title: Relationship of depression and diabetes self-care, medication adherence, and preventive care.
abstract: 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.
authors.affiliation: Center for Health Studies, Group Health Cooperative, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA. lin.e@ghc.org
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Carolyn
authors.initials: C
authors.lastname: Rutter
authors.forename: Greg E
authors.initials: GE
authors.lastname: Simon
authors.forename: Malia
authors.initials: M
authors.lastname: Oliver
authors.forename: Paul
authors.initials: P
authors.lastname: Ciechanowski
authors.forename: Evette J
authors.initials: EJ
authors.lastname: Ludman
authors.forename: Terry
authors.initials: T
authors.lastname: Bush
authors.forename: Bessie
authors.initials: B
authors.lastname: Young
mesh_terms: 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
chemical_list: D007004:Hypoglycemic Agents