Depression Treatment Improves Diabetes Control

Depression appears common in those with diabetes. Depression may influence the outcome of diabetes through a variety of mechanisms. One mechanism is reduced motivation and drive to comply with dietary, exercise and pharamacological recommendations.

Echeverry et al recently published results of a depression intervention in a serious of patients with diabetes. The population for this study was a group of low-income individuals of Hispanic and African American race and ethnicity.

Patients were screened for depression using a two-question screen called the Whooley two-question tool. Question 1 is "During the past month, have you often been bothered by feeling down, depressed or hopeless?". Question 2 is "During the past month, have you often been bothered by having little interest or pleasure in doing things?". Patients who answered yes to either of these questions received a computerized interview for the diagnosis of depression (Computerized Diagnostic Interview Survey).

Patients with depression and elevated A1C levels (indicating poor glucose control) were randomized to receive the antidepressant sertraline or placebo. The primary outcome measures for the study were AIC levels and measures of depression severity (Hamilton Depression Scores). Quality of life was also assessed.

The primary findings of the study were:

• The screening questions had positive prediction for depression ranging from 67 to 84%
• Both groups had improvement in depression scores
• The sertraline group had greater improvement in A1C levels (10.0 to 8.0 at 6 month)
• The sertraline group also had greater improvement in systolic blood pressure (137 mm to 122 mm)
• Weight levels did not change for either sertraline or placebo groups
• Most quality of life measures improved for both groups

The authors concluded "One interpretation of these results is that increased contact with a sympathetic questioner (and listener) helps patients leading to better medication adherence, but pharmacological treatment of the underlying depression yields an incremental benefit.

The study also demonstrated that a low intensity screen and computerized assessment can aid primary care physicians in establishing a diagnosis of depression.

Reference
Echeverry D et al: Effect of pharmacological treatment of depression on A1C and quality of life in low-income hispanics and african americans with diabetes. Diabets Care 32:2156-2160, 2009.

Link to Abstract

Photo Ndamukong Suh Courtesy Yates Photography

Losing Weight Using Your Cell Phone

Several studies have now demonstrated the potential for cell phones and text messages to help in the battle against obesity.

How do these types of programs work?

The free text article by Patrick et al (see below for link) outlines a typical program. Participants receive daily text messages customized to the individual. Text messages are typically sent in the morning and evening. Additional messages may be sent throughout the day.

Message topics change weekly through the period of intervention. The topics include dietary and behavioral strategies for weight loss such as goal setting, weight monitoring, calorie education, portion control, use of pedometers, volumetric, physical activity. The messages are supportive and encouraging in tone.

More information about the program can be accessed in the manuscript.

So what is the effect of cell phone text messaging in weight loss?

Over a 4 month period, the cell phone intervention group lost about 5 more pounds than the control group. The Haapali et al study found an approximate weight loss of 10 pounds after one year.

These results are modest, but potentially important from a public health perspective. Applied widely across a population, a ten pound weight loss average could have significant effects on blood pressure and glucose metabolism.

The potential commercial effects appear significant. Most cell phone weight loss participants report that they enjoyed the interaction and would recommend them to others. The current commercial applications are limited, but you can expect more offerings with research supporting this type of intervention.

Reference:

Patrick K et al: A text message-based intervention for weight loss: Randomized controlled trial. J Med Internet Res Jan 2009.

Full Text

Reference:

Haapala I et al: Weight loss by mobile phone: a 1-year effectiveness study. Public Health Nutr 12:2382-91, 2009

Photo: Blue Jay in Snow Courtesty of Yates Photography

The Uniqueness of Humans: TED Talk by Robert Sapolsky

Robert Sapolsky recently gave a commencement address at Stanford University. A primatologist, Sapolsky summarized what makes humans unique. I've posted the TED video above and made notes below from his presentation. You can advance the YouTube video to about 5 minutes to bypass the introduction or go to the TED site here.

Humans are unique but it is not related to our genetic structure. We share the vast majority of genes with primates. We have challenges in making sense of human uniqueness.

We share many more features than unique features with the animal world.

Humans are not the only species that kills others. Even organized murder is seen in the animal world. However, humans are unique in their use of passive aggression.

Humans possess Theory of Mind--understanding that others have thoughts different than our own. Some primates possess rudimentary forms of Theory of Mind, but it's development in humans is unique. Humans alone have secondary theory of mind allowing appreciation of complex interactions.

Humans understand the Golden Rule and engage in treating others as we want to be treated. There are examples in the animal kingdom. But humans understand others may not want the same things we do.

Empathy is demonstrated by others in the animal kingdom, but humans have extended capacity to apply empathy. We can extend empathy across species, across time and apply to abstract areas.

Humans also have the unique ability to participate in delayed gratification and postponement of reward. Humans even demonstrate goal-directed behavior for abstract after-life rewards.

Chimpanzees can demonstrate passing knowledge on to subsequent generations, an element of culture. However, humans have a more complex developed form of culture.

Humans also show the capacity to simultaneously embrace contradictory ideas. Humans understand their limited ability to influence the world, but engage in personal efforts to do so.