Chronic Disease

Patients with diabetes and depression tend to skip self-care behaviors that would help keep their diabetes in check

Many persons with diabetes also suffer from depression. In fact, a new study found that nearly one-fifth of patients with type 2 diabetes probably suffered from major depression and an additional two-thirds had at least some depressive symptoms. Both the very depressed patients and those with a few depressive symptoms (subclinical depression) were less likely than the 14 percent of patients who were not depressed to perform self-management tasks needed to control their blood-sugar levels.

For example, individuals with major depression (including those on antidepressants) spent fewer days than others following the recommended diet (such as eating lots of fruits and vegetables and spacing carbohydrates throughout the day), exercise, and glucose self-monitoring regimens. They were also 2.3 times more likely to miss medication doses in the prior week than patients who were not depressed.

Major depression was a better predictor of self-monitoring of blood-glucose levels. Yet the depression symptom severity score was a better predictor of not following diet, exercise, and medications. For example, a 1-point increase in the symptom severity score was associated with a 10 percent increase in the odds of missing one or more doses of prescribed medications over the prior week. Also, a symptom severity score of 6 was associated with a half-day less of exercise per week than a score of 1.

These findings challenge the current belief that only major depression is a risk factor for nonadherence to diabetes self-care. They suggest that there is a continuous relationship between symptoms of depression and nonadherence to self-care for diabetes that is evident even at subclinical levels. The findings were based on a survey of 879 patients with type 2 diabetes from 2 primary care clinics. The study was supported in part by the Agency for Healthcare Research and Quality (HS14010).

See "Depression, self-care, and medication adherence in type 2 diabetes," by Jeffrey S. Gonzalez, Ph.D., Steven A. Safren, Ph.D., Enrico Cagliero, M.D., and others, in the September 2007 Diabetes Care 30(9), pp. 2222-2227.

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