Depression derails diabetics' self-care

People with diabetes who are depressed are less likely to watch what they eat, to exercise, and to take their medications, researchers report.

"Major depression is common among diabetes patients, affecting more than one in eight diabetes patients," Dr. Elizabeth H. B. Lin from the Group Health Cooperative, Seattle, Washington told AMN Health.

"Depressed patients with diabetes are more likely to be obese, have poorly controlled diabetes, suffer more complications such as heart disease, and use more medical services than non-depressed patients," she said

Lin and her colleagues assessed diabetes self-care, adherence to medication, and use of preventive services among 4463 people with type 2 diabetes enrolled in a large health maintenance organization.

Twelve percent of the diabetic patients in this study had major depression, the authors report in the medical journal Diabetes Care. Depression affected more women (14 percent) than men (10 percent).

Compared with patients without depression, depressed patients ate less fruit and vegetables and more fat, the report indicates, and depressed patients were significantly less likely to exercise. They also showed less adherence to their prescribed regimens, the researchers note.

In contrast, depressed and non-depressed patients did not differ in frequency of blood glucose self-monitoring, foot checks for ulcers or infections, or the use of diabetes monitoring and preventive services.

"Disease management of common chronic diseases, such as congestive heart failure and diabetes, has had some success in improving clinical outcomes," Lin said. "But depression is a missing link in most disease management programs."

Lin concluded that people with poor diabetes control might be helped "by screening for major depression and treating it effectively, including systematic follow-up."

SOURCE: Diabetes Care, September 2004.