Treating Depression Improves Health in People with Type 2 Diabetes
A Randomized Controlled Trial of Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in Patients With Uncontrolled Type 2 Diabetes. By Safren and colleagues. Diabetes Care 2014;37:625-633.
What is the problem and what is known about it so far?
Evidence suggests that people with diabetes are twice as likely to develop clinical depression as those without the disease. Depression is associated with a loss of blood glucose control, and poorer health in general.
Why did the researchers do this particular study?
Results from previous studies suggest that treating depression in people with diabetes may improve medication adherence, blood glucose levels, and other health measures, but the data have been mixed. The researchers in this study wanted to figure out if adding cognitive behavioral therapy—a systematic approach that focuses on goals—to an enhanced version of treatment as usual, which included diabetes education, provided a clear benefit over the enhanced treatment alone.
Who was studied?
The study included 87 adults with depression and poorly controlled type 2 diabetes.
How was the study done?
The researchers split the participants into a cognitive behavioral therapy group, that also received enhanced diabetes treatment, and a group that received only the enhanced diabetes treatment. As part of the enhanced diabetes treatment, all participants met with a dietician to create individualized nutrition plans as well as a diabetes educator to establish goals for diabetes self-care, glucose monitoring, foot care, and exercise. Those participants in the cognitive behavioral therapy group also attended approximately 11 therapy sessions with topics such as mood assessment, thought monitoring, problem solving, and relaxation. The researchers assessed the participants’ depression and blood glucose control several times over the year-long study. At the same time, they determined how well participants were following their medication and glucose monitoring regimens.
What did the researchers find?
The researchers found that participants who received cognitive behavioral therapy were better at following doctors' orders with respect to taking their medications and measuring their blood glucose levels than those who received only enhanced diabetes care. People who’d been in therapy also ended up with lower A1C levels (average blood glucose over the previous 2 to 3 months) and reported being less depressed than the other group.
What were the limitations of the study?
It may be possible that the benefits observed with the therapy were due to increased attention by medical personnel, rather than the therapy itself. Also, 86% of participants in the study were white, so the findings may not translate to ethnic minorities.
What are the implications of the study?
Cognitive behavioral therapy may improve the health and happiness of people with poorly controlled type 2 diabetes and depression.