Effect of pharmacological treatment of depression on A1C and quality of life in low-income Hispanics and African Americans with diabetes: a randomized, double-blind, placebo-controlled trial

Diana Echeverry, Petra Duran, Curley Bonds, Martin Lee, Mayer B Davidson, Diana Echeverry, Petra Duran, Curley Bonds, Martin Lee, Mayer B Davidson

Abstract

Objective: To determine whether pharmacological treatment of depression in low-income minorities with diabetes improves A1C and quality of life (QOL).

Research design and methods: This was a 6-month, randomized, double-blind, placebo-controlled trial. Patients were screened for depression using Whooley's two-question tool at a county diabetes clinic. Depression was confirmed (or not) with the Computerized Diagnostic Interview Survey (CDIS) software program, and the severity of depression was assessed monthly by the Hamilton Depression Scale (HAM-D). Depressed subjects with A1C levels >or=8.0% were randomly assigned to receive either sertraline or placebo. Diabetes care was provided by nurses following detailed treatment algorithms who were unaware of therapy for depression.

Results: A total of 150 subjects answered positively to at least one question on Whooley's questionnaire. The positive predictive value for depression diagnosed by CDIS was 69, 67, and 84% for positive answers to question 1 only, question 2 only, or both, respectively. Of the 89 subjects who entered the study, 75 completed. An intention-to-treat analysis revealed significant differences between baseline and 6 months in HAM-D and pain scores, QOL, and A1C and systolic blood pressure levels in both groups, with no differences between groups for the first three but a significantly greater decrease with sertraline in A1C and systolic blood pressure levels. Changes in HAM-D scores and A1C levels were significantly correlated in all subjects (P = 0.45 [P < 10(-6)]).

Conclusions: In this low-income minority population, pharmacological treatment of depression significantly improved A1C and systolic blood pressure levels compared with placebo.

Trial registration: ClinicalTrials.gov NCT00624013.

Figures

Figure 1
Figure 1
CONSORT diagram depicting subject flow.

References

    1. Anderson S, Freedland K, Clouse R, Lustman P: The prevalence of co-morbid depression in adults with diabetes. Diabetes Care 2001; 24: 1069– 1077
    1. Lustman P, Anderson R, Freedland K, Groot MD, Carney R, Clouse R: Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 2000; 23: 934– 942
    1. Gonzalez J, Safran S, Cagliero E, Wexler D, Delahanty L, Wittenberg E, Blais M, Meigs J, Grant R: Depression, self care, and medication adherence in type 2 diabetes: relationships across the full range of symptom severity. Diabetes Care 2007; 30: 2222– 2227
    1. Black SA, Markides KS, Ray LA: Depression predicts increased incidence of adverse health outcomes in Mexican Americans with type 2 diabetes. Diabetes Care 2003; 26: 2822– 2828
    1. Xuanping Z, Norris S, Gregg E, Cheng Y, Beckles G, Kahn H: Depressive symptoms and mortality among persons with and without diabetes. Am J Epidemiol 2005; 161: 652– 660
    1. Simon G, Katon W, Lin E, Ludman E, Von Korff M, Ciechanowski P, Young B: Diabetes and depression as predictors of health care costs. Gen Hosp Psychiatry 2005; 27: 344– 351
    1. Wagner J, Tsimikas J, Abbot G, De Groot M, Heapy A: Racial and ethnic differences in diabetic patient-reported depression symptoms, diagnosis, and treatment. Diabetes Res Clin Pract 2007; 75: 119– 122
    1. Black SA: Increase in Health Burden Associations with co-morbid depression in older diabetic Mexican Americans: results from the Hispanic Established Population for the Epidemiologic Study of the Elderly survey. Diabetes Care 1999; 22: 56– 64
    1. Kirk J, Passmore L, Bell R, Narayan KM, D'Agostino R, Arcury T, Quandt S: Disparities in A1C levels between Hispanic and non-Hispanic white adults with diabetes: a meta analytic analysis. Diabetes Care 2008; 31: 240– 246
    1. Roy M, Roy A, Affouf M: Depression is a risk factor for poor glycemic control and retinopathy in African Americans with type 1 diabetes. Psychosom Med 2007; 69: 537– 542
    1. Lustman PJ, Griffith LS, Clouse RE, Freedland KE, Eisen SA, Rubin EH, Carney RM, McGill JB: Effects of nortriptyline on depression and glucose regulation in diabetes: results of a double blind, placebo controlled trial. Psychosom Med 1997; 59: 241– 250
    1. Lustman P, Griffith L, Freedland K, Kissel S, Clouse R: Cognitive behavior therapy for depression in type 2 diabetes: a randomized, controlled trial. Ann Intern Med 1998; 129: 613– 621
    1. Lustman P, Freedland K, Griffith L, Clouse R: Fluoxetine for depression in diabetes: a randomized double-blind placebo controlled trial. Diabetes Care 2000; 23: 618– 623
    1. Williams JW, Katon W, Lin EHB, Noel PH, Worchel J, Cornell J, Harpole L, Fultz BA, Hunkeler E, Mika VS, Unutzer J. IMPACT Investigators: The effectiveness of depression care management on diabetes-related outcomes in older patients. Ann Intern Med 2004; 140: 1054– 1056
    1. Katon WJ, van Korff M, Lin EHB, Simon G, Ludman E, Russo J, Ctechanowski P, Walker E, Bush T: The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry 2004; 61: 1042– 1049
    1. Lustman PJ, Clouse RE, Hirsh IB, Gelenberg AJ, Nix BD, Freedland KE: Sertraline for the prevention of depression recurrence in diabetes: a randomized, double-blind, placebo controlled trial. Arch Gen Psychiatry 2006; 63: 521– 529
    1. Lustman P, Williams M, Sayuk G, Nix B, Clouse R: Factors influencing glycemic control in type 2 diabetes during acute-and maintenance phase treatment of major depressive disorder with bupropion. Diabetes Care 2007; 30: 459– 466
    1. Paile-Hyvarinen M, Wahlbeck K, Eriksson J: Quality of life and metabolic status in mildly depressed patients with type 2 diabetes treated with paroxetine: a double-blind randomized placebo-controlled 6 month trial. BMC Fam Pract 2007; 8: 34– 40
    1. Georgiades A, Zucker N, Friedman KE, Mosunic CJ, Applegate K, Lane JD, Feinglos MN, Surwit RS: Changes in depressive symptoms and glycemic control in diabetes mellitus. Psychosom Med 2007; 69: 235– 241
    1. Snoek FJ, van der Ven NCW, Twisk JWR, Hogenelst MHE, Tromp-Wever AME, van der Ploeg HM, Heine RJ: Cognitive behavior therapy (CBT) compared with blood glucose awareness training (BGAT) in poorly controlled type 1 diabetic patients: long term effects on HbA1c moderated by depression: a randomized controlled trial. Diabetic Med 2008; 25: 1337– 1342
    1. Whooley MA, Avins AL, Miranda J: Case-finding instruments for depression: two questions are as good as many. J Gen Intern Med 1997; 12: 439– 445
    1. Hamilton M: A rating scale for depression. J Neuro Neurosurg Psychiatry 1960; 23: 56– 62
    1. Davidson MB, Castellanos M, Duran P, Karlan V: Effective diabetes care by a registered nurse following treatment algorithms in a minority population. Am J Manag Care 2006; 12: 226– 232
    1. Boyer JG, Earp JA: The development of an instrument for assessing the quality of life of people with diabetes: Diabetes-39. Med Care 1997; 35: 440– 453
    1. Gonzalez JS, Peyrot M, McCarl LAM, Collins EM, Serpa L, Mimiaga MJ, Safren S: Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 2008; 31: 2398– 2403

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa