Diabetes in Primary Care: Prospective Associations between Depression, Nonadherence and Glycemic Control

Psychotherapy and Psychosomatics - Tập 79 Số 3 - Trang 172-178 - 2010
Jörg Dirmaier1, Birgit Watzke1, Uwe Koch1, Holger Schulz1, Hendrik Lehnert2,3, Lars Pieper4, Hans‐Ulrich Wïttchen4
1Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg,
2First Department of Medicine, University of Lübeck, Lübeck, and
3Warwick Medical School, University Hospital of Coventry, Coventry, UK
4Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany

Tóm tắt

<i>Background:</i> Findings are inconsistent regarding the degree to which depression may exert a negative impact on glycemic control in patients with type 2 diabetes. We therefore aimed to examine the longitudinal relationship between depression, behavioral factors, and glycemic control. <i>Methods:</i> In a prospective component of a nationally representative sample, 866 patients with type 2 diabetes aged ≧18 years completed a standardized assessment including a laboratory screening, questionnaires, and diagnostic measures. Subsequent to baseline (t&#8320;), patients were tracked over a period of 12 months (t<sub>1</sub>). Depression was assessed according to DSM-IV and ICD-10 criteria. Glycemic control was determined by levels of glycosylated hemoglobin (HbA<sub>1c</sub>); a level of ≧7% was judged as unsatisfactory. Regression analyses were performed to analyze the prospective relationship between depression, medication adherence, diabetes-related health behavior, and HbA<sub>1c</sub>. <i>Results:</i> Patients with depression at t&#8320; revealed increased rates of medication nonadherence (adjusted OR: 2.67; CI: 1.38–5.15) at t<sub>1</sub>. Depression (adjusted regression coefficient: β = 0.96; p = 0.001) and subthreshold depression (β = 1.01; p < 0.001) at t&#8320; also predicted increased problems with diabetes-related health behavior at t<sub>1</sub>. Adjusted ORs for poor glycemic control (HbA<sub>1c</sub> ≧7%) at t<sub>1</sub> were also increased for patients with baseline depression (2.01; CI: 1.10–3.69). However, problems with medication adherence as well as problems with diabetes-related health behavior at t&#8320; did not predict poor glycemic control at t<sub>1</sub>. <i>Conclusions:</i> In a prospective representative study of patients with type 2 diabetes, baseline depression predicted problems with medication adherence, problems with health-related behaviors, and unsatisfactory glycemic control at follow-up.

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Thông tin xuất bản

Psychotherapy and Psychosomatics

Tập 79 Số 3

172-178

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