Relationship of depression and diabetes self-care, medication adherence, and preventive care.
OBJECTIVE
We assessed whether diabetes self-care, medication adherence, and use of preventive services were associated with depressive illness.


METHODS
In a large health maintenance organization, 4,463 patients with diabetes completed a questionnaire assessing self-care, diabetes monitoring, and depression. Automated diagnostic, laboratory, and pharmacy data were used to assess glycemic control, medication adherence, and preventive services.


RESULTS
This predominantly type 2 diabetic population had a mean HbA(1c) level of 7.8 +/- 1.6%. Three-quarters of the patients received hypoglycemic agents (oral or insulin) and reported at least weekly self-monitoring of glucose and foot checks. The mean number of HbA(1c) tests was 2.2 +/- 1.3 per year and was only slightly higher among patients with poorly controlled diabetes. Almost one-half (48.9%) had a BMI >30 kg/m(2), and 47.8% of patients exercised once a week or less. Pharmacy refill data showed a 19.5% nonadherence rate to oral hypoglycemic medicines (mean 67.4 +/- 74.1 days) in the prior year. Major depression was associated with less physical activity, unhealthy diet, and lower adherence to oral hypoglycemic, antihypertensive, and lipid-lowering medications. In contrast, preventive care of diabetes, including home-glucose tests, foot checks, screening for microalbuminuria, and retinopathy was similar among depressed and nondepressed patients.


CONCLUSIONS
In a primary care population, diabetes self-care was suboptimal across a continuum from home-based activities, such as healthy eating, exercise, and medication adherence, to use of preventive care. Major depression was mainly associated with patient-initiated behaviors that are difficult to maintain (e.g., exercise, diet, medication adherence) but not with preventive services for diabetes.
Lin
Elizabeth H B
EH
Center for Health Studies, Group Health Cooperative, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA. lin.e@ghc.org
Katon
Wayne
W
Von Korff
Michael
M
Rutter
Carolyn
C
Simon
Greg E
GE
Oliver
Malia
M
Ciechanowski
Paul
P
Ludman
Evette J
EJ
Bush
Terry
T
Young
Bessie
B
D015992:Body Mass Index; D003866:Depressive Disorder / Q000453:epidemiology*; D048909:Diabetes Complications / Q000523:psychology; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000517:prevention & control / Q000523:psychology*; D006279:Health Maintenance Organizations; D006306:Health Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D009765:Obesity / Q000150:complications / Q000523:psychology; D012648:Self Care; D011795:Surveys and Questionnaires; D014861:Washington
D007004:Hypoglycemic Agents