Effects of enhanced depression treatment on diabetes self-care.
OBJECTIVE
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.
Lin
Elizabeth H B
EH
Center for Health Studies, Group Health Cooperative, Seattle, Wash 98101, USA. lin.e@ghc.org
Katon
Wayne
W
Rutter
Carolyn
C
Simon
Greg E
GE
Ludman
Evette J
EJ
Von Korff
Michael
M
Young
Bessie
B
Oliver
Malia
M
Ciechanowski
Paul C
PC
Kinder
Leslie
L
Walker
Edward
E
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003866:Depressive Disorder / Q000150:complications / Q000628:therapy*; D003920:Diabetes Mellitus / Q000523:psychology / Q000628:therapy*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care / Q000523:psychology*; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000523:psychology*
D000928:Antidepressive Agents