Depression and glycemic control in Hispanic primary care patients with diabetes.
BACKGROUND
Maintaining optimal glycemic control is an important goal of therapy in patients with diabetes mellitus. Patients of Hispanic ancestry have been shown to have high rates of diabetes and poor glycemic control (PGC). Although depression is common in adults with diabetes, its relationship to glycemic control remains unclear, especially among Hispanics.


OBJECTIVE
To assess the association of depression with PGC in Hispanics.


METHODS
Data from a cross-sectional mental health survey in primary care were crosslinked to the hospital's computerized laboratory database.


METHODS
Urban general medicine practice at a teaching hospital.


METHODS
Two hundred and nine patients (mean [standard deviation] age, 57.1 [10.3] years; 68% females) with recent International Classification of Diseases, Ninth Revision (ICD-9) codes for diabetes mellitus, and 1 or more hemoglobin A(1c) (HbA(1c)) tests.


METHODS
Probability of PGC (HbA(1c)>or=8%).


RESULTS
Probability for PGC steadily increased with severity of depression. Thirty-nine (55.7%) of the 70 patients with major depression had HbA(1c)>or=8%, compared with 39/92 (42.4%) in the minimal to mild depression group, and 15/47 (31.9%) in the no depression group (P(trend)=.01; adjusted odds ratio, 3.27; 95% confidence interval, 1.23 to 8.64, for moderate or severe depression vs no depression). Only 29 (41.4%) of the patients with major depression received mental health treatment in the previous year.


CONCLUSIONS
In this primary care sample of Hispanic patients with diabetes, we found a significant association between increasing depression severity and PGC. Yet, less than one half of the patients with moderate or severe depression received mental health treatment in the previous year. Improving identification and treatment of depression in this high-risk population might have favorable effects on diabetic outcomes.
Gross
Raz
R
Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute, New York, NY, USA. rg547@columbia.edu <rg547@columbia.edu>
Olfson
Mark
M
Gameroff
Marc J
MJ
Carasquillo
Olveen
O
Shea
Steven
S
Feder
Adriana
A
Lantigua
Rafael
R
Fuentes
Milton
M
Weissman
Myrna M
MM
D000368:Aged; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology / Q000208:ethnology*; D005260:Female; D006442:Glycated Hemoglobin; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology
D006442:Glycated Hemoglobin