Factors Influencing Glycemic Control in Type 2 Diabetes During Acute- and Maintenance-Phase Treatment of Major Depressive Disorder With Bupropion

Lustman, Patrick J.; Williams, Monique; Sayuk, Gregory S.; Nix, Billy D.; Clouse, Ray E.

doi:10.2337/dc06-1769

Cited by 114 publications

(86 citation statements)

References 52 publications

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“…Healthy Border 2010 identifies diabetes and mental health issues as border health priorities. Screening diabetics for depression is of great importance because there is evidence that treatment of depression improves glycemic control 64 and increases a patient's quality of life. 65 Healthy Border 2010, however, recognizes that access to mental health services along the US Mexico border is problematic because of a shortage of specialty mental health providers and services.…”

Section: Discussionmentioning

confidence: 99%

Clinical Depressive Symptoms and Diabetes in a Binational Border Population

Mier

Bocanegra-Alonso²,

Zhan³

et al. 2008

The Journal of the American Board of Family Medicine

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Section: Discussionmentioning

confidence: 99%

Clinical Depressive Symptoms and Diabetes in a Binational Border Population

Mier

Bocanegra-Alonso²,

Zhan³

et al. 2008

The Journal of the American Board of Family Medicine

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“…Novel approaches to investigating the role of subclinical symptoms of depression in patients with type 2 diabetes may also be valuable. As of yet, it is unclear whether interventions that reduce symptoms of depression could improve diabetes self-care, but there is recent evidence supporting this possibility (26). Efforts to reduce barriers to effective diabetes management should include both increased screening for depression in the primary care setting and increased recognition that even subclinical symptoms of depression may negatively impact diabetes self-care behaviors.…”

Section: Self-care Among Patients Not Meeting Criteria For Major Deprmentioning

confidence: 99%

Depression, Self-Care, and Medication Adherence in Type 2 Diabetes

et al. 2007

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OBJECTIVE -We examined the association between depression, measured as either a continuous symptom severity score or a clinical disorder variable, with self-care behaviors in type 2 diabetes.RESEARCH DESIGN AND METHODS -We surveyed 879 type 2 diabetic patients from two primary care clinics using the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS), the Summary of Diabetes Self-Care Activities, and self-reported medication adherence.RESULTS -Of the patients, 19% met the criteria for probable major depression (HANDS score Ն9), and an additional 66.5% reported at least some depressive symptoms. After controlling for covariates, patients with probable major depression reported significantly fewer days' adherent to diet, exercise, and glucose self-monitoring regimens (P Ͻ 0.01) and 2.3-fold increased odds of missing medication doses in the previous week (95% CI 1.5-3.6, P Ͻ 0.001) compared with all other respondents. Continuous depressive symptom severity scores were better predictors of nonadherence to diet, exercise, and medications than categorically defined probable major depression. Major depression was a better predictor of glucose monitoring. Among the two-thirds of patients not meeting the criteria for major depression (HANDS score Ͻ9, n ϭ 709), increasing HANDS scores were incrementally associated with poorer self-care behaviors (P Ͻ 0.01).CONCLUSIONS -These findings challenge the conceptualization of depression as a categorical risk factor for nonadherence and suggest that even low levels of depressive symptomatology are associated with nonadherence to important aspects of diabetes self-care. Interventions aimed at alleviating depressive symptoms, which are quite common, could result in significant improvements in diabetes self-care. Diabetes Care 30:2222-2227, 2007M ajor depression is a significant problem among patients with diabetes, with an estimated prevalence of 15-20%, compared with 2-9% in the general population (1). Among patients with type 2 diabetes, major depression is associated with a 2.3-fold increase in mortality, and minor or "subclinical" depression is associated with a 1.7-fold increase (2). Depression also increases the risk of poorer diabetes-specific outcomes such as hyperglycemia (3) and an increase in diabetes complications (4).The available literature suggests that clinically significant levels of depression are associated with a range of poorer selfcare behaviors including adherence to diet (5-8), exercise (6,7), and prescribed medications (5,7,9,10). However, although depression is clinically conceptualized as a discrete comorbid illness, few researchers have investigated the possibility of a dose-response relationship between symptoms of depression and poorer self-care, favoring instead a conceptualization of depression as a discrete comorbid illness when examining its relationship to diabetes self-care behaviors.The aim of the current study was to extend previous research by examining the relationships between depression and the full range of diab...

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“…However, one study used a longitudinal design and found significant relationships between depressive symptoms at baseline and increases in symptoms of depression over time and a variety of self-care behaviors assessed 9 months later, even when baseline levels of self-care were controlled (14). Another study of an open-label treatment trial of bupropion hydrochloride in patients with type 2 diabetes and major depressive disorder found that depression severity, BMI, total fat mass, and A1C decreased during the acute phase of treatment, whereas adherence to diet and exercise improved significantly (30). The pattern of findings from these studies is consistent with a causal relationship but does not provide conclusive proof.…”

Section: Moderation Analysesmentioning

confidence: 99%

Depression and Diabetes Treatment Nonadherence: A Meta-Analysis

et al. 2008

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OBJECTIVE -Depression is common in patients with diabetes and is associated with worse treatment outcomes. Its relationship to treatment adherence, however, has not been systematically reviewed. We used meta-analysis to examine the relationship between depression and treatment nonadherence in patients with type 1 and type 2 diabetes.RESEARCH DESIGN AND METHODS -We searched MEDLINE and PsycINFO databases for all studies published by June 2007 and reviewed references of published articles. Meta-analytic procedures were used to estimate the effect size r in a random effects model. Significance values, weighted effect sizes, 95% CIs, and tests of homogeneity of variance were calculated.RESULTS -Results from 47 independent samples showed that depression was significantly associated with nonadherence to the diabetes treatment regimen (z ϭ 9.97, P Ͻ 0.0001). The weighted effect size was near the medium range (r ϭ 0.21, 95% CI 0.17-0.25). Moderator analyses showed that the effect was significantly larger in studies that measured self-care as a continuous versus categorical variable (P ϭ 0.001). Effect sizes were largest for missed medical appointments and composite measures of self-care (r values ϭ 0.31, 0.29). Moderation analyses suggest that effects for most other types of self-care are also near the medium range, especially in studies with stronger methodologies.CONCLUSIONS -These findings demonstrate a significant association between depression and treatment nonadherence in patients with diabetes. Studies that used stronger methodologies had larger effects. Treatment nonadherence may represent an important pathway between depression and worse diabetes clinical outcomes.

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Factors Influencing Glycemic Control in Type 2 Diabetes During Acute- and Maintenance-Phase Treatment of Major Depressive Disorder With Bupropion

Cited by 114 publications

References 52 publications

Clinical Depressive Symptoms and Diabetes in a Binational Border Population

Clinical Depressive Symptoms and Diabetes in a Binational Border Population

Depression, Self-Care, and Medication Adherence in Type 2 Diabetes

Depression and Diabetes Treatment Nonadherence: A Meta-Analysis

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