Depression-Diabetes Mechanisms: Urban African Americans

抑郁症与糖尿病的机制：城市非裔美国人

• 批准号: 6572117
• 负责人: DOMINIQUE L. MUSSELMAN
• 金额: $ 38万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-07-18 至 2008-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6572117
• 关键词: African American; behavioral /social science research tag; blood glucose; citalopram; clinical research; cytokine; depression; early experience; health disparity; health services research tag; hormone regulation /control mechanism; human middle age (35-64); human subject; human therapy evaluation; hypothalamic pituitary adrenal axis; insulin sensitivity /resistance; mental disorder chemotherapy; mental health epidemiology; neuropsychology; noninsulin dependent diabetes mellitus; patient care management; patient oriented research; stress management; therapy compliance; urban area

DESCRIPTION (provided by applicant): African-Americans have increased prevalence of both diabetes and diabetes complications, reflecting combined psychobehavioral and metabolic dysfunction. Depression may contribute to both the genesis of Type 2 diabetes, and difficulties in management; we find that many African-Americans with diabetes also have depression, that depression is a factor in nonadherence, and that nonadherence leads to poor glycemic control- a major cause of complications. (1) To establish the prevalence, socioecoloqic associates, and. qlycemic impact of depression, we will study patients presenting to the Grady Diabetes Clinic; evaluate socioeconomic status, literacy, and access to care; and relate depression to these factors and to metabolic control both at presentation and after one year of care. (2) To define the pathways through which depression contributes to metabolic imbalance, we will study patients exposed to progressive psychobehavioral challenge (depression and/or early life stress), and assess (a) hypothalamic-pituitary-adrenal activation; (b) counter-regulatory hormones; and (c) immunoinflammatory cytokines; in relation to (d) insulin resistance. (3) To determine the psychobehavioral and neurohormonal mechanisms of treatment, we will conduct a randomized, placebo-controlled, double-blind trial: patients with depression will receive stress management videotapes and either placebo or the selective serotonin reuptake inhibitor (SSRI) citalopram, and we will assess (a) overall glycemic control (HbAlc levels), and (b) patient adherence -to a prescribed diet/exercise program, to use of medications, and to scheduled return appointments; in relation to (c) depressive symptoms and (d) neurometabolic function as defined in Aim #2. These questions will be addressed by a multidisciplinary team with experience in both neuroendocrine analysis, clinical psychiatry, and diabetes management. The goal of this proposal is to use state-of-the-art psychobiological techniques to define the neurobehavioral and neurometabolic abnormalities and their response to treatment in urban African-Americans with type 2 diabetes and depression, as needed to improve basic understanding of disordered metabolism in this patient population and to help relieve their disparity in health.

描述（由申请人提供）：非洲裔美国人的糖尿病和糖尿病并发症的患病率增加，反映了综合心理狂热和代谢功能障碍。抑郁症可能导致2型糖尿病的起源和管理困难。我们发现，许多患有糖尿病的非洲裔美国人也患有抑郁症，抑郁症是不依从性的因素，不遵守导致血糖控制不佳 - 并发症的主要原因。 （1）确定患病率，社会核心协会和。抑郁症的血糖影响，我们将研究出现在Grady糖尿病诊所的患者；评估社会经济地位，识字和获得护理；并将抑郁症与这些因素联系起来，并在介绍和一年的护理后都与代谢控制有关。 （2）定义抑郁症导致代谢失衡的途径，我们将研究受到进行性心理心理挑战（抑郁症和/或早期生命压力）的患者，并评估（a）下丘脑 - 垂体 - 肾上腺肾上腺激活； （b）反调节激素； （c）免疫炎性细胞因子；与（d）胰岛素抵抗有关。 (3) To determine the psychobehavioral and neurohormonal mechanisms of treatment, we will conduct a randomized, placebo-controlled, double-blind trial: patients with depression will receive stress management videotapes and either placebo or the selective serotonin reuptake inhibitor (SSRI) citalopram, and we will assess (a) overall glycemic control (HbAlc levels), and (b) patient adherence -to a处方饮食/运动计划，使用药物以及预定的返回任命；关于（c）抑郁症状和（d）AIM＃2中定义的神经代谢功能。这些问题将由一个具有神经内分泌分析，临床精神病学和糖尿病管理的经验的多学科团队解决。该提案的目的是使用最先进的心理生物学技术来定义神经行为和神经代谢异常，及其对2型糖尿病和抑郁症的城市非裔美国人对治疗的反应，根据需要改善该患者的非代谢和健康状况的基本理解。