title: Association Between Specific Depression Symptoms and Glycemic Control Among Patients With Comorbid Type 2 Diabetes and Provisional Depression.
abstract: OBJECTIVE
  To determine whether specific depression symptoms are associated with glycemic control independent of potential demographic and clinical covariates among primary care patients with comorbid type 2 diabetes and provisional threshold or subthreshold depression.
  
  
  METHODS
  We examined a convenience sample of patients diagnosed with type 2 diabetes and provisional threshold or subthreshold depression (N = 82) at 2 family health centers. Cases were identified using a population-based registry of patients diagnosed with type 2 diabetes (ICD-9 codes 250.00 for controlled type 2 diabetes and 250.02 for uncontrolled type 2 diabetes). Data from patients with a primary care provider appointment from the beginning of April 2011 through the end of June 2012 and with at least one 9-item Patient Health Questionnaire (PHQ-9) depression screener and a glycated hemoglobin A1c (HbA1c) laboratory test between 2 weeks before and 10 weeks after PHQ-9 screening were eligible for inclusion. We defined provisional threshold or subthreshold depression using PHQ-9 scoring criteria, which were designed to yield provisional diagnostic information about major depressive disorder based on DSM-5 diagnostic criteria.
  
  
  RESULTS
  Patients reporting higher severity of sleep problems on the PHQ-9 had significantly higher HbA1c levels (mean = 8.48, SD = 2.17) compared to patients reporting lower severity or absence of this symptom (mean = 7.19, SD = 1.34, t 48.88 = -3.13, P = .003). Problems with sleep contributed unique variance on glycemic control (β = 0.27, P = .02) when controlling for potential clinical and demographic covariates, with those reporting more sleep difficulties having higher HbA1c levels.
  
  
  CONCLUSIONS
  For patients with type 2 diabetes and provisional threshold or subthreshold depression, it may be prudent to aggressively address sleep problems as a potential mechanism toward improving diabetes control.
authors.affiliation: Department of Psychiatry, Rhode Island Hospital, Providence.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Czech
authors.affiliation: Department of Psychology, Suffolk University, Boston, Massachusetts.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Orsillo
authors.affiliation: Primary Care, Providence VA Medical Center and Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Pirraglia
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: English
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester.
authors.forename: Alexa J
authors.initials: AJ
authors.lastname: Connell
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