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Treating Diabetes Distress and Depression in Type 1, Type 2 Diabetes
June 16, 2014 (Healio) - Two presentations at the American Diabetes Association's 74th Scientific Sessions contributed to the growing body of knowledge on the intersections of diabetes, depressive symptoms and disease-related distress.
One study developed a protocol to identify specific distress related to type 1 diabetes in adults, while a second study found an association between depressive symptoms and premature mortality in type 1 diabetes.
Diabetes distress, not major depression
Previous research has associated depression with poor self-management, poor glycemic control and high health care costs for patients with diabetes, according to Lawrence Fisher, PhD, ABPP, professor of family and community medicine at the University of California San Francisco.
"New research has indicated that much of what we have previously considered to be clinical depression may best be labeled as the emotional distress associated with having a severe, chronic and progressive disease like diabetes and not necessarily a freestanding, comorbid psychiatric condition," Fisher said in a press briefing at the meeting.
"Diabetes distress accounts for most of the associations we have seen previously between depressive symptoms and diabetes. With the increasing focus on the affective, or emotional side of diabetes, [diabetes distress] is something we're talking about more," Fisher said.
"Diabetes-related emotional distress is a term that's become more popular over the years to try to capture a lot of the stresses and strains and emotional concerns that patients have," added Bill Polanksy, PHD, CDE, moderator of the press briefing and a clinical psychologist in San Francisco.
The large, intervention-based trial recruited 392 adults aged 19 and older with type 2 diabetes who reported feelings of distress but were not diagnosed as depressed. The patients were divided into three study arms, each of which utilized a different therapeutic protocol to treat diabetes distress. Patients were assessed at baseline, 4 and 12 months using two measures of patient health and emotional status. The first study arm provided support and education to study participants; the second study arm was a web-based intervention, which provided online diabetes management tools to help reduce stress; and the third study arm utilized direct intervention tactics borrowed from problem-solving psychotherapy.
"All three types of diabetes distress interventions led to significant reductions in diabetes distress at both 4 and 12 months," Fisher said during the press briefing. The research team found that depressive symptoms were decreased alongside the distress symptoms.
"Of those patients who scored on the patient health questionnaire at 10 or above — which is considered the moderate range of depression symptoms— 78.6% and 83.9% were no longer in the moderate range of depression symptoms at 4 and 12 months, respectively."
Fisher said that the findings suggest that interventions that target diabetes distress could be superior to treating depressive symptoms only.
Depressive symptoms, premature mortality
Catherine Fickley, MPH, CPH, of the University of Pittsburgh School of Public Health, spoke at an ADA 74th Scientific Sessions press briefing about newly published data. Fickley said in a press briefing that these findings follow an earlier study using the University of Pittsburgh's Epidemiology of Diabetes Complications (EDC) data, which demonstrated that antidepressant use increased the risk of mortality in women only.
In the study, data were extracted for 458 participants (51% female) with clinically meaningful depressive symptoms, =16 on the Beck Depression Inventory (BDI), with a primary outcome of all-cause mortality. The BDI was surveyed at baseline and biennially during the 20-year study period.
After 20 years, 94 (20.5%) deaths occurred (51 men, 43 women) in the population, and a clinically significant BDI score was univariately associated with mortality (HR=1.05, 1.03-1.07). Notably, no significant gender-based association was demonstrated.
Fickley said the study demonstrates that depressive symptoms are a predictor of mortality in both men and women with type 1 diabetes.
"As depressive symptoms seem to predict mortality in type 1 diabetes, further work should address the value of screening for, and treatment of, depressive symptoms in this population," the study said.