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.
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