A Randomized Trial of Telephonic Counseling Plus Walking for Depressed Diabetes Patients

Abstract

Background Patients with diabetes and depression often have self-management needs that require between-visit support. This study evaluated the impact of telephone-delivered cognitive behavioral therapy (CBT) targeting patients’ management of depressive symptoms, physical activity levels, and diabetes-related outcomes. Methods 291 patients with type 2 diabetes and significant depressive symptoms (Beck Depression Inventory scores ≥14)were recruited from a community-university-and VA healthcare system. A manualized telephone CBT program was delivered by nurses weekly for 12weeks, followed by nine monthly booster sessions. Sessions initially focused exclusively on patients’ depression management and then added a pedometer-based walking program. The primary outcome was hemoglobin A1cmeasured at 12-months. Blood pressure was a secondary outcome; levels of physical activity were determined by pedometer readings; depression, coping, and health related quality of life (HRQL) were measured using standardized scales. Results Baseline A1c levels were relatively good and there was no difference in A1c at follow-up. Intervention patients experienced a4.26 mmHg decrease in systolic blood pressure relative to controls (p=.05). Intervention patients had significantly greater increases in step-counts (mean difference 1,131 steps/day; p=.0002) and greater reductions in depressive symptoms (58%remitted at12 months versus 39%; p=.002). Intervention patients also experienced relative improvements in coping and HRQL. Conclusions This program of telephone delivered CBT combined with a pedometer-based walking program did not improve A1c values but significantly decreased patients’ blood pressure, increased physical activity, and decreased depressive symptoms. The intervention also improved patients’ functioning and quality of life.

Associação entre depressão e doenças crônicas: um estudo populacional

“…Interventions like telephonic counseling targeted at these patients, 17 patients' proper follow-up by primary care professionals 23 or drug administration when indicated 14 seem to present positive results in the handling of chronic diseases.…”

Development and validation of the ASPIRE-VA coaching fidelity checklist (ACFC): a tool to help ensure delivery of high-quality weight management interventions

“…The use of two raters highlighted the need for clearly defined criteria by which to score each ACFC item. A manual to help guide [41,42] assignment of ratings is provided in Appendix 3. This guide helped to ensure high reliability between raters.…”

Simplifying Care for Complex Patients

“…For example, Lin et al and others have previously shown that depression care management has the potential to improve multiple symptom domains. [8][9][10] Further, patient populations with multiple morbidities and depression may be more responsive to general self-management interventions than are populations with no depression and fewer medical conditions. 11,12 Thus, there seems to be little doubt that care management attending to depression and other conditions has the potential to improve several health outcomes for both conditions.…”