title: Web-based depression treatment for type 1 and type 2 diabetic patients: a randomized, controlled trial.
abstract: OBJECTIVE
  Comorbid depression is common in patients with type 1 and type 2 diabetes, adversely affecting quality of life, diabetes outcomes, and mortality. Depression can be effectively treated with cognitive behavior therapy (CBT). The Internet is a new and attractive method for delivering CBT intervention on a large scale at relatively low costs. This study evaluated the effectiveness of Web-based CBT for depression treatment in adults with type 1 or type 2 diabetes, with minimal guidance.
  
  
  METHODS
  A randomized controlled trial was conducted in the Netherlands in 255 adult diabetic patients with elevated depressive symptoms. Primary outcomes were depressive symptoms. Secondary outcomes were diabetes-specific emotional distress and glycemic control. Assessments were at baseline, after treatment, and at the 1-month follow-up.
  
  
  RESULTS
  The Web-based CBT was effective in reducing depressive symptoms by intention-to-treat analyses (P = 0.04, d = 0.29; clinical improvement 41% vs. 24% P < 0.001) and by per-protocol analyses (P < 0.001, d = 0.70; clinical improvement, 56% vs. 24% P < 0.001). The intervention reduced diabetes-specific emotional distress (P = 0.03) but had no beneficial effect on glycemic control (P > 0.05).
  
  
  CONCLUSIONS
  Web-based CBT depression treatment is effective in reducing depressive symptoms in adults with type 1 and type 2 diabetes. In addition, the intervention reduces diabetes-specific emotional distress in depressed patients.
authors.affiliation: Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands. k.vanbastelaar@vumc.nl
authors.forename: Kim M P
authors.initials: KM
authors.lastname: van Bastelaar
authors.forename: François
authors.initials: F
authors.lastname: Pouwer
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.forename: Heleen
authors.initials: H
authors.lastname: Riper
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Snoek
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000628:therapy; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000628:therapy*; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome