title: Cognitive Behavioral Therapy Versus Sertraline in Patients With Depression and Poorly Controlled Diabetes: The Diabetes and Depression (DAD) Study: A Randomized Controlled Multicenter Trial.
abstract: OBJECTIVE
  This study compared the long-term efficacy of a diabetes-specific cognitive behavioral group therapy (CBT) with sertraline in patients with diabetes and depression who initially responded to short-term depression treatment.
  
  
  METHODS
  A randomized controlled single-blind trial was conducted in 70 secondary care centers across Germany comparing 12 weeks of CBT with sertraline in 251 patients with type 1 or 2 diabetes (mean HbA1c 9.3%, 78 mmol/mol) and major depression (Structured Clinical Interview for DSM-IV [SCID]). After 12 weeks, treatment responders (≥50% reduction Hamilton Depression Rating Scale [HAMD-17]) were included in the 1-year study phase where CBT patients were encouraged to use bibliotherapy and sertraline patients received continuous treatment. We analyzed differences for HbA1c (primary outcome) and reduction (HAMD-17) or remission (SCID) of depression from baseline to the 1-year follow-up using ANCOVA or logistic regression analysis.
  
  
  RESULTS
  After 12 weeks, 45.8% of patients responded to antidepressant treatment and were included in the 1-year study phase. Adjusted HbA1c mean score changes from baseline to the end of the long-term phase (-0.27, 95% CI -0.62 to 0.08) revealed no significant difference between interventions. Depression improved in both groups, with a significant advantage for sertraline (HAMD-17 change: -2.59, 95% CI 1.15-4.04, P < 0.05).
  
  
  CONCLUSIONS
  Depression improved under CBT and sertraline in patients with diabetes and depression, with a significant advantage for sertraline, but glycemic control remained unchanged. CBT and sertraline as single treatment are insufficient to treat secondary care diabetes patients with depression and poor glycemic control.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany Center for Psychotherapy Wiesbaden, Wiesbaden, Germany mail@dr-frank-petrak.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Petrak
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Herpertz
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Köln, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Albus
authors.affiliation: Diabetes Center Mergentheim, Bad Mergentheim, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Hermanns
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Centre, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hiemke
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hiller
authors.affiliation: Interdisciplinary Centre for Clinical Trials Mainz (IZKS Mainz), University Medical Centre, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Kronfeld
authors.affiliation: Clinic for Psychosomatic and Psychotherapy, University Clinic Gießen/Marburg, Philipps University Marburg, Marburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kruse
authors.affiliation: Diabetes Center Mergentheim, Bad Mergentheim, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Kulzer
authors.affiliation: Interdisciplinary Centre for Clinical Trials Mainz (IZKS Mainz), University Medical Centre, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ruckes
authors.affiliation: Department of Health Psychology, Institute of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Zahn
authors.affiliation: Vitos Clinical Centre Gießen-Marburg and Justus Liebig University Gießen, Marburg, Germany.
authors.forename: Matthias J
authors.initials: MJ
authors.lastname: Müller
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000628:therapy*; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D005260:Female; D005858:Germany; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D020280:Sertraline / Q000627:therapeutic use*; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D020280:Sertraline