Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care
- Elizabeth H.B. Lin, MD, MPH1,
- Wayne Katon, MD2,
- Michael Von Korff, SCD1,
- Carolyn Rutter, PHD1,
- Greg E. Simon, MD, MPH1,
- Malia Oliver, BA1,
- Paul Ciechanowski, MD, MPH2,
- Evette J. Ludman, PHD1,
- Terry Bush, PHD1 and
- Bessie Young, MD3
- 1Center for Health Studies, Group Health Cooperative, Seattle, Washington
- 2Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- 3Department of Medicine, Veterans Administration Hospital, University of Washington, Seattle, Washington
- Address correspondence and reprint requests to Elizabeth H.B. Lin, MD, MPH, Center for Health Studies, Group Health Cooperative, 1730 Minor Ave., Suite 1600, Seattle, WA 98101. E-mail: lin.e{at}ghc.org
Abstract
OBJECTIVE—We assessed whether diabetes self-care, medication adherence, and use of preventive services were associated with depressive illness.
RESEARCH DESIGN AND METHODS—In a large health maintenance organization, 4,463 patients with diabetes completed a questionnaire assessing self-care, diabetes monitoring, and depression. Automated diagnostic, laboratory, and pharmacy data were used to assess glycemic control, medication adherence, and preventive services.
RESULTS—This predominantly type 2 diabetic population had a mean HbA1c level of 7.8 ± 1.6%. Three-quarters of the patients received hypoglycemic agents (oral or insulin) and reported at least weekly self-monitoring of glucose and foot checks. The mean number of HbA1c tests was 2.2 ± 1.3 per year and was only slightly higher among patients with poorly controlled diabetes. Almost one-half (48.9%) had a BMI >30 kg/m2, and 47.8% of patients exercised once a week or less. Pharmacy refill data showed a 19.5% nonadherence rate to oral hypoglycemic medicines (mean 67.4 ± 74.1 days) in the prior year. Major depression was associated with less physical activity, unhealthy diet, and lower adherence to oral hypoglycemic, antihypertensive, and lipid-lowering medications. In contrast, preventive care of diabetes, including home-glucose tests, foot checks, screening for microalbuminuria, and retinopathy was similar among depressed and nondepressed patients.
CONCLUSIONS—In a primary care population, diabetes self-care was suboptimal across a continuum from home-based activities, such as healthy eating, exercise, and medication adherence, to use of preventive care. Major depression was mainly associated with patient-initiated behaviors that are difficult to maintain (e.g., exercise, diet, medication adherence) but not with preventive services for diabetes.
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted May 27, 2004.
- Received February 12, 2004.
- DIABETES CARE
