Depression and glycemic control in elderly ethnically diverse patients with diabetes: the IDEATel project.
OBJECTIVE
The purpose of the study was to investigate the effect of comorbid depression on glycemic control and on response to a telemedicine case management intervention for elderly, ethnically diverse diabetic patients.


METHODS
Medicare beneficiaries in underserved areas were participants (n = 1,665) in the Informatics for Diabetes Education and Telemedicine (IDEATel) project and randomized to a telemedicine case management intervention or usual care. The data analyzed include baseline demographics (age, sex, race/ethnicity, marital status, insulin use, years of education, years of diabetes, and pack-years smoked) and measures of glycemic control (HbA(1c) [A1C]), comorbidity, diabetes symptom severity, functional disability and depression, and 1-year (n = 1,578) A1C. The association between depression and glycemic control was analyzed cross-sectionally and prospectively.


RESULTS
At baseline, there was a significant correlation between depression and A1C and a trend for depression to predict A1C when other factors were controlled. However, in prospective analyses, depression did not predict change in A1C, either in the control or intervention group.


CONCLUSIONS
In this large sample of elderly diabetic patients, a weak relationship between depression and A1C was found, but depression did not prospectively predict change in glycemic control. Thus, there is no evidence that depression should be used to exclude patients from interventions. Also, we should evaluate the impact of depression on outcomes other than glycemic control.
Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, NY 13210, USA. triefp@upstate.edu
Paula M
PM
Trief
Philip C
PC
Morin
Roberto
R
Izquierdo
Jeanne
J
Teresi
Joseph P
JP
Eimicke
Robin
R
Goland
Justin
J
Starren
Steven
S
Shea
Ruth S
RS
Weinstock
D000203:Activities of Daily Living; D000368:Aged; D044383:Black People; D001786:Blood Glucose; D019090:Case Management; D015897:Comorbidity; D003863:Depression / Q000150:complications*; D048909:Diabetes Complications / Q000523:psychology*; D003920:Diabetes Mellitus / Q000097:blood / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D017216:Telemedicine; D044465:White People
D001786:Blood Glucose; D006442:Glycated Hemoglobin