title: Effectiveness of a multifactorial cardiovascular risk reduction clinic for diabetes patients with depression.
abstract: BACKGROUND
  Depression may attenuate the effects of diabetes interventions. Our ongoing Cardiovascular Risk Reduction Clinic simultaneously addresses hyperglycemia, hypertension, smoking, and hyperlipidemia. We examined the relationship between depression diagnosis and responsiveness to the Cardiovascular Risk Reduction Clinic.
  
  
  METHODS
  We studied Cardiovascular Risk Reduction Clinic participants with diabetes who had a depression diagnosis and those with no mental health diagnosis. Our outcome measure was change in 20-year cardiovascular mortality risk according to the United Kingdom Prospective Diabetes Study (UKPDS) score.
  
  
  RESULTS
  Of 231 participants, 36 (15.6%) had a depression diagnosis. Participants with a depression diagnosis had a higher baseline UKPDS score (56.8 [SD 21.3]) than participants with no mental health diagnosis (49.5 [SD 18.7], P = .04). After Cardiovascular Risk Reduction Clinic participation, mean UKPDS scores did not differ significantly (37.8 [SD 15.9] for no mental health diagnosis and 39.4 [SD 18.6] for depression diagnosis). Mean UKPDS score reduction was 11.6 [SD 15.6] for no mental health diagnosis compared with 18.4 [SD 15.9] for depression diagnosis (P = .03). Multivariable linear regression that controlled for baseline creatinine, number of Cardiovascular Risk Reduction Clinic visits, sex, and history of congestive heart failure showed significantly greater improvement in UKPDS score among participants with a depression diagnosis (beta = 6.0, P = .04) and those with more Cardiovascular Risk Reduction Clinic visits (beta = 2.1, P < .001).
  
  
  CONCLUSIONS
  The Cardiovascular Risk Reduction Clinic program reduced cardiovascular disease risk among patients with diabetes and a diagnosis of depression. Further work should examine how depressive symptom burden and treatment modify the effect of this collaborative multifactorial program and should attempt to determine the durability of the effect.
authors.affiliation: Program to Integrate Psychosocial and Health Services in Chronic Diseases and Disability, Providence Veterans Affairs Medical Center, 830 Chalkstone Ave, Bldg T32, Providence, RI 02908-4799, USA. Paul.Pirraglia@va.gov
authors.forename: Paul A
authors.initials: PA
authors.lastname: Pirraglia
authors.forename: Tracey H
authors.initials: TH
authors.lastname: Taveira
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Cohen
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Wu
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications*; D015331:Cohort Studies; D003863:Depression / Q000150:complications*; D048909:Diabetes Complications / Q000517:prevention & control*; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors
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