title: A randomized trial of telephonic counseling plus walking for depressed diabetes patients.
abstract: BACKGROUND
  Patients with diabetes and depression often have self-management needs that require between-visit support. This study evaluated the impact of telephone-delivered cognitive behavioral therapy (CBT) targeting patients' management of depressive symptoms, physical activity levels, and diabetes-related outcomes.
  
  
  METHODS
  Two hundred ninety-one patients with type 2 diabetes and significant depressive symptoms (Beck Depression Inventory scores ≥ 14) were recruited from a community-based, university-based, and Veterans Affairs health care systems. A manualized telephone CBT program was delivered weekly by nurses for 12 weeks, followed by 9 monthly booster sessions. Sessions initially focused exclusively on patients' depression management and then added a pedometer-based walking program. The primary outcome was hemoglobin A1c levels measured at 12 months. Blood pressure was a secondary outcome; levels of physical activity were determined by pedometer readings; depression, coping, and health-related quality of life were measured using standardized scales.
  
  
  RESULTS
  Baseline A1c levels were relatively good and there was no difference in A1c at follow-up. Intervention patients experienced a 4.26 mm Hg decrease in systolic blood pressure relative to controls (P=0.05). Intervention patients had significantly greater increases in step counts (mean difference, 1131 steps/d; P=0.0002) and greater reductions in depressive symptoms (58% remitted at 12 mo vs. 39%; P=0.002). Intervention patients also experienced relative improvements in coping and health-related quality of life.
  
  
  CONCLUSIONS
  This program of telephone-delivered CBT combined with a pedometer-based walking program did not improve A1c values, but significantly decreased patients' blood pressure, increased physical activity, and decreased depressive symptoms. The intervention also improved patients' functioning and quality of life.
authors.affiliation: Ann Arbor VA Healthcare System, Flint, MI, USA. jpiette@umich.edu
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.forename: Caroline
authors.initials: C
authors.lastname: Richardson
authors.forename: Joseph
authors.initials: J
authors.lastname: Himle
authors.forename: Sonia
authors.initials: S
authors.lastname: Duffy
authors.forename: Trissa
authors.initials: T
authors.lastname: Torres
authors.forename: Mark
authors.initials: M
authors.lastname: Vogel
authors.forename: Kimberly
authors.initials: K
authors.lastname: Barber
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000209:etiology* / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology; D012959:Socioeconomic Factors; D013689:Telephone; D016896:Treatment Outcome; D016138:Walking
chemical_list: D006442:Glycated Hemoglobin