Depressed Mood_DM - Depressed Mood Is a Factor in Glycemic...

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Depressed Mood Is a Factor in Glycemic Control in Type 1 Diabetes M IRANDA A.L. V AN T ILBURG ,P H D, C YNTHIA C. M C C ASKILL , MSN, J AMES D. L ANE ,P H D, C HRISTOPHER L. E DWARDS ,P H D, A NGELYN B ETHEL , MD, M ARK N. F EINGLOS ,MD , AND R ICHARD S. S URWIT ,P H D Objective: The diabetes literature contains conflicting evidence on the relationship between depression and glycemic control. This may be due, in part, to the fact that past studies failed to distinguish between patients with type 1 and type 2 diabetes. Because these are actually completely different diseases that are often treated differently and consequently make different demands on patients, the relationship between glycemic control and depressed mood in type 1 and type 2 diabetes was examined separately. Methods: The relationship between Beck Depression Inventory (BDI) scores and HbA 1c , as an index of long-term glycemic control, was measured in samples of 30 patients with type 1 and 34 patients with type 2 diabetes. Results: Groups of patients with type 1 and type 2 diabetes did not differ in mean BDI score or HbA 1c level. Correlation analysis revealed a significant positive relationship between BDI scores and HbA 1c in the type 1 group ( r 5 .44, p , .02) but not in the type 2 group ( r 52 0.06, p . .05). This relationship was evident throughout the entire range of BDI scores and was not restricted to scores indicative of clinical depression. Patients with type 1 diabetes who had higher HbA 1c and BDI scores reported a lower frequency of home blood glucose monitoring. Conclusions: Variations in depressive mood, below the level of clinical depression, are associated with meaningful differences in glycemic control in type 1 but not type 2 diabetes. Preliminary data analysis suggests that this effect may be mediated, at least in part, by decreased self-care behaviors in patients with more depressed mood. Key words: depression, type 1 diabetes, type 2 diabetes, glycemic control. HbA 1c 5 hemoglobin A 1c ; BDI 5 Beck Depression Inventory; SMBG 5 self-monitored blood glucose; BMI 5 body mass index. INTRODUCTION Diabetes is a chronic metabolic disorder that affects almost 14 million Americans (1). Many patients with diabetes eventually develop severe complications, in- cluding amputations, blindness, kidney failure, and cardiovascular disease. The main goal of treatment is the control of blood sugar. Patients must follow rigor- ous daily dietary, exercise, and medication regimens for the remainder of their lives. Because successful diabetes management depends on the behavior of the patient, biopsychosocial factors are thought to contrib- ute to clinical outcomes. One important factor is de- pression. Diabetes mellitus is a significant risk factor for depression. Recent prevalence studies suggest that approximately 15% of all patients with diabetes suffer from clinical depression, and even a greater percentage (about 30%) suffer from some sort of psychiatric dis-
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Depressed Mood_DM - Depressed Mood Is a Factor in Glycemic...

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