Prospective study participants included low-income Hispanic and African American adults with elevated HbA1c levels. They underwent a low-intensity (two-question) primary care screen for depression, which, if positive, was followed by a computerized diagnostic interview survey for the diagnosis of depression. Patients with depression were then randomized to receive the antidepressant sertraline or placebo. At 6 months, the sertraline group demonstrated greater improvements in HbA1c levels and systolic blood pressure, compared with the control group, and both groups had improved depression scores–possibly because of the increased contact with a “sympathetic questioner,” according to the authors. They noted that the screening questions had positive prediction for depression ranging from 67% to 84%, indicating the value of a low-intensity screen and computerized assessment in the primary care setting (Diabetes Care 2009;32:2156–60).
Combined behavioral interventions also can play an important role in the management of depression in adult patients with diabetes. Mary de Groot, Ph.D., of Indiana University, Indianapolis, and her colleagues recently reported the results of a study designed to test the effectiveness of a combination behavioral approach to the treatment of depression in adult patients with type 2 diabetes living in the rural Appalachian region. The 12-week interdisciplinary intervention, called Program ACTIVE, combined concurrent cognitive behavioral therapy and community-based exercise. The study enrolled 50 adults with diabetes who had screened positive for depression at baseline. Immediately after the intervention and at 3 months after the intervention, the mean Beck Depression Inventory scores of the participants improved significantly relative to baseline, and more than half of the patients no longer met the criteria for major depressive disorder, the authors reported.
With respect to diabetes outcomes, significant improvements were observed in blood glucose levels and low-density lipoprotein cholesterol levels relative to baseline, both immediately after and 3 months after the intervention, the authors wrote (Diabetes Spectrum 2010;23:18–25).
Interventions such as Program ACTIVE can be successful in improving depression and diabetes outcomes despite geographic and financial obstacles “if they are flexible in their approach and make use of community resources to facilitate participant self-care,” according to Dr. de Groot. “In doing so, there is great opportunity to address the significant costs associated with comorbid depression and diabetes.”
By Diana Mahoney. Share your thoughts and suggestions at cpnews@elsevier.com