台灣中老年人憂鬱症狀與新發糖尿病關聯之探討

The association of depressive symptoms with new-onset diabetes in Taiwanese aged over 53 years

目標：憂鬱與糖尿病都是中老年人常見的健康議題，且相互影響，但憂鬱症狀對老年人新發糖尿病的影響則研究較少。因此，本研究探討台灣中老人憂鬱症狀與新發糖尿病的關聯。方法：分析「台灣中老年身心社會生活狀況長期追蹤調查」1999及2003年的資料庫。以邏輯斯迴歸分析基準點憂鬱症狀（依CES-D分數分無（0分）、輕（1－5分）、中（6－9分）、和重（≥10分）四組）與4年後（2,937人）新發糖尿病的縱性關聯（先排除於1999年患糖尿病者），及憂鬱症狀與糖尿病於1999年（4,214人，≥53歲）的橫斷關聯。結果：在控制性別、年齡、教育年數、運動、抽菸、喝酒、嚼檳榔、BMI、行動依賴、高血壓、心臟病、腎臟病、痛風、及各類食物攝取頻率的狀況下，發現憂鬱症狀與新發糖尿病呈縱性正關聯（重度症狀增加新發糖尿病76％（OR=1.76，95％CI=1.11－2.80，p=0.016），中度症狀增加89％（1.89，1.24－2.91，p＝0.003）。憂鬱症狀與糖尿病也呈橫斷正關聯。結論：結果顯示憂鬱症狀，甚至只具中度症狀都會增高新發糖尿病的風險。憂鬱症狀篩檢應為中老年人糖尿病防治重要的一環。

Objectives: Depression and diabetes mellitus are two major geriatric health issues. The two diseases also share a bidirectional relationship. However, the association between depressive symptoms and new-onset diabetes in older adults has not yet been well investigated. Thus, the present study was aimed to determine the association between depressive symptoms and new-onset diabetes in older Taiwanese. Methods: The study analyzed the 1999 and 2003 datasets of the 'Taiwan Longitudinal Survey on Aging' (TLSA). Logistic regression analyses were performed to determine the longitudinal association of depressive symptoms (classified into four levels according to CES-D score: 0 = no, 1-5 = low, 6-9 = moderate, and ≥10 = high) with new-onset diabetes four years later (N=2,937) after excluding those who had diabetes at baseline, and the cross-sectional association of depressive symptoms with diabetes at baseline (N=4,214, ≥53 years old). Results: Under the control of the potential confounders (including sociodemographic, lifestyle, and health) and disease-related factors, depressive symptoms were significantly associated with new-onset diabetes during the subsequent four years (OR=1.76, 95%CI=1.11-2.80, p=0.016 for high symptoms). The association also existed in those with moderate (CES-D score 6-9) symptoms (1.89, 1.24-2.91, p=0.003). There was also a significant cross-sectional association between depressive symptoms and diabetes at baseline. Conclusions: The presence of high or moderate depressive symptoms significantly increased subsequent new-onset diabetes in older Taiwanese. These findings highlight the importance of routine screening and timely intervention to reduce the risk of new-onset diabetes in older adults.