Diabetes Distress but Not Clinical Depression or Depressive Symptoms Is Associated With Glycemic Control in Both Cross-Sectional and Longitudinal Analyses

  1. Lawrence Fisher, PHD1,
  2. Joseph T. Mullan, PHD2,
  3. Patricia Arean, PHD3,
  4. Russell E. Glasgow, PHD4,
  5. Danielle Hessler, PHD1 and
  6. Umesh Masharani, MD5
  1. 1Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California;
  2. 2Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California;
  3. 3Department of Psychiatry, University of California, San Francisco, San Francisco, California;
  4. 4Kaiser Permanente, Colorado, Denver, Colorado;
  5. 5Department of Medicine, University of California, San Francisco, San Francisco, California.
  1. Corresponding author: Lawrence Fisher, fisherl{at}fcm.ucsf.edu.


OBJECTIVE To determine the concurrent, prospective, and time-concordant relationships among major depressive disorder (MDD), depressive symptoms, and diabetes distress with glycemic control.

RESEARCH DESIGN AND METHODS In a noninterventional study, we assessed 506 type 2 diabetic patients for MDD (Composite International Diagnostic Interview), for depressive symptoms (Center for Epidemiological Studies-Depression), and for diabetes distress (Diabetes Distress Scale), along with self-management, stress, demographics, and diabetes status, at baseline and 9 and 18 months later. Using multilevel modeling (MLM), we explored the cross-sectional relationships of the three affective variables with A1C, the prospective relationships of baseline variables with change in A1C over time, and the time-concordant relationships with A1C.

RESULTS All three affective variables were moderately intercorrelated, although the relationship between depressive symptoms and diabetes distress was greater than the relationship of either with MDD. In the cross-sectional MLM, only diabetes distress but not MDD or depressive symptoms was significantly associated with A1C. None of the three affective variables were linked with A1C in prospective analyses. Only diabetes distress displayed significant time-concordant relationships with A1C.

CONCLUSIONS We found no concurrent or longitudinal association between MDD or depressive symptoms with A1C, whereas both concurrent and time-concordant relationships were found between diabetes distress and A1C. What has been called “depression” among type 2 diabetic patients may really be two conditions, MDD and diabetes distress, with only the latter displaying significant associations with A1C. Ongoing evaluation of both diabetes distress and MDD may be helpful in clinical settings.


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    • Received July 7, 2009.
    • Accepted October 5, 2009.
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  1. Diabetes Care vol. 33 no. 1 23-28
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