title: A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes.
abstract: OBJECTIVE
  To test cognitive behavioral therapy for adherence and depression (CBT-AD) in type 2 diabetes. We hypothesized that CBT-AD would improve adherence; depression; and, secondarily, hemoglobin A1c (A1C).
  
  
  METHODS
  Eighty-seven adults with unipolar depression and uncontrolled type 2 diabetes received enhanced treatment as usual (ETAU), including medication adherence, self-monitoring of blood glucose (SMBG), and lifestyle counseling; a provider letter documented psychiatric diagnoses. Those randomized to the intervention arm also received 9-11 sessions of CBT-AD.
  
  
  RESULTS
  Immediately after acute treatment (4 months), adjusting for baseline, CBT-AD had 20.7 percentage points greater oral medication adherence on electronic pill cap (95% CI -31.14 to -10.22, P = 0.000); 30.2 percentage points greater SMBG adherence through glucometer downloads (95% CI -42.95 to -17.37, P = 0.000); 6.44 points lower depression scores on the Montgomery-Asberg Depression Rating Scale (95% CI 2.33-10.56, P = 0.002); 0.74 points lower on the Clinical Global Impression (95% CI 0.16-1.32, P = 0.01); and 0.72 units lower A1C (95% CI 0.29-1.15, P = 0.001) relative to ETAU. Analyses of 4-, 8-, and 12-month follow-up time points indicated that CBT-AD maintained 24.3 percentage points higher medication adherence (95% CI -38.2 to -10.3, P = 0.001); 16.9 percentage points greater SMBG adherence (95% CI -33.3 to -0.5, P = 0.043); and 0.63 units lower A1C (95% CI 0.06-1.2, P = 0.03) after acute treatment ended. For depression, there was some evidence of continued improvement posttreatment, but no between-group differences.
  
  
  CONCLUSIONS
  CBT-AD is an effective intervention for adherence, depression, and glycemic control, with enduring and clinically meaningful benefits for diabetes self-management and glycemic control in adults with type 2 diabetes and depression.
authors.affiliation: Corresponding author: Steven A. Safren, ssafren@partners.org.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gonzalez
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Wexler
authors.forename: Christina
authors.initials: C
authors.lastname: Psaros
authors.forename: Linda M
authors.initials: LM
authors.lastname: Delahanty
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Blashill
authors.forename: Aleksandra I
authors.initials: AI
authors.lastname: Margolina
authors.forename: Enrico
authors.initials: E
authors.lastname: Cagliero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003376:Counseling; D003865:Major Depressive Disorder / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology / Q000628:therapy*; D019263:Dysthymic Disorder / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D040242:Risk Reduction Behavior; D012648:Self Care; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents