RT Journal Article
SR Electronic
T1 Effects of Enhanced Depression Treatment on Diabetes Self-Care
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 46
OP 53
DO 10.1370/afm.423
VO 4
IS 1
A1 Elizabeth H. B. Lin
A1 Wayne Katon
A1 Carolyn Rutter
A1 Greg E. Simon
A1 Evette J. Ludman
A1 Michael Von Korff
A1 Bessie Young
A1 Malia Oliver
A1 Paul C. Ciechanowski
A1 Leslie Kinder
A1 Edward Walker
YR 2006
UL http://www.annfammed.org/content/4/1/46.abstract
AB PURPOSE Among patients with diabetes, major depression is associated with more diabetic complications, lower medication adherence, and poorer self-care of diabetes. We reported earlier that enhanced depression care reduces depression symptoms but not hemoglobin A1c level. This study examined effects of depression interventions on self-management among depressed diabetic patients. METHODS A total of 329 patients in 9 primary care clinics were randomized to an evidence-based collaborative depression treatment (pharmacotherapy, problem-solving treatment, or both in combination) or usual primary care (routine medical services). Outcome measures included the Summary of Diabetes Self-Care Activities (SDSCA), reported at baseline and 3, 6, and 12 months, and medication non-adherence as assessed by automated pharmacy refill data of oral hypoglycemic agents, lipid-lowering agents, and angiotensin-converting enzyme inhibitors. We used mixed regression models adjusted for baseline differences to compare the intervention with usual care groups at follow-up assessments. RESULTS During the 12-month intervention period, enhanced depression care and outcomes were not associated with improved diabetes self-care behaviors (healthy nutrition, physical activity, or smoking cessation). Relative to the usual care group, the intervention group reported a small decrease in body mass index (mean difference = 0.70 kg/m2, 95% CI, 0.17 to 1.24 kg/m2) and a higher rate of nonadherence to oral hypoglycemic agents (mean difference = −6.3%, 95% CI, −11.91% to −0.71%). Adherence to lipid-lowering agents and to antihypertensive medicines was similar for the 2 groups. CONCLUSIONS In general, diabetes self-management did not improve among the enhanced depression treatment group during a 12-month period, except for small between-group differences of limited clinical importance. Research needs to assess whether self-care interventions tailored for specific conditions, in addition to enhanced depression care, can achieve better diabetes and depression outcomes.