Research ArticleOriginal Research

Effects of Enhanced Depression Treatment on Diabetes Self-Care

Elizabeth H. B. Lin, Wayne Katon, Carolyn Rutter, Greg E. Simon, Evette J. Ludman, Michael Von Korff, Bessie Young, Malia Oliver, Paul C. Ciechanowski, Leslie Kinder and Edward Walker
The Annals of Family Medicine January 2006, 4 (1) 46-53; DOI: https://doi.org/10.1370/afm.423

Article Figures & Data

Tables

  • Table 1.

    Demographic and Baseline Clinical Characteristics

    CharacteristicUsual Care (n = 165) % (No.)Intervention (n = 164) % (No.)
    Dichotomous characteristics
    Female64.8 (107)65.2 (107)
    Married54.9 (90)54.8 (94)
    Employed (full- or part-time)45.2 (71)54.2 (84)
    White81.1 (133)75.2 (115)
    Type 2 diabetes95.8 (158)96.3 (157)
    Taking insulin43.0 (71)38.4 (63)
    Major depression69.1 (114)62.6 (102)
    Lifetime dysthymia70.3 (116)67.5 (110)
    ≥ 3 previous episodes of depression60.5 (92)68.6 (107)
    Antidepressant use in previous 3 months54.0 (101)46.0 (86)
    Mean (SD)Mean (SD)
    HbA1c = hemoglobin A1c; SCL-20 = Hopkins Symptom Checklist-20.
    Continuous characteristics
    Age, y58.1 (12.0)58.6 (11.8)
    HbA1c, %8.0 (1.5)8.0 (1.6)
    Number of diabetic complications1.5 (1.4)1.5 (1.3)
    Baseline SCL-20 score1.6 (0.5)1.7 (0.5)
  • Table 2.

    Self-Care Activities of Patients With Diabetes and Depression in the Past 7 Days at Baseline and at Various Follow-up Times

    ActivityUsual Care (n = 165) Mean (SD)*Intervention (n = 164) Mean (SD)*Adjusted Mean Difference (95% CI)†
    CI = confidence interval; BMI = body mass index.
    * Means and SDs are unadjusted.
    † Adjusted mean differences and 95% CIs are based on regression models that adjusted for the baseline value, age, sex, race, education, comorbid conditions other than diabetes and depression, complications, and use of insulin, with variance estimates that accounted for clustering of measurements within patients, patients within physicians, and physicians within clinics.
    ‡ Intervention and usual care groups differ significantly, with adjustment, P ≥ .005.
    § Intervention and usual care groups differ significantly, without adjustment, P ≥ .05
    ¶ Intervention and usual care groups differ significantly, with adjustment, P ≥ .01.
    Generally healthy diet, number of days
    Baseline3.7 (2.1)3.7 (2.1)—
    3 mo4.3 (2.0)4.1 (1.9)0.15 (–0.15 to 0.45)
    6 mo4.4 (1.9)4.2 (2.0)0.07 (–0.21 to 0.35)
    12 mo4.5 (2.1)4.5 (1.9)–0.01 (–0.56 to 0.54)
    Recommended diet, number of days
    Baseline3.2 (1.6)3.5 (1.7)—
    3 mo3.6 (1.7)3.8 (1.8)–0.07 (–0.34 to 0.20)
    6 mo3.8 (1.7)3.9 (1.8)–0.01 (–0.22 to 0.20)
    12 mo3.8 (1.8)4.1 (1.9)–0.05 (–0.42 to 0.32)
    Physical activity (≥ 30 min), number of days
    Baseline2.3 (2.2)2.6 (2.4)—
    3 mo2.7 (2.4)2.7 (2.5)0.08 (–0.43 to 0.59)
    6 mo2.4 (2.3)2.3 (2.3)0.19 (–0.21 to 0.60)
    12 mo2.6 (2.5)2.7 (2.4)–0.12 (–0.50 to 0.26)
    Exercise session, number of days
    Baseline‡1.2 (1.8)1.9 (2.2)—
    3 mo1.7 (2.4)1.9 (2.3)–0.12 (–0.84 to 0.59)
    6 mo1.7 (2.2)1.6 (2.2)0.19 (–0.37 to 0.76)
    12 mo1.6 (2.1)1.9 (2.3)–0.19 (–0.57 to 0.19)
    BMI, kg/m2
    Baseline§36.3 (11.1)33.9 (8.6)—
    12 mo36.1 (10.0)33.0 (7.9)0.70 (0.17 to 1.24)
  • Table 3.

    Nonadherence to Prescribed Medications (Percentage of Days Nonadherent During the 12-Month Prerandomization and Postrandomization Periods)

    MedicationUsual Care % of Days Mean (SD)* [No. of Patients]Intervention % of Days Mean (SD)* [No. of Patients]Adjusted Mean Difference % of Days (95% CI)†
    CI = confidence interval; ACE = angiotensin-converting enzyme.
    * Means and SDs are unadjusted.
    † Estimated differences and 95% CIs are based on regression models that adjusted for the baseline value, age, sex, race, education, comorbid conditions other than diabetes and depression, complications, and use of insulin, with variance estimates that account for clustering of measurements within patients, patients within physicians, and physicians within clinics.
    ‡ Intervention and usual care groups differ significantly, P <.03.
    Oral hypoglycemic agent
    Prerandomization22.9 (24.0) [103]19.8 (21.3) [103]
    Postrandomization‡24.0 (24.7) [103]28.2 (28.9) [103]–6.3 (–11.91 to −0.71)
    ACE inhibitor
    Prerandomization29.7 (29.3) [65]27.4 (27.1) [54]
    Postrandomization18.9 (17.4) [52]24.2 (22.7) [59]–2.5 (–8.69 to 3.70)
    Lipid-lowering agent
    Prerandomization24.5 (23.0) [52]29.3 (26.7) [50]
    Postrandomization27.7 (24.0) [63]28.8 (27.1) [54]–0.2 (–7.23 to 6.76)

Additional Files

  • The Article in Brief

    Effects of Enhanced Depression Treatment on Diabetes Self-care

    Elizabeth H. B. Lin, MD, MPH , and colleagues

    Background Healthy nutrition, physical activity, and use of appropriate medications can slow the progression of diabetes and reduce complications associated with the disease. However, many people with diabetes, particularly those with depression, do not practice these healthy self-care habits. This study looked at whether improved depression treatment in diabetes patients has an influence on self-care behaviors, including taking diabetes medications as prescribed.

    What This Study Found Treatment for depression does not improve self-management of diabetes among patients with both illnesses. Increased depression care was not associated with improved diabetes self-care behaviors, such as proper nutrition, physical activity, or stopping smoking, or increased use of medications as prescribed.

    Implications

    • Patients who manage multiple medical conditions face complex challenges.
    • Further study is needed to determine whether combined management of diabetes and depression would help patients achieve better psychological and diabetes results.
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