Chronic Disease

People with diabetes and depression are less likely to self-manage their diabetes

Indigent persons suffering from type 2 diabetes and depression are less likely to manage their diabetes with proper diet, exercise, medication, and blood-sugar testing, and also feel less in control of their illness than their nondepressed counterparts, according to a new study. Self-management of the disease is critical to achieving optimal blood-sugar control and avoiding diabetes-related complications that range from stroke and hypertension to blindness, kidney disease, and amputations (due to poor circulation).

Medical University of South Carolina researchers, Leonard E. Egede, M.D., M.S., and Charles Ellis, Ph.D., recruited 201 patients with type 2 diabetes from an indigent care clinic; 20 percent of them were depressed. The patients were surveyed to assess their diabetes knowledge, diabetes self-management, and perceived control of diabetes.

Patients with depression were more than twice as likely to report self-care control problems, were nearly three times less likely to report a positive attitude about their condition, and were more than three times less likely to report self-care ability and adherence to self-care regimens. Depressed patients were also less likely to feel in control of their diabetes (mean of 47.7 vs. 57.8 out of 75). It is thought that good diabetes knowledge enhances diabetes self-management. However, the groups were not significantly different in their knowledge of diabetes, understanding of self-care tasks, and perceived importance of self-care tasks.

Depression-related perceived lack of control and impairment in self-care were probably more important barriers to good diabetes outcomes than differences in knowledge among this group of patients, note the researchers. They suggest that future programs targeted toward this group focus on improving self-management skills and patient empowerment.

The study was supported by the Agency for Healthcare Research and Quality (HS11418). More details are in "The effects of depression on diabetes knowledge, diabetes self-management, and perceived control in indigent patients with type 2 diabetes," by Drs. Egede and Ellis, in the June 2008 Diabetes Technology & Therapeutics 10(3), pp. 213-219.

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