title: Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses.
abstract: OBJECTIVE
  To determine the concurrent, prospective, and time-concordant relationships among major depressive disorder (MDD), depressive symptoms, and diabetes distress with glycemic control.
  
  
  METHODS
  In a noninterventional study, we assessed 506 type 2 diabetic patients for MDD (Composite International Diagnostic Interview), for depressive symptoms (Center for Epidemiological Studies-Depression), and for diabetes distress (Diabetes Distress Scale), along with self-management, stress, demographics, and diabetes status, at baseline and 9 and 18 months later. Using multilevel modeling (MLM), we explored the cross-sectional relationships of the three affective variables with A1C, the prospective relationships of baseline variables with change in A1C over time, and the time-concordant relationships with A1C.
  
  
  RESULTS
  All three affective variables were moderately intercorrelated, although the relationship between depressive symptoms and diabetes distress was greater than the relationship of either with MDD. In the cross-sectional MLM, only diabetes distress but not MDD or depressive symptoms was significantly associated with A1C. None of the three affective variables were linked with A1C in prospective analyses. Only diabetes distress displayed significant time-concordant relationships with A1C.
  
  
  CONCLUSIONS
  We found no concurrent or longitudinal association between MDD or depressive symptoms with A1C, whereas both concurrent and time-concordant relationships were found between diabetes distress and A1C. What has been called "depression" among type 2 diabetic patients may really be two conditions, MDD and diabetes distress, with only the latter displaying significant associations with A1C. Ongoing evaluation of both diabetes distress and MDD may be helpful in clinical settings.
authors.affiliation: Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA. fisherl@fcm.ucsf.edu
authors.forename: Lawrence
authors.initials: L
authors.lastname: Fisher
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Mullan
authors.forename: Patricia
authors.initials: P
authors.lastname: Arean
authors.forename: Russell E
authors.initials: RE
authors.lastname: Glasgow
authors.forename: Danielle
authors.initials: D
authors.lastname: Hessler
authors.forename: Umesh
authors.initials: U
authors.lastname: Masharani
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000503:physiopathology*; D003866:Depressive Disorder / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin