Depression, deficits in functional capacity, and impaired glycemic control in urban African Americans with type 2 diabetes.
BACKGROUND
Effective depression treatment does not reliably reduce glycosylated hemoglobin (HbA1c) in depressed patients with type 2 diabetes, possibly in part due to deficits in functional capacity, i.e. performance of certain everyday living skills, essential for effective diabetes self-management. We sought to determine: a) the magnitude of deficits in functional capacity among urban, African American (AA) patients with type 2 diabetes, and b) whether these deficits were associated with poorer glycemic control.


METHODS
At their initial visit to an inner-city diabetes clinic, 172 AA patients with type 2 diabetes were assessed with a variety of instruments, including the Mini International Neuropsychiatric Interview (MINI) and the UCSD Performance Skills Assessment-Brief (UPSA-B). They then entered a comprehensive diabetes management intervention, whose success was indexed by HbA1c levels at up to four reassessments over a one-year period. A mixed-effects model repeated-measures method was used to predict HbA1c.


RESULTS
The prevalence of depression was 19%; the mean UPSA-B score was 81 ± 17. After multivariate adjustment, increased HbA1c levels over time were predicted by the presence of major depression (B = .911, p = .002) and decreasing (worse) scores on the UPSA-B (B = -.016, p = .027), respectively. Further adjustment for increasing the dosage of oral or insulin during the treatment eliminated the association between the UPSA score and HbA1c level (B = -.010, p = .115).


CONCLUSIONS
Depression, as well as deficits in functional capacity, predicted reduced effectiveness of a diabetes self-management intervention. Future studies will determine whether interventions targeted at both improve glycemic control.
Department of Psychiatry and Behavioral Sciences, University of Miami Leonard Miller School of Medicine, Miami, FL, USA. Electronic address: dmusselman@med.miami.edu.
Dominique L
DL
Musselman
Department of Medicine, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA.
David C
DC
Ziemer
University of Miami, Department of Psychology, Miami, FL, USA.
Marcia D
MD
McNutt
University of Miami, Department of Psychology, Miami, FL, USA.
Julia S
JS
Seay
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
Erica B
EB
Royster
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
Bridget
B
Larsen
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
Terrika
T
Barham
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
Angelo R
AR
Brown
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
Octavia L
OL
Vogel
Department of Medicine, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA.
Lawrence S
LS
Phillips
Department of Psychiatry and Behavioral Sciences, University of Miami Leonard Miller School of Medicine, Miami, FL, USA.
Philip D
PD
Harvey
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D003863:Depression / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000523:psychology; D005215:Fasting / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012648:Self Care; D014505:Urban Population; D055815:Young Adult
D001786:Blood Glucose; D006442:Glycated Hemoglobin
African Americans; Functional capacity; Glycemic control; HbA1c; MINI structured diagnostic interview; Major depression; Neurocognition; Type 2 diabetes; UPSA-B; Zung Depression Rating Scale