title: The effect of a Diabetes-Specific Cognitive Behavioral Treatment Program (DIAMOS) for patients with diabetes and subclinical depression: results of a randomized controlled trial.
abstract: OBJECTIVE
  Subclinical depression is one of the most frequent mental comorbidities in patients with diabetes and is associated with a poorer long-term prognosis. Since there is a lack of specific intervention concepts for this patient group, a self-management-oriented group program (DIAMOS [Diabetes Motivation Strengthening]) was newly developed and evaluated in a randomized trial.
  
  
  METHODS
  DIAMOS is composed of cognitive behavioral interventions aiming at the reduction of diabetes distress. The active control group (CG) received diabetes education. The primary outcome was depressive symptoms. Secondary outcomes were diabetes distress, well-being, self-care behavior, diabetes acceptance, diabetes treatment satisfaction, HbA1c, and subclinical inflammation.
  
  
  RESULTS
  Two hundred fourteen participants (mean age 43.3 ± 13.3 years, female sex 56.5%, type 2 diabetes 34.1%, mean diabetes duration 14.2 ± 10.5 years, HbA1c 8.9 ± 1.8%, BMI 28.7 ± 71 kg/m(2)) were randomized. The 12-month follow-up revealed a significantly stronger reduction of depressive symptoms (Center for Epidemiologic Studies Depression Scale score) in the DIAMOS group compared with the CG (Δ3.9 [95% CI 0.6-7.3], P = 0.021). Of the secondary variables, the Patient Health Questionnaire-9 (Δ1.7 [95% CI 0.2-3.2], P = 0.023), Problem Areas in Diabetes scale (Δ8.2 [95% CI 3.1-13.3], P = 0.002), and Diabetes Distress Scale scores (Δ0.3 [95% CI 0.1-0.5], P = 0.012) displayed significant treatment effects. Moreover, the risk of incident major depression in the DIAMOS group was significantly reduced (odds ratio 0.63 [95% CI 0.42-0.96], P = 0.028). Inflammatory variables were not substantially affected.
  
  
  CONCLUSIONS
  DIAMOS is more effective in lowering depressive symptoms and diabetes-related distress in diabetic patients with subclinical depression. DIAMOS also has a preventive effect with respect to the incidence of major depression.
authors.affiliation: Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany Diabetes Center Mergentheim, Bad Mergentheim, Germany Institute of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany hermanns@diabetes-zentrum.de.
authors.forename: Norbert
authors.initials: N
authors.lastname: Hermanns
authors.affiliation: Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schmitt
authors.affiliation: Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Gahr
authors.affiliation: Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University Düsseldorf, Düsseldorf, Germany German Center for Diabetes Research, Partner Düsseldorf, Düsseldorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Herder
authors.affiliation: Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University Düsseldorf, Düsseldorf, Germany Department of Endocrinology and Diabetology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Nowotny
authors.affiliation: Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University Düsseldorf, Düsseldorf, Germany German Center for Diabetes Research, Partner Düsseldorf, Düsseldorf, Germany Department of Endocrinology and Diabetology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Roden
authors.affiliation: Coordination Center for Clinical Trials, University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ohmann
authors.affiliation: Klinik für Psychosomatik und Psychotherapie des Universitätsklinikum Giessen und Marburg, Justus-Liebig-Universität Giessen und Philipps-Universität Marburg, Giessen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kruse
authors.affiliation: Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany Diabetes Center Mergentheim, Bad Mergentheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Haak
authors.affiliation: Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany Diabetes Center Mergentheim, Bad Mergentheim, Germany Institute of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kulzer
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases; D015928:Cognitive Behavioral Therapy / Q000379:methods; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation / Q000502:physiology; D012648:Self Care; D016896:Treatment Outcome