of noncore areas in the South and Midwest, racial and ethnic minorities, as well as the uninsured population.
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Affiliation(s)
- Alva O Ferdinand
- Department of Health Policy & Management, Texas A&M University, School of Public Health, College Station, Texas, USA
- Southwest Rural Health Research Center, Texas A&M University, School of Public Health, College Station, Texas, USA
| | - Marvellous A Akinlotan
- Department of Health Policy & Management, Texas A&M University, School of Public Health, College Station, Texas, USA
- Southwest Rural Health Research Center, Texas A&M University, School of Public Health, College Station, Texas, USA
- College of Nursing, Texas A&M University, Bryan, Texas, USA
| | - Timothy Callaghan
- Department of Health Policy & Management, Texas A&M University, School of Public Health, College Station, Texas, USA
- Southwest Rural Health Research Center, Texas A&M University, School of Public Health, College Station, Texas, USA
| | - Samuel D Towne
- Southwest Rural Health Research Center, Texas A&M University, School of Public Health, College Station, Texas, USA
- Department of Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
- Disability, Aging, & Technology Faculty Cluster Initiative, University of Central Florida, Orlando, Florida, USA
| | - Jane N Bolin
- Department of Health Policy & Management, Texas A&M University, School of Public Health, College Station, Texas, USA
- Southwest Rural Health Research Center, Texas A&M University, School of Public Health, College Station, Texas, USA
- College of Nursing, Texas A&M University, Bryan, Texas, USA
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Abstract
PURPOSE OF REVIEW To examine developments in the understanding of certain aspects of depression in diabetes mellitus patients with a special focus on diabetes distress, screening of depression and its management in persons with type 2 diabetes mellitus. RECENT FINDINGS Recent studies reviewed indicate an increasing trend of both major and minor depression in patients with diabetes. Depression is also reported to be persistent and chronic in diabetes patients. There is a bidirectional link between depression and diabetes. Diabetes-related distress independently increases the diabetes-related complications. Collaborative care is both applicable and helpful in managing depression in diabetes. SUMMARY Although a significant number of patients with diabetes suffer from depression or diabetes-related distress, majority of them remain undiagnosed and untreated. This treatment gap suggests the need for routine screening for depression and distress in patients with diabetes. Studies have confirmed that treatment focussing on diabetes may alleviate depressive symptoms. Diabetes-specific psychological interventions may prove useful in improving diabetes self-management in depressed diabetes patients. Effect of specific psychopharmacological and psychological interventions in treating depression in diabetes patients should be examined in future studies.
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Liu SY, Huang J, Dong QL, Li B, Zhao X, Xu R, Yin HF. Diabetes distress, happiness, and its associated factors among type 2 diabetes mellitus patients with different therapies. Medicine (Baltimore) 2020; 99:e18831. [PMID: 32176027 PMCID: PMC7440060 DOI: 10.1097/md.0000000000018831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study aimed to investigate diabetes distress, happiness, and its associated factors of patients with type 2 diabetes mellitus (T2DM) treated by different therapies, and to analyze the related impact factors. A total of 1512 patients with T2DM were randomly selected from 18 tertiary hospitals in Hunan province from January 2016 to April 2016 who has been treated with oral antidiabetics monotherapy, insulin monotherapy, and combination therapy. Use the general information questionnaire, WHO-5 (the World Health Organization 5 well-being index) and PAID (the problem areas in diabetes scale) to collect the data. There are 846 (55.95%) patients that have serious emotional disorders, and the diabetes related distress in insulin treatment group was higher than that in combination treatment group (P < .05). Happiness of T2DM patients in combination therapy was higher than oral antidiabetic drug monotherapy and insulin monotherapy (P < .05). There was a negative correlation between diabetic suffering and happiness in patients with different treatments (R ranged from -0.335 to -0.436, P < .001). Age and happiness experience could explain 14.8% of the variance. Acute and chronic complications, controlled blood glucose level, lifestyle, therapies, and school education can explain 18.3% variance. Under different therapies, the suffering and happiness of T2DM patients differed from each other. The suffering and happiness of T2DM were related to different therapies, age, complications, glycaemic control, lifestyle, school education, and so on.
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Affiliation(s)
- Shun-Ying Liu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
| | - Jin Huang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
| | - Qiao-Liang Dong
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
| | - Bei Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
| | - Xue Zhao
- the affiliated hospital of Guizhou medical university
| | - Rong Xu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
| | - Hong-Fang Yin
- Department of Endocrinology, Hunan Provincial People's Hospital, Changsha, Hunan, P.R. China
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11
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Kao LT, Shih JH, Yeh CB, Wang CH, Chen HC, Chien WC, Li IH. Association between major depressive disorder and subsequent tinnitus: A population-based study. J Affect Disord 2020; 263:367-372. [PMID: 31969266 DOI: 10.1016/j.jad.2019.11.141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/01/2019] [Accepted: 11/29/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous studies have presented an unclear association between major depressive disorder (MDD) and tinnitus. Therefore, in this study, we aimed to demonstrate the actual association between MDD and new-onset tinnitus using a large, population-based dataset in Taiwan. METHOD This case-control study used the data from the National Health Insurance Database. In total, 18,365 patients with tinnitus were recruited as cases, and 18,365 propensity score-matched patients without tinnitus were identified as controls. Logistic regression models were constructed to calculate the odds ratios (ORs) and to estimate the association between prior MDD and tinnitus. RESULTS MDD was found in 396 (2.16%) patients with tinnitus and 228 (1.24%) controls without tinnitus. The logistic regression model indicated that prior MDD was associated with tinnitus (adjusted OR, 1.74; 95% CI, 1.47-2.05). Moreover, MDD was positively associated with tinnitus among most subgroups. Notably, a significant association between MDD and tinnitus was observed among patients with diabetes (adjusted OR, 2.05) and hyperlipidemia (adjusted OR, 1.94). Furthermore, sensitivity analyses consistently found a relationship between prior MDD and tinnitus. LIMITATIONS The database used in this study does not provide information regarding the lifestyle and gene factors. CONCLUSIONS Our results showed a positive association between prior MDD and tinnitus. In addition, MDD may be one of the risk factors for tinnitus onset. Therefore, we recommended that the clinicians should be alert about the tinnitus condition among patients with MDD and provide appropriate interventions for them.
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Affiliation(s)
- Li-Ting Kao
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; School of Pharmacy, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Jui-Hu Shih
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan; School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Chih-Hung Wang
- Department of Otorhinolaryngology, Taichung Armed Forces General Hospital, Taichung, Taiwan
| | - Hsin-Chien Chen
- Department of Otorhinolaryngology- Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Wu-Chien Chien
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - I-Hsun Li
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan; School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.
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12
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Du W, Hu Z, Wang L, Li M, Zhao D, Li H, Wei J, Zhang R. ABCA1 Variants rs1800977 (C69T) and rs9282541 (R230C) Are Associated with Susceptibility to Type 2 Diabetes. Public Health Genomics 2020; 23:20-25. [PMID: 31982877 DOI: 10.1159/000505344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/22/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Accumulated evidence suggests that ATP-binding cassette A1 transporter (ABCA1) contributes to secreting insulin in pancreatic β-cells and amyloid beta formation. This study aimed to investigate the association between three single nucleotide polymorphisms (SNPs) of ABCA1 and susceptibility to type 2 diabetes mellitus (T2DM) in a Han Chinese population. METHODS A total of 996 T2DM patients and 1,002 controls were included in the study. Three SNPs in the ABCA1 gene, i.e., rs2230806 (R219K), rs1800977 (C69T), and rs9282541 (R230C), were genotyped by SNaPshot. A genotype model, an allele model, a dominant model, and a recessive model were used to assess susceptibility to T2DM. RESULTS There were significant associations between rs1800977 and T2DM in different genetic models (TT vs. CC, OR = 0.591 [0.446-0.793], p < 0.001; T vs. C, OR = 0.835 [0.735-0.949], p = 0.006; recessive model, OR = 0.583 [0.449-0.756], p < 0.001). There were also significant associations between rs9282541 and T2DM in different genetic models (CT vs. CC, OR = 1.690 [0.807-1.005], p = 0.048; T vs. C, OR = 1.756 [0.694-1.060], p = 0.029; dominant model, OR = 1.735 [0.715-1.034], p = 0.037). CONCLUSION Our case-control study showed that the two SNPs rs1800977 and rs9282541 in the ABCA1 gene are significantly associated with susceptibility to T2DM in our Han Chinese population. Study of further mechanisms should be performed before application to clinical therapy.
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Affiliation(s)
- Weiping Du
- Department of Clinical Laboratory, Affiliated Hospital of Yan'an University, Yan'an, China
| | - Zhixi Hu
- Department of Clinical Laboratory, Affiliated Hospital of Yan'an University, Yan'an, China
| | - Li Wang
- Department of Clinical Laboratory, Affiliated Hospital of Yan'an University, Yan'an, China
| | - Miaomiao Li
- Department of Clinical Laboratory, Affiliated Hospital of Yan'an University, Yan'an, China
| | - Dong Zhao
- Department of Clinical Laboratory, Affiliated Hospital of Yan'an University, Yan'an, China
| | - Hui Li
- Department of Clinical Laboratory, Affiliated Hospital of Yan'an University, Yan'an, China
| | - Junsheng Wei
- Department of Clinical Laboratory, Affiliated Hospital of Yan'an University, Yan'an, China
| | - Rui Zhang
- Department of Clinical Laboratory, Affiliated Hospital of Yan'an University, Yan'an, China,
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13
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Li CI, Liu CS, Lin CH, Lin WY, Lee YD, Yang SY, Li TC, Lin CC. Competing risk analysis on visit-to-visit glucose variations and risk of depression: The Taiwan Diabetes Study. DIABETES & METABOLISM 2019; 46:223-229. [PMID: 31472230 DOI: 10.1016/j.diabet.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/09/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
AIM Patients with diabetes have higher rates of depression than does the general population, but diabetes management mainly aims to maintain glucose stability. For this reason, our study assessed the relationship between 1-year variations in fasting plasma glucose (FPG) and risk of depression in Chinese patients with type 2 diabetes (T2D). METHODS This retrospective cohort study was conducted on 32,829 patients aged ≥30 years who were diagnosed with T2D and who participated in the National Diabetes Case Management Program in Taiwan. Their 1-year FPG variation as a predictor was determined by coefficient of variation (CV), whereas depressive events were analyzed by Cox's proportional hazards models. RESULTS During a mean 8.23 years of follow-up, 1041 new cases of depression were diagnosed. When patients were grouped based on quartiles of FPG-CV, incidence rates were 3.23, 3.49, 3.96 and 4.80 per 1000 person-years in the first, second, third and fourth quartile subgroups, respectively. After adjusting for traditional risk factors, baseline fasting glucose and HbA1c levels, and diabetes complications, FPG-CV was independently linked with incident depression. Hazard ratios of depression for FPG-CV in the fourth vs first quartile subgroups was 1.33 (95% CI: 1.11-1.59), respectively. CONCLUSION Patients whose 1-year FPG variations were>42.6% had an increased risk of depression, thus suggesting that FPG variations may be a predictor of depression in patients with T2D. Also, glucose variation during outpatient visits may be an indicator for individualized diabetes management in clinical practice.
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Affiliation(s)
- C-I Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - C-S Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - C-H Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - W-Y Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Y-D Lee
- Department of Psychiatry, Medical College, National Cheng-Kung University, Tainan, Taiwan
| | - S-Y Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - T-C Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - C-C Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
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14
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Wang F, Wang S, Zong QQ, Zhang Q, Ng CH, Ungvari GS, Xiang YT. Prevalence of comorbid major depressive disorder in Type 2 diabetes: a meta-analysis of comparative and epidemiological studies. Diabet Med 2019; 36:961-969. [PMID: 31127631 DOI: 10.1111/dme.14042] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 01/14/2023]
Abstract
AIMS To examine the average point prevalence of major depressive disorder in people with Type 2 diabetes and its associated factors in a comprehensive meta-analysis. METHODS Two researchers independently conducted a systematic literature search of PubMed, EMBASE, PsycINFO and Cochrane databases. Studies reporting the prevalence of major depressive disorder in people with Type 2 diabetes were identified and analysed using a random-effects model. RESULTS A total of 26 studies meeting the inclusion criteria were included in the study. The point prevalence of major depressive disorder was 14.5% (95% CI 7.9-25.3; I²=99.65). People with Type 2 diabetes were more likely to have major depressive disorder compared with the general population (odds ratio 1.73, 95% CI 1.38-2.16). Subgroup and meta-regression analyses showed that study site, study type, diagnostic criteria and age significantly moderated the prevalence of major depressive disorder. CONCLUSIONS In this meta-analysis, the average point prevalence of major depressive disorder in people with Type 2 diabetes was high. Routine screening and more effective interventions should be implemented for this population.
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Affiliation(s)
- F Wang
- Guangdong Provincial People's Hospital, Guangdong Province
| | - S Wang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Q-Q Zong
- School of Nursing, Capital Medical University, Beijing
- National Clinical Research Centre for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing
| | - Q Zhang
- National Clinical Research Centre for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing
| | - C H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, VIC
| | - G S Ungvari
- University of Notre Dame Australia, Fremantle, WA
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Y-T Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
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15
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Mattina GF, Van Lieshout RJ, Steiner M. Inflammation, depression and cardiovascular disease in women: the role of the immune system across critical reproductive events. Ther Adv Cardiovasc Dis 2019; 13:1753944719851950. [PMID: 31144599 PMCID: PMC6545651 DOI: 10.1177/1753944719851950] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Women are at increased risk for developing depression and cardiovascular disease (CVD) across the lifespan and their comorbidity is associated with adverse outcomes that contribute significantly to rates of morbidity and mortality in women worldwide. Immune-system activity has been implicated in the etiology of both depression and CVD, but it is unclear how inflammation contributes to sex differences in this comorbidity. This narrative review provides an updated synthesis of research examining the association of inflammation with depression and CVD, and their comorbidity in women. Recent research provides evidence of pro-inflammatory states and sex differences associated with alterations in the hypothalamic–pituitary–adrenal axis, the renin–angiotensin–aldosterone system and the serotonin/kynurenine pathway, that likely contribute to the development of depression and CVD. Changes to inflammatory cytokines in relation to reproductive periods of hormonal fluctuation (i.e. the menstrual cycle, perinatal period and menopause) are highlighted and provide a greater understanding of the unique vulnerability women experience in developing both depressed mood and adverse cardiovascular events. Inflammatory biomarkers hold substantial promise when combined with a patient’s reproductive and mental health history to aid in the prediction, identification and treatment of the women most at risk for CVD and depression. However, more research is needed to improve our understanding of the mechanisms underlying inflammation in relation to their comorbidity, and how these findings can be translated to improve women’s health.
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Affiliation(s)
- Gabriella F Mattina
- Neuroscience Graduate Program, McMaster University, 1280 Main Street West, ON L8S 4L8, Canada
| | - Ryan J Van Lieshout
- Neuroscience Graduate Program, McMaster University, ON, Canada.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Meir Steiner
- Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
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Wang D, Shi L, Li L, Guo X, Li Y, Xu Y, Yin S, Wu Q, Yang Y, Zhuang X, Gai Y, Li Q, Liu Y. Subthreshold depression among diabetes patients in Beijing: Cross-sectional associations among sociodemographic, clinical, and behavior factors. J Affect Disord 2018; 237:80-86. [PMID: 29793084 DOI: 10.1016/j.jad.2018.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 04/05/2018] [Accepted: 05/15/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND This study explores the prevalence of subthreshold depression (SubD) and its association with factors in type 2 diabetes mellitus (T2DM) patients. METHODS This cross-sectional study involved 808 outpatients with T2DM from ten hospitals in Beijing between September 2015 and January 2016. All participants completed the Patient Health Questionnaire 9-item (PHQ-9) to evaluate depressive status, with scores between 5 and 14 considered SubD. Conditional logistic regression was conducted to investigate the variables associated with SubD in T2DM patients. RESULTS T2DM patients with SubD comprised 11.6% (n = 94) of the sample. The odd ratios for the variables having significant positive associations with SubD were: being a women (OR = 1.90; 95%CI: 1.09-3.32), divorced/widowed (OR = 3.27; 95%CI: 1.46-7.30), comorbidity of cerebrovascular disease (OR = 2.00; 95%CI: 1.06-3.76), more diabetic complications (OR = 8.04; 95%CI: 2.77-23.31), and higher HbA1c in men (OR = 2.41; 95%CI: 1.25-4.64). Being older (OR = 0.78; 95%CI: 0.62-0.98), exercising more (OR = 0.44; 95%CI: 0.22-0.91) and poverty (OR = 0.36; 95%CI: 0.19-0.69) were negatively related to SubD. LIMITATIONS The sample was mainly recruited from hospital settings, which limits generalization. The study's cross-sectional design precludes making causal inferences. CONCLUSIONS The proportion of SubD was estimated to be 11.6% among T2DM patients in Beijing. Having more diabetic complications and being divorced/widowed made the odds of having SubD 8-fold and 3-fold higher than not having it, respectively. The relationship between SubD and diabetes necessitates early screening for milder forms of depression, which can alleviate the social burden and individual impairment from major depression or other chronic diseases.
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Affiliation(s)
- Dandan Wang
- Department of Endocrinology, The 306th Teaching Hospital of People's Liberation Army, Peking University, Beijing, China
| | - Lintao Shi
- Department of Endocrinology, The 306th Hospital of People's Liberation Army, Beijing, China
| | - Leling Li
- School of Public Health, Peking University, Beijing, China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Yufeng Li
- Department of Endocrinology and Metabolism, Pinggu Teaching Hospital, Capital Medical University, Beijing, China
| | - Yuan Xu
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shinan Yin
- Department of Endocrinology, The 304th Hospital of People's Liberation Army, Beijing, China
| | - Qiaozhen Wu
- Outpatient Department of Sinopec Petroleum Exploration and Production Research Institute, Beijing, China
| | - Yu Yang
- Department of Endocrinology, Huairou Hospital, Beijing, China
| | - Xiaoming Zhuang
- Department of Endocrinology, Beijing Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Yingli Gai
- Outpatient Department of Beihang University, Beijing, China
| | - Quanmin Li
- Department of Endocrinology, The Rocket Force Hospital of People's Liberation Army, Beijing, China
| | - Yanjun Liu
- Department of Endocrinology, The 306th Teaching Hospital of People's Liberation Army, Peking University, Beijing, China; Department of Endocrinology, The 306th Hospital of People's Liberation Army, Beijing, China.
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