January 31, 2006

Depression therapy does not help diabetics cope

NEW YORK (Reuters Health) - Even though many patients with
diabetes are also depressed, which may complicate their efforts
at managing their diabetes, better treatment of their
depression seems to have no effect on how they deal with their

In their report in the Annals of Family Medicine, Dr.
Elizabeth H. B. Lin and her associates point out that diabetics
are roughly twice as likely as the general population to have
depression. Patients with both disorders tend to have worse
blood sugar control, more severe symptoms and complications due
to diabetes, and to use health care resources at a higher rate.

Lin, from the Group Health Cooperative in Seattle, and her
associates proposed that better treatment of the depression
would result in patients taking better care of their diabetes.
The researchers enrolled 329 patients with a dual diagnosis of
diabetes and depression.

The patients were randomly assigned to an intervention
group, which received optimal treatment for depression,
including drug therapy, problem-solving treatment or both) for
12 months. The remaining patients were assigned to usual care
from their primary care physician, with the proviso that they
could see a mental health clinician if they wanted to.

Overall, the researchers detected no differences in
diabetes self-management between the intervention and the usual
care groups during the 12-year period.

"No difference was observed between the two groups in
healthy nutrition, following a recommended diet, days with 30
or more minutes of continuous physical activity, days with
specific exercise sessions, or smoking status," the authors

Patients in depression care intervention group actually had
a slightly higher rate of nonadherence to prescription drugs
for diabetes compared with the usual treatment group
(nonadherent on 28.2 percent of days versus 24.0 percent of
days, respectively).

However, the researchers say the findings do not imply that
"depression care is not useful for improving diabetes
self-management or outcomes."

They suggest that "integrated diabetes and depression care
management, including specific support for diabetes medication
adherence and self-care activities, as well as systematic
depression care, can help patients achieve better psychological
and diabetes outcomes."

SOURCE: Annals of Family Medicine, January/February 2006.