If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  ADA: Depressive Symptoms In Diabetics Worsen Glycemic Control By Jill Stein Special to DG News PHILADELPHIA, PA -- June 25, 2001 -- New findings indicate that depression impairs glycemic control over time, according to study findings reported here yesterday during the 61st Scientific Sessions of the American Diabetes Association (ADA). Dr. William H. Polonsky, with the University of California, San Diego, said that depression also may attenuate the positive impact of diabetes treatment interventions. At the Tripler Army Medical Center in San Diego, 158 patients with poorly controlled type 2 diabetes participated in a one-year treatment intervention study. Patients were randomly assigned to an experimental intervention or a control intervention. The experimental intervention involved an intensive 3 ½ day educational and medical management protocol followed by nurse care management over 12 months. The control intervention involved quarterly mailings of relevant educational materials. A self-report questionnaire was completed and hemoglobin A1c (HbA1c) levels were obtained at baseline and at 12 months. The Center for Epidemiological Studies Depression Scale (CES-D), a widely used scale for depression screening, was also included. Dr. Polonsky presented results in the first 61 patients in whom a 12-month HbA1c level was obtained. Baseline CES-D was positively associated with baseline HbA1c and also with HbA1C at follow-up after adjustment for baseline HbA1c. Further adjustment for the treatment condition did not affect this latter finding, suggesting that the influence of depressive symptoms on future glycemic control was independent of the experimental intervention. In fact, treatment condition did not lead to a significant change in CES-D at follow-up. Notably, the change in CES-D over the one-year period was not associated with the change in HbA1c. Dr. Polonsky pointed out that, as in prior cross-sectional studies, this investigation found that depression was common in diabetes and linked to poor glycemic control. However, he was quick to point out that the patients in this series were not representative of the general population in that all of them had elevated HbA1c levels and the ethnic mix was not typical. He also noted that self-care behavior changes did not mediate the link between depression and future glycemic control, suggesting that depression-related physiologic changes may be to blame and that more careful assessment of self-care behaviors is needed. Finally, he said that early and aggressive treatment of depression may be extremely important for improving glycemic control, especially when combined with standard diabetes treatment interventions.
|
